Shen YJ, Song JJ, Liu XQ, Hu FL. Phenylephrine-provoked endoscopy reveals an occult Dieulafoy’s lesion in a duodenal diverticulum: A case report and review of literature. World J Gastroenterol 2026; 32(44): 121710 [DOI: 10.3748/wjg.121710]
Corresponding Author of This Article
Feng-Ling Hu, Chief Physician, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. 1509035@zju.edu.cn
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Gastroenterology & Hepatology
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case-report
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Shen YJ, Song JJ, Liu XQ, Hu FL. Phenylephrine-provoked endoscopy reveals an occult Dieulafoy’s lesion in a duodenal diverticulum: A case report and review of literature. World J Gastroenterol 2026; 32(44): 121710 [DOI: 10.3748/wjg.121710]
World J Gastroenterol. Nov 28, 2026; 32(44): 121710 Published online Nov 28, 2026. doi: 10.3748/wjg.121710
Phenylephrine-provoked endoscopy reveals an occult Dieulafoy’s lesion in a duodenal diverticulum: A case report and review of literature
Yu-Jie Shen, Jiao-Jiao Song, Xiao-Qin Liu, Feng-Ling Hu
Yu-Jie Shen, Feng-Ling Hu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Jiao-Jiao Song, Endoscopy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Xiao-Qin Liu, Department of Gastroenterology, Jingning People’s Hospital, Lishui 323500, Zhejiang Province, China
Author contributions: Shen YJ contributed to drafting of manuscript; Song JJ and Liu XQ contributed to the literature review; Hu FL performed the endoscopic procedure and revised the manuscript; all authors approved the final version.
AI contribution statement: AI tools (DeepSeek, Doubao and Bimuyu) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors. The authors take full responsibility for all content presented in this article.
Supported by Zhejiang Provincial Natural Science Foundation of China, No. LQ22H030015.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Feng-Ling Hu, Chief Physician, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. 1509035@zju.edu.cn
Received: March 31, 2026 Revised: May 13, 2026 Accepted: June 11, 2026 Published online: November 28, 2026 Processing time: 183 Days and 15.3 Hours
Abstract
BACKGROUND
The diagnosis of a Dieulafoy’s lesion located within a duodenal diverticulum (DD) presents a significant challenge, particularly during nonbleeding intervals. Pharmacological provocation has been proposed for obscure gastrointestinal bleeding. However, experience with provocative endoscopy is largely confined to antithrombotic-based protocols, which are associated with a delayed and unpredictable bleeding onset. The use of vasopressors as pharmacological provocation agents for endoscopic localization has not been previously explored.
CASE SUMMARY
We report the case of a 53-year-old woman with recurrent obscure gastrointestinal bleeding and a haemoglobin level ranging from 50 g/L to 84 g/L. Enhanced abdominal computed tomography showed multiple duodenal diverticula (DDs) in the distal duodenum, with a prominent arterial vessel traversing the wall of one diverticulum. Multiple standard endoscopies revealed fresh clots in the DDs but no definitive bleeding source during nonbleeding intervals. With clinical suspicion of a vascular lesion in the DDs, we administered phenylephrine to induce controlled hypertension for provocative endoscopy, which led to active bleeding from the previously concealed lesion within minutes. Using a colonoscope to enhance distal duodenal visualization, we successfully achieved endoscopic localization and haemostasis in the distal duodenum. The provocation was effective, with no recurrent bleeding or adverse events during a 2-month follow-up.
CONCLUSION
Phenylephrine-provoked endoscopy assists in localizing quiescent occult Dieulafoy’s lesion in a distal duodenal diverticulum with a colonoscope.
Core Tip: Dieulafoy’s lesion inside a duodenal diverticulum is difficult to identify during quiescent phase. Conventional provocative protocols use antithrombotic agents, accompanied by delayed and unpredictable bleeding onset. This case confirms that phenylephrine provocation combined with colonoscopy enables accurate localization of occult Dieulafoy’s lesion in the distal duodenal diverticulum.
