Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2020; 26(30): 4557-4563
Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4557
Endoscopic full-thickness resection to treat active Dieulafoy's disease: A case report
Shan Yu, Xiao-Ming Wang, Xin Chen, Hong-Yan Xu, Guang-Jie Wang, Na Ni, Yu-Xin Sun
Shan Yu, Xiao-Ming Wang, Xin Chen, Hong-Yan Xu, Guang-Jie Wang, Na Ni, Yu-Xin Sun, Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
Author contributions: Yu S and Wang XM designed the research; Wang XM and Sun YX performed the research; Chen X, Xu HY, Ni N and Wang GJ collected the data; Yu S wrote the paper.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors declared that they have no conflicts of interest regarding this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Ming Wang, Chief Doctor, Department of Gastroenterology, Panzhihua Central Hospital, No. 34 Yikang Street, Panzhihua 617067, Sichuan Province, China. 18096308792@163.com
Received: March 29, 2020
Peer-review started: March 29, 2020
First decision: April 26, 2020
Revised: May 6, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 14, 2020
Processing time: 131 Days and 21.5 Hours
Abstract
BACKGROUND

At present, minimally invasive endoscopic treatment is mostly used for patients with actively bleeding Dieulafoy’s lesions, , as it has the advantages of minimal trauma, short operation time and good hemostatic effect, although bleeding can easily recur postoperatively. Recently, extensive gastric cuneiform resection has been advocated for use in these patients because the constant-diameter artery follows a long path to the gastric mucosa.

CASE SUMMARY

A 47-year-old man was admitted to the hospital for repeated hematemesis and black stool, and he was diagnosed with Dieulafoy’s disease. We chose a method that not only simulates surgical gastric cuneiform resection but also reduces trauma. We performed enlarged local endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery and sutured the gastric wall. Postoperative follow-up showed that the constant-diameter artery had been resected from the gastric wall, which was confirmed to have no blood flow signals by endoscopic ultrasonography.

CONCLUSION

Endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery with suturing of the gastric wall has demonstrated potential as a new treatment for Dieulafoy's disease.

Keywords: Dieulafoy’s disease; Endoscopic full-thickness resection; Ultrasound gastroscopy; Case report

Core tip: Gastric Dieulafoy’s disease, also known as gastric submucosal constant-diameter arterial malformation, can occur in any part of the digestive tract but is most common in the esophagus and within 6 cm of the gastroesophageal junction. The main symptoms of this disease are recurrent vomiting and tar-like stool. In severe cases, patients can develop hemorrhagic shock, and the mortality rate is high. We performed enlarged local endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery with suturing of the gastric wall. We report a case diagnosed as Dieulafoy’s disease. This is the first case of Dieulafoy's disease treated by this method.