1987 Volume 29 Issue 1 Pages 141-151_1
Hemostasis and cure were achieved by endoscopic local injection of pure ethanol (ETH) into 4 lesions in 3 patients suspected by emergency endoscopy to, have exulceratio simplex (Dieulafoy). The patients were 49-and 61-year-old males and a 74- year-old female, all exhibiting hematemesis and melena. Emergency endoscopy revealed arterial hemorrhage in the anterior wall of the lesser curvature immediately below the cardia in the first patient, and in the posterior wall in the middle gastric body in the last two. Hemostasis was achieved in all patients by immediate local injection of ETH. The third patient showed melena again due to arterial hemorrhage of the posterior wall of the lower gastric body, and hemostasis was made also by local injection of ETH. Dieulaf oy's ulcer was formerly considered to be rare, but there have been 123 reported cases in Japan including the author's own patients. This disorder is frequently seen in males in their 40's to 60's with a male-female ratio of 3 :1. The lesion, most often involving the posterior wall of the middle to upper gastric bodies, were mostly Ul II, and the mean diameters of the exposed blood vessels and ulcer were 1.3 mm and 5.5 × 7.5 mm, respectively. Nearly all patients showed hematemesis and/or melena, and the hemorrhage was massive in 86% of the cases, of which 82% showed signs of shock. Diagnosis was made by endoscopy in 79% of the patients, but the site of the hemorrhage could not be often indentif ied. Surgery used to be regarded as the best and only effective treatment for Dieulafoy's ulcer, but endoscopic hemostasis is achived with increasing frequency due to recent technological developments of endoscopy. In the 54 patients reported, satisfactory hemostasis was achieved by local injection of ETH or hypertonic saline epinephrine solution (HS-E). However the effect of high frequency electric coagulation was not consistent. These results suggest that local injection of ETH or HS-E should be the first choice in endoscopic treatment of Dieulafoy's ulcer.
