A Challenging Case of Jejunal Dieulafoy’s Lesion: A Rare Cause of Refractory Lower-Gastrointestinal Bleeding

Almazeedi, Ahmad A.; Alkandari, Mohammad F.; Abbas, Mustafa; Alsurayei, Saqer A.; Al-Taher, Nora T.

doi:10.12659/ajcr.936313

Cited by 3 publications

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References 19 publications

(58 reference statements)

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“…Despite the diagnostic progress made, the timely identification of Dieulafoy’s lesion (DL) in the small bowel presents a considerable challenge. DL is characterized by a submucosal artery exhibiting an abnormally enlarged diameter and a tortuous course along the GI lining [ 7 ]. This condition was initially described in 1898 by the French surgeon Paul Georges Dieulafoy and has been found to account for 1–2% of all cases of GI hemorrhage [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous articles have underscored the challenges associated with diagnosing and managing small bowel DLs, and various strategies for approaching refractory bleeding have been suggested [ 7 – 9 ]. Thus far, an Austrian study documenting the treatment of 10 cases of small bowel DL using single or double-balloon endoscopy (DBE) has been published [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Nakamura,

Yamamura,

Maeda

et al. 2023

BMC Gastroenterol

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Background Obscure gastrointestinal bleeding refers to bleeding for which the source cannot be ascertained even through balloon-assisted endoscopy. In certain instances, Dieulafoy’s lesion in the small bowel is presumed to be the underlying cause. Aim This retrospective study aimed to elucidate the clinical characteristics of Dieulafoy’s lesion in the small bowel as diagnosed via double-balloon endoscopy while also exploring the feasibility of predicting bleeding from Dieulafoy’s lesion prior to endoscopy in cases of obscure gastrointestinal bleeding. Methods A comprehensive analysis of our database was conducted, identifying 38 patients who received a diagnosis of Dieulafoy’s lesion and subsequently underwent treatment via double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy’s lesion were carefully examined. Results The median age of the 38 patients was 72 years, and 50% of the patients were male. A total of 26 (68%) patients exhibited a high comorbidity index. The upper jejunum and lower ileum were the most frequently reported locations for the occurrence of Dieulafoy’s lesion in the small bowel. The detected Dieulafoy’s lesions exhibited active bleeding (n = 33) and an exposed vessel with plaque on the surface (n = 5). Rebleeding after endoscopic treatment occurred in 8 patients (21%, median period: 7 days, range: 1-366 days). We conducted an analysis to determine the definitive nature of the initial double-balloon endoscopy diagnosis. Multivariate analysis revealed that hematochezia of ≥ 2 episodes constituted the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. Additionally, we explored factors associated with rebleeding following endoscopic treatment. Although the number of hemoclips utilized displayed a likely association, multivariate analysis did not identify any independent factor associated with rebleeding. Conclusion If a patient encounters multiple instances of hematochezia, promptly scheduling balloon-assisted endoscopy, equipped with optional instruments without delay is advised, after standard endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy is unrevealing.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Nakamura,

Yamamura,

Maeda

et al. 2023

BMC Gastroenterol

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Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

Nakamura

Yamamura

Maeda

et al. 2023

Preprint

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BACKGROUNDS Obscure gastrointestinal bleeding indicates bleeding in which the source cannot be determined even by balloon-assisted endoscopy. In some cases, the cause is assumed to be a Dieulafoy’s lesion in the small bowel. AIM This retrospective study aimed to reveal the clinical characteristics of Dieulafoy’s lesion in the small bowel as diagnosed by double-balloon endoscopy and consider whether it is possible to predict bleeding from Dieulafoy’s lesionbefore endoscopy in obscure gastrointestinal bleeding. METHOD We reviewed the database of our hospital and identified 38 patients who were diagnosed with Dieulafoy’s lesion and underwent treatment during double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy’s lesion were examined. RESULTS The median age of the 38 patients was 72 years, and 50% of the patients were male. Of the patients, 26 (68%) had a high comorbidity index. We analyzed whether the first double-balloon endoscopy could be definitely diagnosed. Multivariate analysis revealed that hematochezia of ≥ 2 episodes was the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. The factors associated with re-bleeding after endoscopic treatment were analyzed. Multivariate analysis did not reveal any independent factor associated with re-bleeding, although the number of hemoclips used was likely to be associated. CONCLUSION In cases where a patient experiences two or more episodes of hematochezia, balloon-assisted endoscopy, prepared with optional devices, should be scheduled at the earliest possible time.

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A Challenging Case of Jejunal Dieulafoy’s Lesion: A Rare Cause of Refractory Lower-Gastrointestinal Bleeding

Cited by 3 publications

References 19 publications

Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

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Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

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