Upper endoscopy

Discussion in 'MRCS Forum' started by Joseph., May 31, 2008.

  1. Joseph.

    Joseph. Guest

    Upper endoscopy is performed on a patient with recurrent small upper GI bleeding episodes. A lesion is seen in the proximal stomach that is characterized as a bleeding vessel. Dieulafoy’s lesion of the stomach is suspected. This lesion is characterized by -

    a- A large mucosal defect with underlying friable vascular plexus
    b- Frequent rebleeding after Endoscopic treatment
    c- Massive bleeding that requires subtotal gastrectomy
    d- Location in the proximal stomach
    e- Acid-peptic changes of the gastric mucosa
  2. Joseph.

    Joseph. Guest

    Answer: d. (Reilly, Dig Dis Sci 36:1702-1707, 1991) Recently, Dieulafoy’s lesion has been identified more frequently as a source of gastrointestinal bleeding. It is characteristically located within 6 cm distal to the gastroesophageal junction. Dieulafoy’s lesion typically consists of an abnormally large submucosal artery that protrudes through a small, solitary mucosal defect. For unclear reasons, the lesions may bleed spontaneously and massively, in which case they require emergency intervention. Upper endoscopy is usually successful in localizing the lesion, and permanent hemostasis can be obtained endoscopically in most cases with injection Sclerotherapy, electrocoagulation, or heater probe. If surgery is required, a gastrotomy and simple ligation or wedge resection of the lesion may be adequate. No large series have yet established the optimal surgical treatment for Dieulafoy’s lesion; however, acid-reducing procedures have not been successful in preventing further bleeding.

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