DIEULAFOYS VASCULAR MALFORMATION - ROLE OF ENDOSCOPIC ULTRASONOGRAPHYIN THERAPEUTIC DECISION-MAKING

Background: Dieulafoy's vascular malformation may cause severe, potent ially life-threatening gastrointestinal bleeding. Endoscopic diagnosis may be difficult because of minute mucosal lesions, and additional in tramural abnormalities are usually not encountered. Endoluminal high-f requency ultrasonography is a new modality for imaging intramural and perivisceral structures. Methods: We report two cases of recurrent sev ere gastric bleeding in which different endosonographic modalities wer e used in the diagnosis of Dieulafoy's malformation, and the impact of endosonography on therapeutic strategy is discussed. In the first cas e a radial-scanning 7.5/12-MHz echoendoscope and a linear 20-MHz minia ture probe were applied for B-mode imaging in a stable-state patient w ho had undergone previous endoscopic sclerotherapy, and arterial flow signals from the small intramural lesion were recorded using a 10-MHz transendoscopic pulsed Doppler probe. In the other case urgent endoson ography was performed shortly after a bleeding episode, disclosing an aberrant large-calibre artery entering the gastric wall with a long su bmucosal branch. Results: Both patients were successfully operated on with a transabdominal approach. Conclusion: Endosonography is a quick and safe diagnostic method and should be considered when vascular malf ormations are suspected as the cause of gastric bleeding.