Gastric Dieulafoy's Lesion Research Articles

Gastric Dieulafoy lesion as a cause of upper gastro-intestinal bleeding in a 4-year-old child: a case report

Dieulafoy lesion, although rare, is a significant gastrointestinal condition that can affect children. These quiescent lesions can easily be overlooked and bleeding lesions are occasionally misidentified on endoscopy. So, accurate diagnosis depends on increased knowledge and improvements in endoscopic procedures. Treatment of Dieulafoy lesion in children usually involves in different modalities of endoscopic interventions to stop the bleeding and promote healing. In more severe cases or when endoscopic treatments are unsuccessful, surgical intervention may be required to remove the lesion. In this case report, we present the case of a boy of 4 years and 4 months old, who presented with hematemesis with melena. He appeared mildly pale, moderately dehydrated, had a moderate pulse volume, prolonged capillary refill time, a narrow pulse pressure and tenderness in the epigastrium when the abdomen was examined. His tests showed a low hemoglobin level (7.5 g/dl), a normal coagulation profile and several bleeding sites in the fundus and upper part of stomach on endoscopic examination, which are consistent with Dieulafoy lesions. BIRDEM Med J 2023; 13(3): 163-166

EP.FRI.988Life threatening recurrent bleeding gastric fundus Dieulafoy lesion: A case report

Abstract Introduction Dieulafoy lesion is a rare but significant cause of upper gastrointestinal tract (GIT) bleeding. Over 75% of Dieulafoy lesions are located in the stomach and they tend to be responsible for recurrent upper GIT bleeding. Endoscopic therapy is the first line intervention to achieve haemostasis. Patient A 49-year old normally fit man known to have a gastric Dieulafoy lesion since 2008 presented with a history of collapse on the street and significant melaena. He was tachycardic, with a heart rate of 116, and hypotensive, blood pressure 109/68 mmHg on admission. He had significant upper GIT bleeding from the gastric fundus Dieulafoy lesion in April 2008, requiring a massive blood transfusion. At the time, the attempted endoscopic therapy was unsuccessful, resulting in an emergency surgery and under-running of the bleeding vessels. For the recent admission, he underwent an urgent therapeutic oesophagogastroduodenoscopy, with 3 endoscopic clips applied, but this failed to maintain haemostasis. Four units of packed red cell were transfused and he was transferred immediately to the operating theatre. He underwent an emergency laparotomy, adhesiolysis, gastrostomy and wedge resection of the bleeding gastric fundus Dieulafoy lesion using a linear cutter 75mm stapler. He had an uneventful post-operative recovery and was discharged home on day four after surgery. The histology of the wedged gastric specimen confirmed an area of gastric mucosa ulceration with a network of mixed dilated, thin and thick-walled tortuous vessels in the adjacent submucosal layer. The histologic features are consistent with a bleeding gastric Dieulafoy lesion.

Hematemesis in a 13-Year-Old Boy due to a Dieulafoy Lesion in his Stomach: A Case Report

Objective – Massive gastrointestinal bleeding in children is rare. A Dieulafoy lesion is an uncommon condition which may lead to massive and repeated upper gastrointestinal bleeding. We report a pediatric case of gastric Dieulafoy lesion which was successfully treated surgically, after repeated unsuccessful endoscopic treatment. Case Report – A previously healthy 13-year-old boy presented with hematemesis upon admission to the hospital. He had tachycardia and mild anemia. A gastroscopy revealed erosive gastritis. During the following days, hematemesis continued to reoccur and consequently led to the development of hemorrhagic shock requiring endoscopic treatment with hemoclipping and adrenalin injection. Despite that, hematemesis continued, and it was decided to perform surgical treatment. During open surgery, a tortuous blood vessel was found, suggesting a Dieulafoy lesion. Conclusion – Although rare, a Dieulafoy lesion should be suspected when treating repeating hematemesis in children. Endoscopic treatment is recommended as first-line management, but rarely, in unclear cases, surgery proves to be a better diagnostic and therapeutic option for massive gastrointestinal bleeding.

