Mini-loop ligation of a bleeding duodenal Dieulafoy's lesion

Abstract

Two percent of gastrointestinal hemorrhages are caused by Dieulafoy’s lesions, which are located in duodenum in only 15% of cases. There are no recommendations regarding the prime endoscopic treatment technique for this condition. A 61-year-old woman presented with melena without signs of hemodynamic instability. During an urgent upper endoscopy, blood oozing from the normal mucosa of the duodenum was seen and this was classified as a Dieulafoy’s lesion. A mini-loop was opened at the rim of a transparent ligation chamber, at the end of the endoscope, and after aspiration of the lesion, closed and detached. Complete hemostasis was achieved without early or postponed complications. In every day clinical practice, mini-loop ligation is rarely used because of possible complications, such as site ulceration, organ perforation, re-bleeding and possible inexperience of the operator. To the best of our knowledge this is the first case of successful treatment of bleeding duodenal Dieulafoy’s lesion by mini-loop ligation.

Keywords: Dieulafoy’s lesion, Duodenum, Endoscopy, Mini-loop, Hemostasis

Core tip: This is a case of 61-year-old woman who presented with upper gastrointestinal hemorrhage caused by duodenal Dieulafoy’s lesion that presented with blood oozing from the normal mucosa on upper endoscopy. Complete hemostasis was achieved using a mini-loop ligation without a mucosal lesion, such as ulceration, on two month follow-up endoscopy. Thus, mini-loop ligation is an effective, easy to use and safe method for the treatment of Dieulafoy’s lesion. However, case reports with longer follow-up are needed for a definitive statement because of the substantial risk of re-bleeding from a residual aberrant artery.