Endoscopic diagnosis and treatment of Dieulafoy's ulcer.

Dieulafoy's ulcer often develops unmanageable severe gastrointestinal hemorrhage and sometimes takes a fatal course. In the past surgical operations were considered to be the only life-saving measure for this lesion. Since 1979, 46 lesions of Dieulafoy's ulcer in 45 cases with active bleeding from exposed blood vessels were treated during emergency endoscopy by the hemostatic method of pure ethanol injection. Transient hemostasis was obtained in all cases. Rebleeding occurred in 5 cases (11%) and pure ethanol injection was performed again. Hemostasis was obtained in all cases, but one case again had rebleeding due to an overlooked Dieulafoy's ulcer located in the gastric fundus. Emergent surgical operation was performed in this case. No case required elective surgery and no deaths were attributed to bleeding. Our method achieved complete hemostasis at a rate of 98% (44 cases) for Dieulafoy's ulcer. The pure ethanol injection method is one of the most effective hemostatic methods for the Dieulafoy's ulcer.