P4212 - First Report of the Use of Succinic Anhydride and Oxidized Dextran to Treat a Duodenal Dieulafoy Lesion

David Deuth, DO¹, Marcus Byrd, DO², Jimmy Tran, ¹, Jefferson Tran, ¹, Skylar Sullivent, ², Jenna Hightower, RN², Thomas Tran, MD^2
1TMC, Sherman, TX; ²TMC, Denison, TX

Introduction: A Dieulafoy lesion is a large tortuous submucosal artery that erodes and bleeds into the gastrointestinal lumen. Dieulafoy lesions most commonly affect the stomach but can occur anywhere in the GI tract. Even though rare (1-2 % of GI bleeding cases), it can cause profuse hemorrhage leading to significant morbidity and mortality. Novel topical hemostatic agents have shown promise in treating non-variceal upper GI bleeding. This is the first report of the application of succinic anhydride and oxidized dextran compound to successfully treat a life-threatening duodenal Dieulafoy lesion.

Case Description/Methods: Patient is a 65-year-old man with a history of multiple co-morbidities including recent stroke and myocardial infarct on aspirin and clopidogrel. He presented with an acute onset of massive melena, diffuse weakness, dizziness and syncope at the nursing home. He was taken to the ER, where his blood pressure was 50/30. His Hgb was 4.9. Patient was admitted to the ICU, emergently intubated, sedated, placed on vasopressors, started on IV pantoprazole, and transfused. An emergent EGD in the ICU showed a significant amount of fresh blood in duodenum. There was a large Dieulafoy lesion with pulsatile arterial bleeding in the second portion of the duodenum. A topical agent was utilized to achieve hemostasis prior to definitive endoscopic treatment. Three grams of succinic anhydride and oxidized dextran compound (Nexpowder, NextBiomedical, Incheon, Korea) was sprayed onto the Dieulafoy lesion, using a hand-held battery-operated motor. Once hemostasis was achieved, definitive treatment was performed using two hemostatic clips. Patient improved post op with stable vital signs and increase of Hgb to 8.3. He was extubated, taken off vasopressors, and transferred to the floor. Patient was discharged in stable conditions 4 days later.

Discussion: Succinic anhydride and oxidized dextran powder is a hydrophilic biodegradable adhesive compound. Upon contact with fluids, the aldehyde group of the oxidized dextran cross-links with the amine group of the succinic acid to form an adhesive gel creating a mechanical barrier to achieve hemostasis. This technique demonstrated efficacy for treatment of non-variceal upper GI bleeding. To our knowledge, this is the first report of a life-threatening duodenal Dieulafoy lesion successfully treated with this compound. Gastroenterologists should be aware that this novel compound provides a safe and effective treatment option for an actively bleeding Dieulafoy lesion.


Disclosures:


David Deuth, DO¹, Marcus Byrd, DO², Jimmy Tran, ¹, Jefferson Tran, ¹, Skylar Sullivent, ², Jenna Hightower, RN², Thomas Tran, MD². P4212 - First Report of the Use of Succinic Anhydride and Oxidized Dextran to Treat a Duodenal Dieulafoy Lesion, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.