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Dieulafoy’s lesion is a relatively uncommon, occasionally fatal, cause of gastrointestinal bleeding. Endoscopy is useful for its diagnosis/treatment [1–3]. We report a case of bleeding from a Dieulafoy’s lesion in the greater curvature of the fundus treated using an over-thescope clip (OTSC) (Ovesco Endoscopy AG, Tübingen, Germany). A 72-year-old man presented with fainting and shock. Computed tomography revealed an exposed blood vessel with a major axis of 6mm in the fundus and no extravasation (▶Fig. 1). Endoscopy revealed a Dieulafoy’s lesion in the greater curvature of the fundus (▶Fig. 2). We performed endoscopic hemostasis using OTSC (▶Video 1). The following day, hemostasis was confirmed on endoscopy (▶Fig. 3). The patient was discharged on hospital day 5. Dieulafoy’s lesion in the stomach commonly occurs in the lesser curvature [2]. A lesion can be detected by endoscopy in only 71% of patients [1], because securing the visual field is difficult owing to the large amount of blood and small lesion size [2]. Moreover, as in this case, blood and food residue accumulate in the greater curvature of the fundus, making it difficult to locate a lesion during urgent endoscopy. Rebleeding during endoscopic treatment causes further difficulty in securing a visual field. For Dieulafoy’s lesions, injection treatment, thermal coagulation, and mechanical therapy (clipping and band ligation) are endoscopic hemostasis approaches. Although outcomes have improved because of advances in endoscopy, results remain unsatisfactory owing to difficulty in hemostasis (5.9%), rebleeding (10.2%), transition to surgical treatment (4.6%), and death (1.4%) [3]. OTSC is effective as a first-line and second-line treatment for peptic ulcers [4, 5] (injection therapy and throughthe-scope clips are ineffective). OTSC was selected based on the large vessel diameter and lesion site in this case, because we believe OTSC does not induce bleeding, unlike other mechanical hemostatic devices. We considered OTSC to be an effective device for treating a Dieulafoy’s lesion.

Successful Hemostasis Using an Over-the-scope Clip for a Dieulafoy’s Lesion in the Greater Curvature of the Fundus