A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum / 대한소화기내시경학회지

Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3~6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum.

A Case of Gastrointestinal Bleeding Caused by Dieulafoy-like Lesions of the Stomach and Rectum in a Patient with Chronic Renal Failure / 대한소화기내시경학회지

Dieulafoy's lesion is a very rare cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The majority of lesions are found in the stomach, but rarely it has also been identified in the duodenum, small bowel, colon and rectum. We describe a 78-year-old female with chronic renal failure who presented with melena and was subsequently found to have a Dieufaloy-like lesion in the stomach. The bleeding was successfully managed by endoscopic hemoclipping. During the follow-up, massive gastrointestinal bleeding was developed by a Dieulafoy-like lesion in the rectum. This lesion was managed by endoscopic band ligation, but there was recurrent bleeding from the ulcer site. The ulcer site was locally excised and primary closure was carried out.

Clinical Feature and the Effects of Endoscopic Band Ligation of Dieulafoy-like Lesion / 대한소화기내시경학회지

BACKGROUND/AIMS: The Dieulafoy lesion is an important cause of gastrointestinal bleeding. The bleedings from caliber- persistent vessel or abnormally large and tortuous submucosal artery are usually located on proximal stomach. Endoscopic band ligation (EBL) is currently regarded as the treatment of choice of Dieulafoy lesions. This study reports on the clinical features, the efficacy and safety of EBL. METHODS: 10 patients with Dieulafoy-like lesion (median age: 47 yr range: 22~71, M:F 8:2 ) were treated using EBL. EBL was performed as the primary hemostatic tratment as follows in 8 cases of urgency and 2 cases of emergency. RESULTS: The location of all lesions (n=10) were in stomach, 8 in body (4 in posterior wall), 2 in fundus. The bleeding focuses were identified during the first endoscopy. Five lesions were bleeding, 5 had adherent clots or protruding vessels without active bleeding. Hemostasis were achieved with first session of EBL in 9 patients successfully, one case in the fundus was failed due to early band release. CONCLUSION: EBL is a simple, effective, and safe endoscopic method of Dieulafoy-like lesions and, it should be proposed as a primary option.

A Case of Bleeding from Rectal Dieulafoy-like Lesion Treated by Endoscopy / 대한소화기내시경학회지

Dieulafoy-like lesion is a relatively uncommon disease which is a potential source of life-threatening gastrointestinal bleeding. The lesion comprises mainly of an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is frequently found at distal portion of gastroesophageal junction but may occur anywhere in gastrointestinal tract including small bowel, colon and rectum. Moreover bleeding from dieulafoy-like lesion of rectum is very reae. It has been reported that rectal Dieulafoy-like lesion is very rare source of lower gastrointestinal bleeding and its pathogenesis may be associated with constipation. Recently, endoscopy has an important role in the diagnosis and treatment (including injection and coagulation therapy) of bleeding from Dieulafoy-like lesion. We herein report a case of a patient who presented wih massive hemorrhage from a small rectal ulcer with adherent blood clots. Bleeding was controlled with endoscopic treatment by utilizing bipolar electrocoagulation without complication and recurrence.