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

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.

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