Case Report
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World J Gastrointest Endosc. Aug 16, 2013; 5(8): 417-419
Published online Aug 16, 2013. doi: 10.4253/wjge.v5.i8.417
Endoscopic management of Dieulafoy’s lesion using Isoamyl-2-cyanoacrylate
Abd Elrazek M Aly Abd Elrazek, Nakamura Yoko, Moriguchi Hiroki, Mohamed Afify, Mohamed Asar, Badr Ismael, Magdy Salah
Abd Elrazek M Aly Abd Elrazek, Mohamed Afify, Medicine of Liver Transplantation, Department of Tropical Medicine, Faculty of Medicine, Al Azhar University, Cairo 712-572, Egypt
Abd Elrazek M Aly Abd Elrazek, Mohamed Asar, Magdy Salah, Department of General Surgery and Endoscopy, Faculty of Medicine, Al Azhar University, Cairo 712-572, Egypt
Nakamura Yoko, Moriguchi Hiroki, Department of Medical Informatics, Institute of Biomedical Science-University of Tokushima, Tokushima 770-8503, Japan
Badr Ismael, Department of Anesthesia and Intensive Care, Al Azhar University, Cairo 712-572, Egypt
Author contributions: All the authors contributed to this paper.
Correspondence to: Abd Elrazek M Aly Abd Elrazek, MD, PhD, Medicine of Liver Transplantation, Department of Tropical Medicine, Faculty of Medicine, Al Azhar University, Al-Darrasa Cairo, Cairo 712-572, Egypt. ahmadrazek@gmail.com
Telephone: +20-115-3201333 Fax: +20-115-3201333
Received: March 17, 2013
Revised: May 31, 2013
Accepted: June 28, 2013
Published online: August 16, 2013
Abstract

Dieulafoy’s lesion (DL) is a rare but important cause of obscure gastrointestinal bleeding that may be overlooked during diagnostic endoscopy. Mortality rates are similar to those of other causes for gastrointestinal bleeding. Diagnosis by upper endoscopy is the modality of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL, when diagnosed, endoscopist experience is the major determinant of the treatment strategy. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured gastrointestinal lesion is suspected. Cyanoacryltes compounds have been used successfully in management of Gastric varices and DLs. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE®; Concord Drugs Ltd., Hyderabad, India) as an effective therapy for gastric DL without serious complications. In our case study, Isoamyl-2-cyanoacrylate (AMCRYLATE®) was effective and safe for treating DL. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.

Keywords: Dieulafoy’s lesion, Isoamyl-2-cyanoacrylate, Gastrointestinal bleeding, Endoscopy, Stomach

Core tip: The etiology of Dieulafoy’s lesion (DL) is unknown. The hemorrhage is often torrential and life threatening. Diagnosis by upper endoscopy is the modality of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL. When diagnosed, endoscopist experience is the major determinant of the treatment strategy. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE®; Concord Drugs Ltd., Hyderabad, India) as an effective therapy for gastric DLs without serious complications.