A Unique Case of Recurrent Upper Gastrointestinal Bleeding Caused by Two Metachronous Dieulafoy’s Lesions: The Role of EUS Evaluation

Abstract

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.

EUS-guided therapy of nonvariceal refractory bleeding: A prospective observational study

“…EUS has been described as a useful tool both for diagnosing the etiology of gastrointestinal bleeding of obscure or recurrent origin and for localizing the vessel responsible for bleeding for interventional vascular radiology-directed hemostatic therapy. [ 4 ] Our main limitations lie in that it is a single-center study including a low number of patients, so we also accept that therapeutic efficacy is strongly related to the available local experience, which may bias the results. Still, larger studies, possibly including randomized controlled trials, are needed to confirm these results.…”