A successful case of transcatheter arterial embolization for hemostasis of Dieulafoy’s ulcer associated with esophagus achalasia

Abstract

A 69-year-old man was admitted to our hospital due to worsening dysphagia. He had esophageal achalasia 12 years prior and underwent endoscopic balloon dilatation (EBD) twice. Non-steroidal anti-inflammatory drugs (NSAIDs) were also administered because of lower foot fracture 10 days before hospitalization. On the second day, he had hematemesis, and emergency endoscopy revealed an actively oozing Dieulafoy’s ulcer on the left wall of the lower thoracic esophagus. Although the bleeding temporarily stopped by clipping, four hemostatic procedures were required four days thereafter. Because endoscopic hemostasis was considered difficult, transcatheter arterial embolization (TAE) was performed on the esophageal artery branch and left bronchial artery from the left gastric artery. Subsequently, rebleeding did not occur, and EBD was applied to the achalasia. Dysphagia improved, and he was discharged. Dieulafoy’s ulcers associated with esophageal achalasia are rare, and chronic food residue and stagnation of NSAIDs associated with transit disorder may have possibly contributed to ulceration in this case. TAE was effective for this case, wherein the feeder was considered to be a relatively dilated artery and endoscopically difficult to stop the bleeding.