Gastric Dieulafoy's lesion successfully treated by "adjuvant" arterial embolization and endoscopic clipping

While it is well recognized that peptic ulcer disease is the most common cause of nonvariceal upper gastrointestinal bleeding, other lesions cause of haemorrhage, even if rare, may potentially life-threatening. These include arteriovenous malformations such as Dieulafoy's lesion, defined as caliber-persistent submucosal vessel. The endoscopy with its hemostatic techniques is usually the treatment of choice for such patients. In those cases, in which these techniques fail due to the difficult in the correct localization, angiography with embolization may be a good alternative. The use of microcatheters and new embolic agents have improved this procedure. In fact, transcatheter arterial embolization represents a minimally invasive alternative to surgery when endoscopic treatment fails to control gastrointestinal bleeding, especially for the upper tract. This technique proved to be safe, fast and effective. According to our knowledge, only one case of a Dieulafoy's lesion of the duodenum treated with "adjuvant" embolization followed by laser coagulation has been reported in literature. Herein, we report a case of a Dieulafoy's lesion of the stomach, in which "adjuvant" transcatheter arterial embolization has permitted a more easier endoscopic diagnosis and treatment.