Dieulafoy's Lesion Research Articles

Jejunal Dieulafoy's lesion - An exceptionally rare and challenging culprit of gastrointestinal bleeding.

A 78-year-old male presented to the emergency department with melena. He was hemodynamically stable but displayed a hemoglobin level of 5.8g/dL necessitating blood transfusion. Initial esophagogastroduodenoscopy and colonoscopy failed to identify a bleeding source, prompting a capsule endoscopy that revealed an active bleeding site in the jejunum. A single-balloon enteroscopy identified an aberrant vessel in the mid-jejunum protruding through a 3mm mucosal defect, devoid of surrounding inflammation, consistent with a Dieulafoy's lesion, in which two through-the-scope clips were applied. Despite this, ongoing melena and decreasing hemoglobin levels in the subsequent days led to a second single-balloon enteroscopy, which confirmed continued bleeding. Definitive hemostasis was achieved through diluted adrenaline injection, four additional through-the-scope clips, and polidocanol sclerotherapy. Jejunal Dieulafoy's lesion is extremely rare and presents notable diagnostic and therapeutic challenges. Ávila et al. recently reported a case where, despite capsule endoscopy identifying the bleeding site, single-balloon enteroscopy failed to confirm the diagnosis, leading to the use of motorized enteroscopy with argon and metallic clip treatment. Similarly, our experience highlights the diagnostic value of capsule endoscopy and the crucial role of device-assisted enteroscopy in a multimodal therapeutic approach, which was essential for achieving successful hemostasis.

Endoscopic ultrasound-guided vascular interventions: A review (with videos).

Endoscopic ultrasound (EUS) has evolved from a diagnostic to an interventional modality, allowing precise vascular access and therapy. EUS-guided vascular access of the portal vein has received increasing attention in recent years as a diagnostic and therapeutic tool. EUS-guided portal pressure gradient directly measures the hepatic vein portal pressure gradient and is crucial for understanding of liver function and prognostication of liver disease. EUS facilitates the sampling of portal venous blood to obtain circulating tumor cells (CTCs) in pancreatobiliary malignancies. This technique aids in the diagnosis and staging of cancers. EUS-guided interventions have a substantial potential for diagnosing portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma. EUS-guided coil and glue embolization have higher efficacy for the treatment of gastric varices than direct endoscopic glue. Pseudoaneurysm (PsA), a rare vascular complication of acute and chronic pancreatitis, is typically managed with interventional radiology (IR)-guided embolization and surgery. EUS is increasingly used in specialized centers for non-variceal gastrointestinal bleeding, particularly for pseudoaneurysm-related bleeding. There is limited data on EUS-guided intervention for bleeding ectopic varices, rectal varices and Dieulafoy lesions, but it is becoming more widely accepted. In this extensive review, we evaluated both current and potential future applications of EUS-guided vascular interventions, including EUS-guided gastric variceal bleed therapy, rectal and ectopic varices, pseudoaneurysmal bleeding, splenic artery embolization, portal pressure gradient measurement, portal vein sampling for CTCs, fine needle aspiration of PVTT, intrahepatic portosystemic shunt placement, liver tumor ablation and EUS-guided cardiac intervention.

S3799 An Unexpected Case of Lower GI Bleeding From a Rectal Dieulafoy Lesion

S3799 An Unexpected Case of Lower GI Bleeding From a Rectal Dieulafoy Lesion

S3788 First Report of the Use of Succinic Anhydride and Oxidized Dextran to Treat a Duodenal Dieulafoy Lesion

S3788 First Report of the Use of Succinic Anhydride and Oxidized Dextran to Treat a Duodenal Dieulafoy Lesion

S941 Sex Disparities in Short-Term Complications of Patients Admitted for Hemorrhagic Dieulafoy Lesion of Stomach and Duodenum and Underwent Esophagogastroduodenoscopy

S941 Sex Disparities in Short-Term Complications of Patients Admitted for Hemorrhagic Dieulafoy Lesion of Stomach and Duodenum and Underwent Esophagogastroduodenoscopy

S3774 Anchor Pronged Through-the-Scope Clip Saves the Day: A Case of Hemorrhagic Shock due to Dieulafoy Lesion

S3774 Anchor Pronged Through-the-Scope Clip Saves the Day: A Case of Hemorrhagic Shock due to Dieulafoy Lesion

Appendiceal Bleeding, A Rare Yet Important Cause of Lower Gastrointestinal Bleed.

