Control of proximal gastric bleeding: combined laparoscopic and endoscopic approach

Dieulafoy's lesion (exulceratio simplex) of the proximal gastric corpus is a more frequent cause of massive upper gastrointestinal hemorrhage than previously appreciated. Recent management has focused on interventional endoscopic and radiologic techniques, but these have been plagued by high rebleeding rates. The traditional surgical approach of suture control of the bleeding or wedge resection is effective but entails significant morbidity and mortality. This article describes endoscopically guided laparoscopic ligation of the feeding vessels in a patient with massive hemorrhage from a Dieulafoy's ulcer.