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

Abstract

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.

The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room

“…Upper gastrointestinal bleeding (UGIB) is a common medical condition, with high patient morbidity and medical care costs that usually presents as hematemesis and/or melena. 1 – 5 Two-dimensional ultrasonography (2D-U/S) is a simple, portable, and rapid technique that can play an important role in screening for gastrointestinal (GI) and hepatobiliary diseases that cause different forms of UGIB. 6 Additionally U/S has recently been used to assess the degree of esophageal varices (EVs) in cirrhotic patients by 2D-U/S.…”

Role of imaging and endovascular radiology in endoscopically missed Dieulafoy’s lesion of stomach – A case report with review

“…Although endoscopic glue injection has been reported in the literature for DL with success rate of 80–90%, endovascular glue has been sparingly used probably due to fear of gastric ischaemia. 11,12 However, since lesion usually does not supply the mucosa, the use of glue is safe in such lesions without risk of ischaemia. Glue has the advantage of percolating distally in the tortuous vessels challenging to navigate, resulting in complete occlusion of the bleeder resulting in prompt significant response and reducing recurrence rate.…”

Hysteroscopic tubal occlusion using iso‐amyl‐2‐cyanoacrylate in patients with hydrosalpinx

“…Recently the use of cyanoacrylates (CAs), sclerosing agents, was found to be a safe and effective method of hysteroscopic uterine tube occlusion . Iso‐amyl‐2‐cyanoacrylate is a CA derivative, recently used successfully in obstructing digestive, urinary and pulmonary fistulas and for management of bleeding esophageal varices and gastric Dieulafoy's lesion, without serious complications …”