Two cases of small intestinal Dieulafoy's lesions successfully treated by double-balloon endoscopy

Abstract

We report two cases of Dieulafoy's lesions treated by double-balloon endoscopy (DBE). The first case involved an 80-year-old woman with repeated hematochezia. Capsule endoscopy revealed blood accumulation in the ileum. An ileal Dieulafoy's lesion was identified by transanal DBE. Endoscopic clipping was successfully performed for the visible vessel. The second case involved an 85-year-old woman with repeated melena. Capsule endoscopy revealed blood accumulation in the jejunum. Per-oral DBE identified pulsating bleeding. Hemostasis using hemoclips and endoloop was performed for a Dieulafoy's lesion with a visible vessel. Melena recurred after 2 months, and per-oral DBE was repeated, which revealed a visible vessel at the same site. The vessel was successfully treated by endoscopic clipping. If small bowel bleeding is suspected, capsule endoscopy should be used to identify the bleeding site, and DBE should be repeated until hemostasis is confirmed.