Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

Ünal, Fatih; Çakır, Murat; Baran, Maşallah; Duygulu, Şengül; Aydoğdu, Sema

doi:10.5152/tjg.2014.3419

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…Primary hemostasis is best accomplished with hemoclip application rather than an injection or thermocoagulation techniques used in adults. Hemoclipping was 95% successful when treating a Dieulafoy lesion [112]. Clip application can be limited if the lesion is difficult to access due to location, i.e.…”

Section: Discussionmentioning

confidence: 99%

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Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

Baldwin

Wilsey

2016

Pediatr Gastroenterol Hepatol Nutr

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Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, identifying and understanding the differential diagnoses for pediatric UGI bleeds is essential [1]. Dieulafoy lesions are a rare source of GI bleeding in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

Baldwin

Wilsey

2016

Pediatr Gastroenterol Hepatol Nutr

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“…It is defined as a vascular abnormality consisting of a large caliber, persistent, tortuous submucosal artery. The artery fails to taper off as it reaches the mucosa, and hence has a diameter of 1 to 5 mm, which is 10 times thicker than the normal size of an artery at that level [ 3 ]. On microscopic examination, the artery protrudes through a small mucosal defect that is typically 2 to 5 mm long and does not show any other abnormality of the arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…Massive GI bleeding in children is uncommon and is mainly caused by esophageal varices secondary to chronic liver disease. Although DL is a well-recognized cause of GI bleeding in adults, it is rarely described in children, with only a few case reports published in the English literature [ 3 , 6 – 13 ]. Its characteristic clinical presentation is sudden onset of painless, massive, recurrent, and intermittent hematemesis, at times associated with melena, hematochezia, and hypotension [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Dieulafoy lesion in a two-year-old boy: a case report

et al. 2016

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BackgroundMassive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping.Case presentationA 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis. He had no significant past medical illness, and he was well just before the episode of hematemesis. A clinical examination revealed anemia (hemoglobin, 8.0 g/dl). The rapidly progressive anemia associated with massive hematemesis indicated the presence of an active bleeding in his upper gastrointestinal tract. We performed emergency gastroscopy under general anesthesia. The gastroscopy revealed the presence of an abnormal visible vessel with an adherent clot on the lower body of his stomach. No mucosal abnormality surrounding the lesion was noted; the lesion was thus diagnosed as Dieulafoy lesion. One hemostatic clip was placed on the Dieulafoy lesion and excellent hemostasis was obtained. He recovered without blood transfusion and was discharged 4 days post-endoscopy. He has recovered well with no recurrence of hematemesis.ConclusionsDieulafoy lesion is rare cause of sudden massive gastrointestinal bleeding in children. Nevertheless, it should be considered a differential diagnosis, even in babies. With advances in gastrointestinal endoscopy, as both a diagnostic and therapeutic modality, laparotomy secondary to gastrointestinal bleeding from Dieulafoy lesion has decreased in pediatric cases. Our case report demonstrates the feasibility of endoscopic hemoclipping for gastric Dieulafoy lesion in a child.

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“…Dieulafoy lesion (DL) is an extremely rare cause of massive and repeated upper gastrointestinal (GI) bleeding in children, which may lead to consequences ranging from anemia to hypovolemic shock [1]. On microscopic examination, the lesion consists of the submucosal, abnormally large arterial vessel that has protruded through a 2-to-5 mm long mucosal defect.…”

Section: Introductionmentioning

confidence: 99%

Dieulafoy lesion: two pediatric case reports

et al. 2020

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Background: Massive 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 presentation: First 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. Conclusions: we 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.

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Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

Cited by 16 publications

References 15 publications

Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

Dieulafoy lesion in a two-year-old boy: a case report

Dieulafoy lesion: two pediatric case reports

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