Bleeding Dieulafoy’s-like lesions of the gut identified by capsule endoscopy

Abstract

Dieulafoy’s-like lesions (DLs-like) represent a cause of obscure gastrointestinal bleeding, enteroscopy being the main diagnostic and therapeutic procedure. Frequently, more than one enteroscopy is needed to identify the bleeding vessel. In our practice, video capsule endoscopy (VCE) identified and guided therapy in four cases of DLs-like; three of them were localized on the small bowel. We report, for the first time, a diagnosis of colonic DL-like performed by colon capsule endoscopy. Two patients presented with severe cardiovascular disorders, being hemodynamically unstable during VCE examination. Based on the VCE findings, only one invasive therapeutic procedure per patient was necessary to achieve hemostasis. VCE and enteroscopy may be regarded as complementary procedures in patients with gut DLs-like.

Keywords: Obscure gastrointestinal bleeding; Dieulafoy’s-like lesion; Video capsule endoscopy; Enteroscopy; Small bowel

Core tip: This case series emphasizes the role of capsule endoscopy in active obscure gastrointestinal bleeding, even in hemodynamically unstable patients, because it is able to identify the site of bleeding and to guide therapeutic procedures. Emergency capsule endoscopy reduces the number of diagnostic enteroscopies in Dieulafoy’s-like lesions of the small bowel and colon.