Dieulafoy's lesion: new diagnosis using high-definition endoscopy and treatment with isoamyl-2-cyanoacrylate (Amcrylate)

Abstract

Dieulafoy's lesion (DL) is a rare but important cause of gastrointestinal (GI) bleeding, accounting for up to 6% of the cases of nonvariceal bleeding in the upper GI tract and 1–2% of all GI hemorrhages. Mortality rates are similar to those of other causes for GI bleeding. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured GI lesion is suspected. In our seven-case study, we think it was feasible to use high-definition Fujinon intelligent chromoendoscopy to diagnose DL. Isoamyl-2-cyanoacrylate (Amcrylate) was effective and safe for treating DL as well as were other strategies, including ethanolamine oleate, band ligation, and n -butyl-2-cyanoacrylate. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.