Dieulafoy lesion: two pediatric case reports

BackgroundMassive gastrointestinal bleeding in children is uncommon. Dieulafoy lesion is an uncommon disease which may lead to massive and repeated upper gastrointestinal hemorrhage. We report two cases of gastric Dieulafoy lesion successfully treated with either band ligation or endoscopic hemoclipping.Case presentationFirst case report: A previously healthy 18-month-old female infant with E. coli sepsis, pneumonia and respiratory failure with bilateral pneumothorax requiring chest drainage. Over a few days, the patient presented hematemesis and melena with progressively worsening anemia. The esophagogastroduodenoscopy revealed an arterial vessel with eroded apex located between the body and the fundus of the stomach. Two elastic bands were applied which resulted in resolution of hematemesis and melena and improvement of the anemia.Second case report: A 8-year-old male was admitted to our department with sudden massive hematemesis and melena. Clinical examination revealed anemia (hemoglobin, 6.8 g/dl). Esophagogastroduodenoscopy revealed a mucosal erosion with visible vessel located along the small curvature, close to the antrum. Three hemostatic clips were placed on the Dieulafoy lesion and hemostasis was obtained.Conclusionswe showed that, similar to gastric DL in adult patients,, gastric DL in pediatric patients can be successfully treated with endoscopic therapy, and both hemoclipping and band ligation are suitable techniques.

Gastric Dieulafoy's lesion in an elderly man with comorbidities: A case report

Gastric Dieulafoy's lesion in an elderly man with comorbidities: A case report

Gastric Dieulafoy lesion: a rare cause of massive haematemesis in an elderly woman

A 78-year-old woman presented to her local accident and emergency department by ambulance, having collapsed following several episodes of voluminous fresh haematemesis with melaena. The patient had extensive medical comorbidities,...

Chronic Radiation Gastroenteropathy Diagnosed by Small Bowel Capsule Endoscopy: A Case Report

Radiation therapy plays an important role in a vast array of both benign and malignant disease processes. However, gastrointestinal toxicity limits the total radiation dose that can be prescribed. Chronic radiation gastroenteropathy may arise as early as 6 months to as late as several decades after the initial exposure. Microvascular sclerosis, mucosal atrophy, and intestinal wall fibrosis lead to altered intestinal transit, gut dysmotility, malabsorption, and potentially intestinal obstruction, fistulization, and perforation. We present a case of chronic radiation gastroenteropathy diagnosed by small bowel capsule endoscopy. A 56 year old man presented to the gastroenterology clinic for evaluation of chronic refractory iron-deficiency anemia (IDA). He had a history of Hodgkin lymphoma 30 years prior treated at that time with chemoradiation therapy with which he achieved remission; he then suffered from complications of radiation including mild pulmonary fibrosis, cardiomyopathy, coronary artery disease, and myelopathy resulting in paraplegia. As part of the workup for IDA, prior esophagogastroduodenoscopy (EGD) and colonoscopy had been remarkable for diffuse duodenal lymphangiectasias and a benign traversable transverse colon stricture attributed to radiation therapy. At our institution repeat EGD showed a bleeding gastric Dieulafoy lesion treated with bipolar electrocoagulation leading to hemostasis, and repeat colonoscopy was unremarkable except for the colonic stricture. Postprandial bloating, distention, and flatulence responded to a short course of ciprofloxacin, supporting a presumptive diagnosis of small intestinal bacterial overgrowth; recurrent symptoms were treated with a second course of ciprofloxacin and subsequently amoxicillin/clavulanic acid. Given persistent IDA he underwent small bowel capsule endoscopy, which showed mucosal atrophy interspersed with mucosal congestion and erythema as well as diffuse lymphangiectasias throughout the small bowel; these findings were consistent with chronic radiation enteropathy. Despite the decreasing incidence of radiation-induced enteropathy, we continue to encounter patients who present with significant complications after a prolonged latency period. A presumptive diagnosis is often made clinically, although small bowel capsule endoscopy remains a valuable and minimally invasive method to confirm this clinical entity.FigureFigureFigure

