BACKGROUND: Dieulafoy\'s lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy\'s lesion of the upper gastrointestinal tract (UDL).
METHODS: Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist.
RESULTS: In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone.
CONCLUSIONS: Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy\'s lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.

UNASSIGNED: Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients can present with hematemesis, melena, or hematochezia in case of severe bleeding. The initial evaluation should involve assessing the hemodynamic status with adequate resuscitation followed by diagnostic tests to identify the source and potentially treat it. Dieulafoy\'s lesion, sometimes referred to as Dieulafoy\'s disease, is a rare cause of upper GI bleeding with no clear risk factors, which makes it a diagnostic conundrum. Here we describe an unusual case of Dieulafoy\'s lesion developing following percutaneous endoscopic gastrostomy (PEG) placement.
UNASSIGNED: We describe a case of a 70-year-old female patient with a past medical history of hyperlipidemia, well-controlled hypertension, and an ischemic cerebrovascular accident, which caused neurologic dysphagia and placement of a PEG tube 3 weeks prior. She presented to the emergency department due to melena, with hypotension of 90/50 mmHg, tachycardia of 126 beats/minute, and hemoglobin of 5.6 g/dl. An endoscopy revealed a Dieulafoy\'s lesion on the lesser curvature of the stomach just across the PEG tube, which was managed with epinephrine and hemoclips.
UNASSIGNED: This is a rare case of Dieulafoy\'s lesion on the lesser curvature of the stomach, potentially developing due to PEG placement.

Dieulafoy\'s lesion is a rare cause of gastrointestinal bleeding, accounting for approximately 1-2% of all cases of gastrointestinal bleeding. Dieulafoy\'s lesion usually occurs in the lesser curvature of the stomach within six centimeters of the gastroesophageal junction. On the other hand, extragastric Dieulafoy\'s lesions are uncommon. Diagnosing an extragastric Dieulafoy\'s lesion by endoscopy can be challenging because of its small size and obscure location. The key elements for an accurate diagnosis include heightened awareness and a careful early endoscopic evaluation following a bleeding episode. Various endoscopic hemostatic techniques can be used for treatment. This paper presents a case of successful hemostasis using argon plasma coagulation for a life-threatening duodenal Dieulafoy\'s lesion.

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.
OBJECTIVE: 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.
CONCLUSIONS: 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.

Dieulafoy lesion is a rare condition that usually occurs in cases of gastric bleeding in the upper gastrointestinal tract. However, this condition can also occur in the lower gastrointestinal tract but less frequently. The lesion is an arteriolar malformation that extends to the submucosa, causing erosion and bleeding. Meanwhile, this is a case of a 67-year-old woman presenting with a bright red bloody stool prior to admission, as well as a history of constipation which was relieved by digital stool evacuation two weeks earlier. The medical history of the patient reveals episodes of  repeated ischaemic stroke for over seven years and three months, which has led to other conditions such as right-sided paralysis, transcortical motor aphasia, and neurogenic dysphagia. The patient was routinely on antithrombotic medications, which was stopped during hospitalisation where repeated packed cell transfusion was done in order to avoid hematochezia. The patient needed the support of her caregiver most of the time since she was bedridden. Furthermore, the haemostasis and platelet function of the patient were normal. On colonoscopy, there was the discovery of a small lesion of about 3mm in her rectum, protruding into the lumen and pulsated, which was discovered to be Dieulafoy\'s lesion. Subsequently, this lesion was closed using rubber band ligation, and after a month, there was no recurrence of the lower gastrointestinal bleeding.

UNASSIGNED: Dieulafoy\'s lesion is an uncommon cause of hemorrhage of the digestive tract. It often presents with urgent and massive bleeding usually leading to shock, even death. Dieulafoy\'s lesions have been reported throughout the digestive tract but which occurred on duodenal papilla were particularly rare and presented challenges in the choice of hemostasis.
UNASSIGNED: A 66-year-old man with melena for 2 days was admitted. Gastrointestinal endoscopy revealed blood clots covering the duodenal papilla with oozing blood. During the procedure of trying to place a plastic stent into the duodenal papilla first, the hemorrhage began to present pulsating bleeding. The patient went into shock. With consent, two titanium clips were inserted to clamp the bleeding site to stop the bleeding. The patient complained of epigastric pain 14 h after the endoscopy. An abdominal CT scan showed signs of acute pancreatitis. Endoscopy was performed to remove the titanium clips and showed a vessel stump on the duodenal papilla. The patient was discharged from the hospital on the 14th day and followed for 6 months with no recurrence.
UNASSIGNED: This case was diagnosed with a Dieulafoy\'s lesion on the duodenal papilla, which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips but caused acute pancreatitis. Reviewing the treatment, electrocoagulation might be a better choice, and life support treatment, including central vena catheterization and an adequate supply of blood products, should be prepared in advance to provide extra time for the stent placement or vascular intervention treatment.

Dieulafoy\'s lesions are uncommon causes of upper gastrointestinal bleeding (UGIB) that pose a life-threatening risk if not diagnosed promptly and treated appropriately. These lesions are composed of enlarged submucosal blood vessels that bleed despite any gross abnormality. Early intervention with esophagogastroduodenoscopy (EGD) is necessary to avoid more invasive treatment with angiogram embolization or surgical removal. This paper aims to discuss a case regarding a patient with difficult-to-control recurrent bleeding from a Dieulafoy\'s lesion located in the gastric fundus of a previously healthy 60-year-old female. This case highlights the need for dual therapy and special considerations regarding antiplatelet medications and supplements when treating patients with Dieulafoy\'s lesions.

Jejunal Dieulafoy\'s lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy\'s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy\'s lesion should be included in the differential diagnoses.

Diagnosis, management, and treatment of Dieulafoy\'s lesion have been complicated since its first mention in 1884. With increased awareness over the decades, Dieulafoy\'s lesions are being managed differently based on the physician\'s expertise. Herein, we report a case of a 58-year-old female who was found to have a Dieulafoy\'s lesion on endoscopy, with her treatment complicated by gastric necrosis and perforation after multiple embolizations and limited surgical resection.

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