TY - JOUR
T1 - A Unique Case of Recurrent Upper Gastrointestinal Bleeding Caused by Two Metachronous Dieulafoy's Lesions
T2 - The Role of EUS Evaluation
AU - Brito, Mariana
AU - Nunes, Gonçalo
AU - Pinto Marques, Pedro
AU - Canhoto, Manuela
AU - Proença, Ana Luísa
AU - Fonseca, Jorge
N1 - Publisher Copyright:
© 2020
PY - 2021/4
Y1 - 2021/4
N2 - Introduction: Dieulafoy's lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchronous DL but no reported cases of two metachronous DL. Case Report: A 28-year-old healthy male presented with acute severe UGIB. UGIE was inconclusive. Systematic EUS mapping identified a gastric DL. After several attempts of EUS-guided hemostasis, DL was marked using a through-the-scope clip and the patient underwent successful transcatheter arterial embolization (TAE). Three years later, a new severe UGIB episode was caused by a second gastric DL in a different location, which was identified and marked by EUS and further successfully treated through TAE. The patient maintained follow-up without evidence of further bleeding. Discussion/Conclusion: The authors report a unique case of severe, recurrent UGIB caused by two metachronous gastric DL lesions. The importance of systematic EUS scanning for diagnosis, treatment, and follow-up of DL is emphasized, as well as the potential influence in the outcome of other techniques like angiographic embolization.
AB - Introduction: Dieulafoy's lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchronous DL but no reported cases of two metachronous DL. Case Report: A 28-year-old healthy male presented with acute severe UGIB. UGIE was inconclusive. Systematic EUS mapping identified a gastric DL. After several attempts of EUS-guided hemostasis, DL was marked using a through-the-scope clip and the patient underwent successful transcatheter arterial embolization (TAE). Three years later, a new severe UGIB episode was caused by a second gastric DL in a different location, which was identified and marked by EUS and further successfully treated through TAE. The patient maintained follow-up without evidence of further bleeding. Discussion/Conclusion: The authors report a unique case of severe, recurrent UGIB caused by two metachronous gastric DL lesions. The importance of systematic EUS scanning for diagnosis, treatment, and follow-up of DL is emphasized, as well as the potential influence in the outcome of other techniques like angiographic embolization.
KW - Dieulafoy's lesion
KW - Endoscopic hemostasis
KW - Endoscopic ultrasonography
KW - Gastrointestinal bleeding
KW - Interventional radiology
UR - http://www.scopus.com/inward/record.url?scp=85092260263&partnerID=8YFLogxK
U2 - 10.1159/000510027
DO - 10.1159/000510027
M3 - Review article
AN - SCOPUS:85092260263
SN - 2341-4545
VL - 28
SP - 193
EP - 197
JO - GE Portuguese Journal of Gastroenterology
JF - GE Portuguese Journal of Gastroenterology
IS - 3
ER -