Clinical features and treatment of rare etiologies of upper gastrointestinal bleeding

Objective To explore the clinical features and treatment of upper gastrointestinal bleeding with rare etiologies. Methods A total of 45 cases with rare etiologies was selected from a group of 1200 patients with upper gastrointestinal bleeding admitted from January 2012 to December 2015. Results The incidence of gastric stromal tumor (24.4%) and Dieulafoy's lesion (20.0%) was the highest. Among rare etiologies of upper gastrointestinal bleeding were Mallory-Weiss syndrome (17.8%) and stomal ulcer and hemorrhage of efferent loops after subtotal gastrectomy (17.8%), as well as left-side portal hypertension (6.7%), liver cirrhosis complicated with variceal bleeding in the descending part of the duodenum (2.1%), esophageal hematoma (2.1%), esophageal mucosa avulsion (2.1%), P-J syndrome (2.1%), duodenal adenocarcinoma (2.1%), and cutaneous malignant melanoma with duodenal metastasis (2.1%). Conclusions Gastroscopy in early stages played a role in etiologies identification, while etiological treatments could substantially reduce recurrent bleeding rate, thus enhanced cure rate. Analysis on rare etiologies promoted the medical understanding, with clinical diagnosis and treatment improved. Key words: Gastrointestinal hemorrhage/ET/TH

Dieulofaloy lezyonunun kombine tedavisi: Olgu sunumu

Dieulafoy's lesion is an uncommon, but important, cause of upper gastrointestinal bleeding. Dieulafoy's lesion is usually seen in the stomach, but sometimes can be seen in the small or large bowel. Typically, it is located within 6 cm of the esophagogastric junction, generally along the lesser curvature of the stomach. Various methods with endoscopy are used to control the hemostasis due to these lesions, but the most suitable endoscopic treatment method for treating bleeding Dieulafoy's lesion is not yet well established. Argon plasma coagulation has been used successfully in upper gastrointestinal bleeding; however, the experience using argon plasma coagulation to treat Dieulafoy's lesion is quite limited. Herein, we report a case with a bleeding gastric Dieulafoy's lesion that was treated using a combined endoscopic approach with injection therapy and argon plasma coagulation

Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding.

Gastrointestinal bleeding is a common medical emergency. Although endoscopic treatment is effective in controlling non-variceal upper gastrointestinal bleeding, in cases of persistent bleeding radiological or surgical interventions are required. Application of cyanoacrylate for treatment of difficult-to-arrest non-variceal upper gastrointestinal bleeding is poorly investigated. We describe patients in whom cyanoacrylate for acute non-variceal gastrointestinal bleeding was used to stop the bleeding after failure of conventional endoscopic treatment. Five patients were treated with cyanoacrylate application (injection and/or spraying) for persistent bleeding (duodenal ulcer in 3, gastric ulcer in 1 and gastric Dieulafoy's lesion in 1) despite conventional endoscopic therapies. Hemostasis was achieved in all patients (100%). One patient (20%) developed recurrent bleeding 4 days after initial treatment. No complications or adverse events attributed to the cyanoacrylate application during the follow-up period of 57 days were observed. Application of cyanoacrylate is a safe and effective method to achieve immediate hemostasis when conventional endoscopic treatment is unsuccessful. This technique is easy to perform and should be considered in cases of patients with difficult-to-arrest acute non-variceal upper gastrointestinal bleeding.

Novel treatment of a gastric Dieulafoy lesion with an over-the-scope clip

Novel treatment of a gastric Dieulafoy lesion with an over-the-scope clip

Endoscopic management of Dieulafoy’s lesion using Isoamyl-2-cyanoacrylate

Dieulafoy's lesion (DL) is a rare but important cause of obscure gastrointestinal bleeding that may be overlooked during diagnostic endoscopy. Mortality rates are similar to those of other causes for gastrointestinal bleeding. Diagnosis by upper endoscopy is the modality of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL, when diagnosed, endoscopist experience is the major determinant of the treatment strategy. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured gastrointestinal lesion is suspected. Cyanoacryltes compounds have been used successfully in management of Gastric varices and DLs. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE(®); Concord Drugs Ltd., Hyderabad, India) as an effective therapy for gastric DL without serious complications. In our case study, Isoamyl-2-cyanoacrylate (AMCRYLATE(®)) was effective and safe for treating DL. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.

