Dieulafoy disease with gastric MALT lymphoma

Abstract

Rationale: Dieulafoy lesion (DL), a rare cause of gastrointestinal bleeding, is easily covered by blood scab formation on the mucous membrane for its small size, which makes it difficult to be identified under endoscope. In clinical practice, it is also very easy to miss gastric mucosa-associated lymphoid tissue (MALT) lymphoma that exhibits atypical early manifestations under gastroendoscope and is difficult to be diagnosed by routine superficial biopsy. Most patients only experience nonspecific dyspepsia symptoms. Patient concerns: A 68-year-old man suffering from repeated melena for 6 years arrived at our hospital. The patient had undergone gastroscopy and capsule endoscopy at other hospitals for several times and received symptomatic treatment, but his melena still continued to recur. At our hospital, the capsule endoscopy displayed that there existed large hemorrhage in the stomach, after which a gastrointestinal decompression tube was placed, so the bright red blood was drained. Subsequently, a sunken vascular malformation tissue in the anterior wall of the gastric fundus was observed under emergency endoscope. Pulsating blood flow appeared immediately after biopsy, and over-the-scope clip (OTSC) was quickly applied to stop the bleeding. Near the bleeding point, scar-like tissue that was surrounded by interrupted mucosa was discovered, and biopsy was performed at this site. Diagnosis: The diagnosis of DL and gastric MALT were determined by the digestive endoscopy and biopsy pathology. Interventions: With the diagnosis of DL and gastric MALT, the hemorrhagic spot was treated by OTSC. After the patient's condition was stable, anti- Helicobacter pylori treatment was performed. Outcomes: After the corresponding treatment, the 6-month follow-up revealed that the lymphoma was not completely cured, but no further bleeding occurred. There was no bleeding in the epigastric region and the patient was in good condition. Lessons: From endoscopy, it is easy to miss DL. When the hemostatic equipment is fully prepared, biopsy can be performed. After biopsy, pulsatile bleeding is convincing evidence for Dieulafoy disease. OTSC represents an effective and low-risk method for DL and it could replace surgery. Moreover, the mucosa surrounding Dieulafoy disease should be carefully observed to exclude coexisting diseases such as lymphoma or gastric cancer.

Concurrent chronic myelomonocytic leukemia and gastric carcinoma: a case report and literature review

“…It was originally approved for the evaluation of patients with gastrointestinal bleeding of unknown cause, and it is widely used for this purpose as well as for other gastrointestinal diseases ( 10 ). Zeng et al reported a case of Dieulafoy’s disease with gastric Mucosal-associated lymphoid tissue (MALT) lymphoma and found a large hemorrhage in the stomach under capsule endoscopy ( 11 ). Although producing excellent images of the upper gastrointestinal tract is challenging due to the capacious stomach and the rapid transition through the esophagus and duodenum, capsule endoscopy is a non-invasive approach for patients who are at high risk of gastrointestinal endoscopy, and it can identify patients who need conventional endoscopy for biopsy ( 12 ).…”

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

“…However, the use of conventional endoscopic methods may be sometimes challenging because of the location of the lesion, size, and high risk of rebleeding, which may require angiographic embolization or on rare occasions surgical intervention for definitive hemostasis (27). At present, several studies reported only small cases on the use of OTSC for Dieulafoy's lesion, and achieved a reliable clinical effect (28)(29)(30)(31)(32). Our study reported 21 patients with Dieulafoy's lesion treated by OTSC, as far as we know, which was the current maximum sample size in published studies.…”