Review for 10.1186/1471-230X-10-24 (2010)

Reviewer's report
Title:Successful side-viewing endoscopic hemoclipping for Dieulafoy-like lesion
at the brim of a periampullary diverticulum
Version: 1Date:18 December 2009
Reviewer: R Saenz
Reviewer's report:
The presented case report is an interesting one, due to its (Dieulafoy) location
rarity, precise diagnosis, second step local haemostatic treatment thanks to
lateral view endoscope and hemoclipping.
Gastric, colonic and rectal Dieulafoy lesions are often endoscopically diagnosed
and treated. Small bowel Dieulafoy lesions are infrequent with isolated case
reports, some of them published in regional secondary Journals.
- “Endoscopic band ligation versus endoscopic hemoclip placement for bleeding
due to Dieulafoy lesions in the upper gastrointestinal tract”. Liu D, Lu F, Ou D,
Zhou Y, Huo J, Zhou Z.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Sep; 34(9): 905-9 (Chinese)
“Severe digestive hemorrhage by duodenal injury of Dieulafoy lesion”
Rivera R, Mendez I, Ubiña E, Garcia G, Sanchez A.
Rev Gastroenterol Perú. 2006 Apr-Jun; 26 (2) 203-6 (Spanish)
“Dieulafoy lesion in the duodenum”
Anagnostopoulos G, Foley S, Ragunath K.
N Z Med J. 2005 Nov 11; 118 (1225):U1730
And also in other GI Journals such as:
“Endoscopic management and follow up of Dieulafoy lesion in the upper
gastrointestinal tract”.
Sone Y, Kumada T, Toyoda H, Hisanaga Y, Kiriyama S, Tanikawa M.
Endoscopy. 2005 May; 37 (5): 449-53
“Haemorrhage from multiple duodenal Dieulafoy lesions or angiodysplasia?”
Yarze JC
Scand J Gastroenterol. 2003 Jan; 38(1): 123-4
“Endoscopic band ligation of Dieulafoy-like lesions in the upper gastrointestinal
tract”.
Nikolaidis N, Zezos P, Giouleme O, Budas K, Marakis G, Paroutoglou G,
Eugenidis N.
Endoscopy. 2001 Sep; 33(9): 754-60
“Dieulafoy vascular disease as the cause of massive upper tract digestive
hemorrhage”
Perez Folqués JE, Mansilla Molina D, Martín Díaz L, Vásquez Ruiz J, Civera
Muñoz J, Guirao Manzano J, Polo MI, Hernández Martínez YJ.
Gastroenterol Hepatol. 1998 Oct; 21(8): 418.
“Dieulafoy’s disease of the large and small bowel”
Gadenstätter M, Wetscher G, Crookes PF, Mason RJ, Schwab G, Pointner R.
J Clin Gastroenterol 1998 Sep; 27(2):169-72
Dieulafoy bleedings are difficult to diagnose as a visible vessel, bleeding could
be intermittent, and massive. There is usually a delay in the exact diagnosis of a
Dieulafoy lesion as the responsible.
The endoscopical treatment approach could be attempted by injection therapy
plus local electrocoagulation, heather probe, Argon Plasma Coagulation and also
by mechanical devices such as local banding or clipping.
On the other hand duodenal diverticulum, are frequently seen in elderly patients
as reported from ERCP experiences.
Endoscopists are used nowadays to afford local bleedings during papillotomies
and clipping has become a routine practice
In this particular interesting case, haemostasis was attempted initially by an
endoscopy solution, and later with endovascular ultraselective microcoils
embolization and failed.
Finally the haemostasis was achieved thanks to a lateral view endoscope,
permitting a better view and approach to the duodenal diverticulum Dieulafoy
lesion.
Clipping utilizing a duodenoscope is not easy, it needs an extra expertise in the
endoscopist, Endoclips or hemoclips are difficult to insert utilizing the working
channel, and also there is extra complexity in the precise location of the clips.
It was achieved elegantly by the authors.
The nomination of Dieulafoy-like lesion means that the pathology evaluation of
the entire lesion after surgical treatment including the abnormal vessels, was not
available due to local successful treatment avoiding surgery. That is the correct
term in such cases.
Figures are of utility in clearing the endoscope treatment. Spurting jet is an
outstanding image.
Dieulafoy should be always in capitol letter the first initial.
1.- page 4
“large clot” instead of “large hematoma”
marginally
2 months
2.- page 6
Hemoclip
Lesions
Figure 1
“about 11 cm” (it is 6 cm on the text)
There is no explicit mention to COI.