- Video 1
A 55-year-old man presented with massive hematemesis. Upper-GI endoscopy showed an ulcerated nodule with a non-bleeding visible vessel on the anterior wall of the first part of duodenum. Ulcerated submucosal mass, Forrest IIa ulcer, and Dieulafoy's ulcer were considered as differential diagnosis. An EUS examination showed a submucosal vessel with a perforator vessel going across the muscularis propria of the duodenal wall. Application of color and pulse Doppler confirmed the arterial nature of the perforating vessel and confirmed the diagnosis of Dieulafoy's ulcer. Hemoclip application was considered. While applying the first hemoclip, pulsatile bleed started from the visible vessel which could not be settled even after deploying 3 clips. Injection of 20 mL of adrenaline (1:10000 dilution) around the lesion failed to control the bleed. The ulcer, the visible vessel, and the mucosa, along with 3 hemoclips, was sucked in to the cap of the over-the-scope clip before deployment. After deploying the over-the-scope clip, no further bleeding was noted.
- Video Script
Written transcript of the video audio is available online at www.VideoGIE.org.
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