Lower gastrointestinal bleeding accounts for 20 to 25% of all gastrointestinal bleedings. Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding. Here, we present a case of appendiceal bleeding in an elderly female. A 79-year-old female presented with acute onset of gastrointestinal bleeding of same-day duration. Investigations showed that she had an appendiceal bleed originating from an ulcer secondary to a small appendicolith, which has passed through the appendiceal orifice, combined with her aspirin use. Within 12 hours, a laparoscopic appendectomy was performed. No evidence of malignancy or vascular malformation was detected, and the post-operative course was smooth, with resultant discharge at day 3 after her surgery. For lower gastrointestinal bleeding, it is crucial for the endoscopist to reach the terminal ileum during the colonoscopy, and thoroughly inspect the orifice of the appendix to assess any source of bleed including but not limited to Dieulafoy's lesion, angiodysplasia or any vascular malformation. An effective treatment option for appendiceal bleeding is surgical management with appendectomy. Alternative approaches such as vessel embolization and endoscopic treatment have been reported to successfully control bleeding; nevertheless, the risk of acute appendicitis and recurrent bleeding following these procedures can be challenging to manage, potentially leading the patient to still need a surgical treatment with an appendectomy. Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding.

Fatal exulceratio simplex (dieulafoy lesion) – a case report and review

AbstractA 64-year-old man involved in a low-speed vehicle crash was found at autopsy to have altered blood extending from his stomach to his rectum. Within the stomach a small arterial vessel opened onto the mucosa of the posterior wall of the antrum adjacent to the pylorus with no adjacent mucosal ulceration or malignancy. Histologic sections showed the typical appearances of a Dieulafoy lesion with a tortuous small arteriole within the submucosa extending to the gastric lumen with an overlying cap of recently formed clot. There were no injuries attributable to the vehicle collision. Death was due to a bleeding Dieulafoy lesion of the stomach with a background of cardiomegaly. Dieulafoy lesion of the stomach is a rare disorder accounting for only 1–2% of cases of acute gastrointestinal hemorrhage. Although its pathogenesis is poorly understood it is capable of producing life-threatening bleeding, as in the present case. The small size of the lesion may make it difficult to identify at the time of autopsy.

Can Segmental Branch Embolization of the Left Gastric Artery Be an Alternative in the Treatment of Recurrent Dieulafoy Lesion Bleeding? A Case report

Dieulafoy lesions, rare developmental vascular malformations within the gastrointestinal system, present a diagnostic challenge due to their inconspicuous nature. These lesions, primarily located near the esophagogastric junction, can lead to life-threatening bleeding. Although accounting for approximately 1.5-2% of upper gastrointestinal bleeding cases, the exact prevalence remains uncertain. Commonly diagnosed through esophagogastroduodenoscopy, the small size of these lesions often results in oversight during initial endoscopy, necessitating a high index of suspicion, especially in cases of recurrent bleeding. While endoscopic methods are the standard treatment, this case presentation introduces the use of embolization as a rare but effective modality in managing recurrent Dieulafoy lesion bleeding. The presented case underscores the importance of diverse treatment approaches and contributes valuable insights to the medical literature, enhancing the understanding and management of this infrequent yet potentially serious condition.

Ideal strategy for nonvariceal upper gastrointestinal bleeding.

Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology. Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities. This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.

Dieulafoy's lesion, the endovascular approach as a therapeutic option when endoscopic treatment has failed: A case report and brief review

AbstractDieulafoy's lesion is defined as a dilated submucosal artery that can cause spontaneous rupture and massive gastrointestinal bleeding. It is usually an incidental finding and is identified as a prominent linear or serpentine artery.We report the case of a 47-year-old patient who presented with a Dieulafoy's lesion located in the gastric fundus, which was repeatedly treated with clipping and endoscopic sclerosis, without resolving. She presented to the interventional radiology service for endovascular treatment, which after performing angiography confirmed active bleeding at the level of the left gastric artery and proceeded to embolize with 2 coils. This is a case where endovascular treatment proves to be an effective and decisive option for the treatment of bleeding in this type of injury.

A case of Dieulafoy's lesion of the small intestine treated successfully by endoscopic hemostasis

A case of Dieulafoy's lesion of the small intestine treated successfully by endoscopic hemostasis

The efficacy of sclerotherapy as the initial treatment in patients with bleeding from Dieulafoy's lesion of the upper gastrointestinal tract.

Dieulafoy's lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy's lesion of the upper gastrointestinal tract (UDL). Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist. In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5days, p = 0.005) compared to sclerotherapy alone. Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy's lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.

Successful hemostasis with red dichromatic imaging for bleeding rectal dieulafoy's lesion.

Successful hemostasis with red dichromatic imaging for bleeding rectal dieulafoy's lesion.

Jejunal Dieulafoy's lesion as a cause of difficult-to-manage obscure gastrointestinal bleeding. Combined endoscopic treatment.

