A CASE OF DOUBTFUL MULTI DIEULAFOY'S ULCERS TREATED WITH ENDOSCOPIC SUBMUCOSAL DISSECTION INVOLVING LOCAL INJECTION, INCISION, AND CAUTERY

Abstract

The patient was an 80 year-old female with hematemesis. Upper gastrointestinal endoscopy revealed a Dieulafoy's ulcer in the gastric fornix with pulsatile bleeding. Following unsuccessful attempts of several endoscopic hemostasis techniques, endoscopic submucosal dissection (ESD) involving local injection, incision, and cautery was performed to stop bleeding. On the following day, visible exposed vessels were found at a different site, and hemostasis was achieved with endoscopic clipping. The ESD method may be an option of the treatment for gastric Dieulafory's bleeding. In addition, this may be a rare case where another potential but doubtful gastric Dieulafoy's ulcer developed after successful treatment of a previous Dieulafoy's ulcer.