Endoscopic Hemoclipping Treatment for Gastric Dieulafoy Lesion in a Newborn

Dieulafoy’s lesion is defined as a small mucosal defect overlying an abnormal, large caliber submucosal artery that protrudes through the gastrointestinal mucosa. This lesion is a rare cause of massive upper gastrointestinal bleeding in the pediatric population and extremely rare in neonates. We report a 1-day-old neonate who presented with massive gastrointestinal bleeding caused by a gastric Dieulafoy lesion, which was successfully treated by endoscopic hemoclipping without any complications. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 393∼397)

An Unusual Cause of Massive Gastrointestinal Bleeding After Transesophageal Echocardiography

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) performed by experienced operators has been reported to have an acceptable risk profile. 1 Spier B.J. Larue S.J. Teelin T.C. et al. Review of complications in a series of patients with known gastroesophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr. 2009; 22: 396-400 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar In 2 large series, the overall morbidity was between 0.18% and 0.2% with only 1 mortality reported in more than 17,000 patients. 2 Kallmeyer I.J. Collard C.D. Fox J.A. et al. The safety of intraoperative transesophageal echocardiography: A case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92: 1126-1130 Crossref PubMed Scopus (364) Google Scholar , 3 Daniel W.G. Erbel R. Kasper W. et al. Safety of transesophageal echocardiography A multicenter survey of 10,419 examinations. Circulation. 1991; 83: 817-821 Crossref PubMed Scopus (727) Google Scholar The risk of gastrointestinal (GI) bleeding was small. 2 Kallmeyer I.J. Collard C.D. Fox J.A. et al. The safety of intraoperative transesophageal echocardiography: A case series of 7200 cardiac surgical patients. Anesth Analg. 2001; 92: 1126-1130 Crossref PubMed Scopus (364) Google Scholar Indeed, no difference in the incidence of blood in nasogastric aspirates could be found between cardiac patients who had TEE performed and those who did not. 4 Hulyalkar A.R. Ayd J.D. Low risk of gastroesophageal injury associated with transesophageal echocardiography during cardiac surgery. J Cardiothorac Vasc Anesth. 1993; 7: 175-177 Abstract Full Text PDF PubMed Scopus (28) Google Scholar In this context, Spier et al recently argued in favor of using TEE in the setting of known esophageal varices caused by cirrhosis. 1 Spier B.J. Larue S.J. Teelin T.C. et al. Review of complications in a series of patients with known gastroesophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr. 2009; 22: 396-400 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Nonetheless, the prospect of using TEE in such high-risk patients, especially those who have been anticoagulated, increases the level of concern in most clinicians. In contrast to TEE's safety record, the authors present a very unusual case of a man with a massive GI bleed after routine TEE, originating from a gastric Dieulafoy lesion. To the authors' knowledge, this is the first such case in the literature.

Clinical and endoscopic analysis of gastric Dieulafoy’s lesion

To investigate the incidence, location, clinical presentation, diagnosis and effectiveness of endoscopic treatment of gastric Dieulafoy's lesion (DL) in China. All patients who received emergency upper gastrointestinal (GI) endoscopy due to gastric DL from February 2000 to August 2008 at GI endoscopy center of Renmin Hospital of Wuhan University were included in this study. The clinical presentation, medical history, location and characteristics of DL methods and effectiveness of therapy of patients with DL were retrospectively analysed by chart reviews. Long-term follow-up data were collected at outpatient clinics or telephone interviews. Fifteen patients were diagnosized with DL, which account for 1.04% of the source of bleeding in acute non-variceal upper GI bleeding. Common comorbidities were found in one patient with hypertension and diabetic mellitus. Hemoclip or combined therapy with hemoclip produced primary hemostasis in 92.8% (13/14) of patients. DL is uncommon but life-threatening in China. Hemoclip proved to be safe and effective in controlling bleeding from DL.

