Endoscopic band ligation with double‐balloon endoscopy for treatment of jejunal Dieulafoy's lesion

Double-balloon endoscopy (DBE) is a useful method to detect and treat small bowel bleeding. Although DBE allows us to have therapeutic options, the rate of rebleeding is high in Dieulafoy’s lesions even after endoscopic hemostasis. Recently, endoscopic band ligation (EBL) has been applied to the treatment of small bowel bleeding. We report a case of small bowel bleeding from Dieulafoy’s lesions that was successfully treated with EBL using DBE. A 95-year-old womanwith a past medical history of chronic cardiac failure and chronic kidney disease was admitted with episodes of melena for 3 days. Hemoglobin level on admission was 4.3mg/dL. Bleeding source was not found by esophagogastroduodenoscopy and colonoscopy. Although video capsule endoscopy (PillCam SB2; Covidien, Tokyo, Japan) did not reveal active bleeding, the bleeding site was suspected in the jejunum. Antegrade DBE (EN-450P5/20; Fujifilm Co., Tokyo, Japan) was done using pethidine hydrochloride and enabled us to detect Dieulafoy’s lesion in the upper jejunum. Although endoscopic clipping was tried at first, the hemoclip could not be deployed at the targeted lesion located in the opposite direction of the working channel of the enteroscope. Therefore, EBL was selected (Fig. 1). After the lesion was marked with a hemoclip, the enteroscope was removed. The endoscope was reinserted after a band-ligator device (MD-48710 EVL Devices; Sumitomo Bakelite Co. Ltd, Tokyo, Japan) was attached to the tip. The lesion was sucked into the ligator cup, and the O-band was released. The initial hemostasis was successful. Total procedure time was 59min. Complications such as perforation or abscess formation did not occur. There was no rebleeding during the follow-up period of 30days. This is the first report applying EBL toDieulafoy’s lesion in the jejunum using DBE. EBL with DBE may be considered a safe and effective therapy in the treatment of Dieulafoy’s lesion in the jejunum. Authors declare no conflict of interests for this article.