Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

Figure 4 An 81-year-old woman presented with nausea, coffee-ground emesis, and dizziness. She underwent urgent esophagogastroduodenoscopy (EGD), despite a normal initial hemoglobin level of 13.0 g/dL, because of the hematemesis. EGD revealed a small blood clot, overlying a lesion without surrounding ulceration, located in proximal gastric body, which was slowly oozing red blood (A). After detachment of the blood clot with irrigation, a raised, darkly red, blood vessel was visualized consistent with a Dieulafoy lesion (B). The lesion was treated with 4 mL of 1:10000 solution of epinephrine and thermocoagulated via heater probe 5 pulses of 30 Joules/pulse without post-procedural bleeding (C). Patient remained stable after the EGD with no further bleeding and she was discharged 3 d later.