Dieulafoy's lesion (DL) is an uncommon vascular malformation-an aberrant, dilated submucosal arteriole (1-3 mm thick, 10 x nv). It runs near the mucosal surface and protrudes, and may potentially induce gastrointestinal bleeding (GIB). It usually originates in the stomach (upper lesser curvature), with endoscopy being the diagnostic, therapeutic modality of choice. Jejunal DL (JDL) is a rare cause of obscure GIB (OGIB) that is challenging for endoscopists and threatens patient lives. Other diagnostic techniques such as Tc99m-labeled red blood cell scintigraphy, well established in the classic armamentarium for OGIB diagnosis, cannot overcome endoscopic procedures. We report the case of a patient with OGIB secondary to an exceptionally located Dieulafoy's lesion who underwent combined endoscopic treatment.

Usage of Padlock Over-the-Scope-Clip in Difficult-to-Control Recurrent Gastrointestinal Bleeding Due to a Gastric Dieulafoy Lesion.

Dieulafoy's lesions (DLs) are a rare cause of acute gastrointestinal bleeds (GIBs). Here we describe Over-the-Scope Clip Padlock System (OTSC-P) use to treat a gastric fundus DL with recurrent bleeding despite other interventions. The OTSC-P was created for full-thickness defect closure in the event of a perforation, but use has expanded to treatment of GIB. They consist of metal clips mounted on transparent caps, delivered via endoscope. Their size allows control of larger bleeding lesions, provides enhanced tissue stability and the firmer clip grasp reduces rebleeding or clip dislodgement.

Retrospective analysis of patients with Dieulafoy’s lesions

Background and Aims: Gastrointestinal bleeding is an emergent condition in clinical practice. Early diagnosis and proper treatment of the lesion is essential. Dieulafoy's lesion is an aberrant submucosal vessel eroding surrounding mucosa. These lesions cause of 1-2% of all gastrointestinal bleedings. Here we report cases with Dieulafoy's lesion presenting with upper gastrointestinal bleeding. Materials and Methods: Through a time frame of between August 2017-August 2021, patients admitted to our hospital presenting with upper gastrointestinal bleeding and diagnosed as Dieulafoy’s lesion were included in the study. Patients' files were screened retrospectively. Results: The study included 30 patients with a mean age of 65.9 ± 18.2 (20 - 92) years. Half of them were female. The most observed presentations were melena, hematemesis, and hematochezia. Associated diseases were hypertension, atherosclerotic heart disease and diabetes mellitus. In 26 (86.7%) patients, Dieulafoy's lesion was diagnosed in first endoscopy, while in four patients Dieulafoy's lesion was diagnosed in second endoscopy. Time interval between hospital admission to first endoscopy was 3.1 ± 2.5 (1 - 10) hours. In 23 patients Dieulafoy's lesion was in the stomach and in 6 patients in duodenum and in 1 patient in esophagus. Endoscopic therapy was applied to all patients. The most applied treatment modality was sclerotherapy + hemoclip application. One patient had required surgery due to recurrent bleeding. Six patients died. Three of them was bleeding related. Conclusion: Dieulafoy's lesion is a rare but serious cause of gastrointestinal bleedings. Early diagnosis and proper treatment is important. Patients may need repeated endoscopy for diagnosis. Hemoclip application is cheap, easy, safe, and effective treatment modality with/without sclerotherapy.

Duodenal dieulafoy injury: case report

Dieulafoy's lesion is a rare but important cause of upper or lower gastrointestinal bleeding, resulting from bleeding from a large arterial vessel. Its extragastric location is rare and the diagnosis is usually endoscopic, allowing simultaneous treatment either with injection of sclerosing substances or by mechanical means. We present the case of a 72-year-old woman with severe gastrointestinal bleeding with Dieulafoy's lesion in the duodenal bulb, successfully diagnosed and treated endoscopically.

Lesión de Dieulafoy, ¿y eso qué es?

Gastrointestinal bleeding is a common reason for consultation, both in hospital emergency services and in Primary Care. There are multiple etiologies that can motivate it. Dieulafoy's lesion is a rare but potentially serious cause of gastrointestinal bleeding. Its most common location is the stomach. Clinically it is expressed in the form of: melena, hematemesis or hematochezia. Various complementary exams can be used for its diagnosis, such as angiography, angio-CT or endoscopy. Recurrent bleeding treatment consists of embolization through interventional catheterization.

S3075 Dieulafoy Lesion Masquerading as a Gastric Varix: An Unexpected Finding on Upper Endoscopy

S3075 Dieulafoy Lesion Masquerading as a Gastric Varix: An Unexpected Finding on Upper Endoscopy