Double channel pylorus as a complication of carcinoma of the stomach

and alcohol intake seem to be common antecedent factors. I Preceding symptoms can be dyspeptic in nature. I The diagnosis may require multiple endoscopies, arteriography, and sometimes laparotomy. Mortality is high. I Treatment is usually surgical and the lesion is either oversewed or excised. Electrocoagulation was partially successful in one patient. I Laser photocoagulation has been used in the treatment of a variety of bleeding gastrointestinal lesions including gastric and duodenal ulcers, arteriovenous malformations, and Mallory-Weiss tears. We found no reports in the English literature describing its use in treating bleeding Dieulafoy's lesions. In our case, Nd:YAG laser photocoagulation was successful in avoiding a high risk operation by elimination of the lesion as documented by repeat endoscopy. The small ulcer seen by repeat endoscopy is probably the result of laser therapy. Since no histologic data are available from our patient, we cannot comment on the long-term follow-up and the possibility of recurrent bleeding in the future. Laser photocoagulation is not without hazard when used in the treatment of Dieulafoy's lesion since vaporization instead of coagulation can lead to exacerbation of bleeding. It is therefore advisable to apply treatment as short high-energy bursts around the lesion before treating the center of the lesion.