Phenylephrine-provoked endoscopy reveals an occult Dieulafoy’s lesion in a duodenal diverticulum: A case report and review of literature

Table 1 Pharmacologic provocation for obscure gastrointestinal bleeding

Ref.	Provocative drugs	Provocation method	Bleeding location	Positive rate	Complications
Rösch et al[8], 1982	Heparin, streptokinase, tolazoline	Mesenteric angiography	LGIB	3/3 (100%)	1 case with massive haemorrhage
Rösch et al[20], 1986	Heparin, streptokinase, tolazoline	Mesenteric angiography	LGIB	41/63 (65%)	No
Kariya et al[22], 2020	Urokinase, nicardipine, heparin, alprostadil, isosorbide	Mesenteric angiography	LGIB	6/12 (50%)	No
Kim et al[43], 2010	Heparin, nitroglycerin, tolazoline, papaverine, tPA	Mesenteric angiography	LGIB	11/36 (30.1%)	No
Ryan et al[39], 2001	Heparin, tolazoline, tPA	Mesenteric angiography	LGIB	6/17 (37.5%)	No
Miller et al[33], 1999	Urokinase	Angiography	GIB	0/1 (0%)	No
Bloomfeld et al[28], 2000	Tolazoline, heparin, urokinase	Mesenteric angiography	LGIB	2/7 (29%)	No
An et al[26], 2025	Heparin, nitroglycerin, tPA	Mesenteric angiography	LGIB	14/40 (35%)	No
Benvenuti et al[40], 2025	tPA	Mesenteric angiography	LGIB	33/119 (27.7%)	No
Maruhashi et al[41], 2024	Carbon dioxide	Mesenteric angiography	LGIB	35/80 (43.8%)	Vomiting
Werner et al[23], 2022	Norepinephrine	Angiography	LGIB	3/4 (75%)	1 case mesenteric ischemia after embolization
Johnston et al[7], 2007	Heparin, tPA	Angiography	LGIB	1/1 (100%)	No
Remzi et al[17], 2003	Heparin	Angiography	LGIB	1/1 (100%)	No
Shetzline et al[31], 2000	Heparin, priscoline	Angiography	GIB	1/1 (100%)	No
Kokoroskos et al[6], 2020	Heparin, nitroglycerin, tPA	Angiography	GIB	7/23 (30%)	No
Meade et al[32], 2020	Heparin	Angiography	UGIB	1/1 (100%)	No
Widlus et al[38], 2007	tPA	Angiography	LGIB	8/9 (89%)	No
Thiry et al[19], 2022	Heparin, nitroglycerin, tPA	Angiography	LGIB	16/36 (44%)	No
Wu et al[24], 2013	tPA	Angiography	LGIB	1/1 (100%)	No
Nozawa et al[30], 2022	Heparin	Angiography	LGIB	2/2 (100%)	No
Drezdzon et al[29], 2022	Heparin/vasodilators	Angiography	LGIB	0/1 (0%)	No
Mernagh et al[36], 2001	Heparin, papaverine	Angiography	GIB	6/12 (50%)	No
Lee et al[42], 2012	Heparin	Angiography	GIB	1/2 (50%)	1 case with massive hematemesis
Glickerman et al[34], 1988	Heparin, tolazoline, urokinase	Angiography	LGIB	1/1 (100%)	No
St George et al[35], 1991	Heparin, vasodilators, urokinase	Angiography	LGIB	0/3 (0%)	No
Koval et al[37], 1987	Heparin, tolazoline, streptokinase	Mesenteric angiography	LGIB	8/10 (80%)	1 case arterial puncture site hematoma; 1 case massive haemorrhage
Brunnler et al[27], 2008	Heparin	Scintigraphy	LGIB	9/13 (69%)	No
Malden et al[21], 1998	Heparin, urokinase	Scintigraphy	LGIB	7/10 (70%)	No
Kumar et al[12], 2007	Heparin	Colonoscopy	LGIB	1/1 (100%)	No
Berkelhammer et al[9], 2000	Heparin	Colonoscopy	LGIB	1/1 (100%)	No
Wright et al[10], 2004	Heparin	Colonoscopy	GIB	1/1 (100%)	No
Rieder et al[11], 2006	Heparin	Colonoscopy	GIB	2/2 (100%)	No
Raines et al[4], 2017	Heparin, clopidogrel, rivaroxaban	Enteroscopy/colonoscopy	GIB	15/27 (56%)	No

GIB: Gastrointestinal bleeding; UGIB: Upper gastrointestinal bleeding; LGIB: Lower gastrointestinal bleeding; tPA: Tissue plasminogen activator.