Extravasation of sclerosant after injection of N-butyl-2-cyanoacrylate for a bleeding gastric Dieulafoy lesion

Extravasation of sclerosant after injection of N-butyl-2-cyanoacrylate for a bleeding gastric Dieulafoy lesion

Delayed fatal hemorrhage after endoscopic band ligation for gastric Dieulafoy's lesion

Dieulafoy's lesions are well-known, rare, and diagnostically challenging clinical entities that usually cause massive GI bleeding. 1 Miko T.L. Thomazy V.A. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy's lesion, and submucosal arterial malformation. Hum Pathol. 1988; 19: 914-921 Abstract Full Text PDF PubMed Scopus (98) Google Scholar , 2 Juler G.L. Labitzke H.G. Lamb R. Allen R. The pathogenesis of Dieulafoy's gastric erosion. Am J Gastroenterol. 1984; 79: 195-200 PubMed Google Scholar , 3 Schmulewitz N. Baillie J. Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center. Am J Gastroenterol. 2001; 96: 1688-1694 Crossref PubMed Google Scholar , 4 Lee Y.T. Walmsley R.S. Leong R.W. Sung J.J. Dieulafoy's lesion. Gastrointest Endosc. 2003; 58: 236-243 Abstract Full Text PDF PubMed Scopus (142) Google Scholar We describe a patient who received endoscopic band ligation (EBL) for a bleeding Dieulafoy's lesion at the gastric cardia. Despite endoscopic follow-up, the patient died from recurrent fatal hemorrhage. To our knowledge, this is the first reported death caused by delayed hemorrhage after EBL for a Dieulafoy's lesion.

Successful treatment of a gastric Dieulafoy's lesion with a hemoclip in a newborn infant

Dieulafoy's lesion is an abnormally large-caliber submucosal arterial vessel that protrudes through the GI mucosa from a noninflamed base. This lesion is a rare cause of upper GI bleeding that can be potentially life-threatening.1 The safety and efficacy of endoscopic treatment is well documented.2-4 A variety of endoscopic modalities, including monopolar and bipolar electrocoagulation, heat probe coagulation, injection sclerotherapy, hemoclip placement, endoscopic band ligation, and laser photocoagulation, have been used, either alone or in combination, with high success rates.1,2 The Dieulafoy's lesion is extremely rare in the pediatric population5,6 and has not been reported in neonates. This is a report of the case of a newborn infant with a gastric Dieulafoy's lesion that was treated by endoscopic hemostatic clip application.

Endoscopic Management with Ethanol Injection in a Child with Gastric Dieulafoy Lesion

Endoscopic Management with Ethanol Injection in a Child with Gastric Dieulafoy Lesion

Endoscopic band ligation: alternative treatment method in nonvariceal upper gastrointestinal hemorrhage.

In the treatment of acute upper gastrointestinal (GI) bleeding, endoscopic band ligation (EBL) may be performed for nonfibrotic superficial lesions. This method has recently gained popularity in the treatment of nonvariceal upper GI bleeding. Band ligation was performed in 13 patients who were admitted with active upper GI bleeding between December 1998 and February 2001. The sources of the bleeding were Mallory-Weiss syndrome in four patients, Dieulafoy's ulcer in five patients, gastric ulcer near a gastrojejunostomy anastomosis in two patients, gastric angiodysplasia in one patient, and the primary repair site in the stomach of a gunshot wound in one. Bleeding from all lesions except one was managed successfully with EBL. The single failure was in bleeding from a gastric Dieulafoy's lesion. Injection sclerotherapy with 1:10,000 epinephrine solution and EBL was not successful. Rebleeding occurred twice in one patient, and the second rebleeding necessitated surgical treatment. Our results revealed that EBL is a very promising technique in acute nonvariceal upper GI bleeding. Its effectiveness and safety with few complications will allow this modality to be used more widely.