Endoscopy 2005; 37(4): 401-402
DOI: 10.1055/s-2005-861092
Letter to the Editor
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Identification of a Gastric Dieulafoy’s Lesion Following Ephedrine Administration

E.  Brullet1 , F.  Junquera1 , R.  Campo1 , A.  B. Ortega1 , J.  Troy1
  • 1Endoscopy Unit, Sabadell Hospital, Parc Taulí, Sabadell, Spain
Further Information

Publication History

Publication Date:
12 April 2005 (online)

Introduction

The diagnosis of Dieulafoy’s lesions may be difficult even for experienced endoscopists [1]. Nearly one-third of patients who have bleeding from Dieulafoy’s lesions require repeated endoscopic examinations before a conclusive diagnosis can be reached [2]. Failure to diagnose this condition is mainly due to the absence of active bleeding or stigmata of recent hemorrhage during endoscopy (bleeding from Dieulafoy’s lesions is often intermittent) [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]. This report describes a case in which on two occasions, the administration of ephedrine to treat propofol-induced hypotension during gastroscopy was followed by the appearance of active bleeding from a gastric Dieulafoy’s lesion that had not been identified on previous endoscopic and angiographic studies. This allowed endoscopic diagnosis of the Dieulafoy’s lesion and successful treatment by elastic band ligation.

References

  • 1 Norton I D, Petersen B T, Sorbi D. et al . Management and long-term prognosis of Dieulafoy’s lesion.  Gastrointest Endosc. 1999;  50 762-767
  • 2 Lee Y T, Walmsley R S, Leong R WL, Sung J JY. Dieulafoy’s lesion.  Gastrointest Endosc. 2003;  58 236-243
  • 3 Roma˜ozinho J M, Pontes J M, Lérias C. et al . Dieulafoy’s lesion: management and long-term outcome.  Endoscopy. 2004;  36 416-420
  • 4 Lin H J, Lee F Y, Tsai Y T. et al . Therapeutic endoscopy for Dieulafoy’s disease.  J Clin Gastroenterol. 1989;  11 507-510
  • 5 Reilly H F, Al-Kawas F H. Dieulafoy lesion: diagnosis and management.  Dig Dis Sci. 1991;  36 1702-1707
  • 6 Baettig B, Haecki W, Lammer F, Jost R. Dieulafoy’s disease: endoscopic treatment and follow up.  Gut. 1993;  34 1418-1421
  • 7 Chung Y F, Wong W K, Soo K C. Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage.  Br J Surg. 2000;  87 614-617
  • 8 Nikolaidis N, Zezos P, Giouleme O. et al . Endoscopic band ligation of Dieulafoy-like lesions in the upper gastrointestinal tract.  Endoscopy. 2001;  33 754-760
  • 9 Park C H, Sohn Y H, Lee W S. et al . The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions.  Endoscopy. 2003;  35 388-392
  • 10 Katz P O, Salas L. Less frequent causes of upper gastrointestinal bleeding.  Gastroenterol Clin N Am. 1993;  22 875-889
  • 11 Schmulewitz N, Baillie J. Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center.  Am J Gastroenterol. 2001;  96 1688-1694
  • 12 Kasapidis P, Georgopoulos P, Delis V. et al . Endoscopic management and long-term follow-up of Dieulafoy’s lesions in the upper GI tract.  Gastrointest Endosc. 2002;  55 527-531
  • 13 Parra-Blanco A, Takahashi H, Mendez-Jerez P V. et al . Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients.  Endoscopy. 1997;  29 834-839
  • 14 Berkelhammer C, Radvany A, Lin A. et al . Heparin provocation for endoscopic localization of recurrent obscure GI hemorrhage.  Gastrointest Endosc. 2000;  52 555-556
  • 15 Wright C A, Petersen B T, Bridges C M, Alexander J A. Heparin provocation for identification and treatment of a gastric Dieulafoy’s lesion.  Gastrointest Endosc. 2004;  59 728-730
  • 16 Miko T L, Thomazy V A. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy’s lesion, and submucosal arterial malformation.  Hum Pathol. 1988;  19 914-921
  • 17 Juler G L, Labitzke H G, Lamb R, Allen R. The pathogenesis of Dieulafoy’s gastric erosion.  Am J Gastroenterol. 1984;  79 195-200
  • 18 Michelsen I, Helbo-Hansen H S, Kohler F. et al . Prophylactic ephedrine attenuates the hemodynamic response to propofol in elderly female patients.  Anesth Analg. 1998;  86 477-481
  • 19 Vercauteren M P, Coppejans H C, Hoffmann V H. et al . Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients.  Anesth Analg. 2000;  90 324-327
  • 20 Critchley L A, Stuart J C, Conway F, Short T G. Hypotension during subarachnoid anaesthesia: haemodynamic effects of ephedrine.  Br J Anaesth. 1995;  74 373-378
  • 21 Radstrom M, Bengtsson J, Ederberg S. et al . Effects of ephedrine on oxygen consumption and cardiac output.  Acta Anaesthesiol Scand. 1995;  39 1084-1087
  • 22 Gamlin F, Freeman J, Winslow L. et al . The haemodynamic effects of propofol in combination with ephedrine in elderly patients (ASA groups 3 and 4).  Anaesth Intensive Care. 1999;  27 477-480

E. Brullet, M. D.

Endoscopy Unit
Hospital de Sabadell
Corporació Parc Taulí
Parc Taulí s/n

08208 Sabadell
Spain

Fax: +34-93-7236187

Email: ebrullet@cspt.es