<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000300193</article-id>
<article-id pub-id-type="doi">10.1159/000510027</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[A Unique Case of Recurrent Upper Gastrointestinal Bleeding Caused by Two Metachronous Dieulafoy&#8217;s Lesions: The Role of EUS Evaluation]]></article-title>
<article-title xml:lang="pt"><![CDATA[Um caso único de hemorragia digestiva alta recorrente causada por duas lesões de Dieulafoy metácronas: a importância da avaliação por ecoendoscopia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brito]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nunes]]></surname>
<given-names><![CDATA[Gonçalo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[Pedro Pinto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Canhoto]]></surname>
<given-names><![CDATA[Manuela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Proença]]></surname>
<given-names><![CDATA[Ana Luísa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Garcia de Orta Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Almada ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro de investigação interdisciplinar Egas Moniz CiiEM PaMNEC - Grupo de Patologia Médica, Nutrição e Exercício Clínico]]></institution>
<addr-line><![CDATA[Monte da Caparica ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Centro Hospitalar Lisboa Central Hospital Curry Cabral Radiology Department]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>3</numero>
<fpage>193</fpage>
<lpage>197</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000300193&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000300193&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000300193&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Dieulafoy&#8217;s lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchronous DL but no reported cases of two metachronous DL.  Case Report: A 28-year-old healthy male presented with acute severe UGIB. UGIE was inconclusive. Systematic EUS mapping identified a gastric DL. After several attempts of EUS-guided hemostasis, DL was marked using a through-the-scope clip and the patient underwent successful transcatheter arterial embolization (TAE). Three years later, a new severe UGIB episode was caused by a second gastric DL in a different location, which was identified and marked by EUS and further successfully treated through TAE. The patient maintained follow-up without evidence of further bleeding.  Discussion/Conclusion: The authors report a unique case of severe, recurrent UGIB caused by two metachronous gastric DL lesions. The importance of systematic EUS scanning for diagnosis, treatment, and follow-up of DL is emphasized, as well as the potential influence in the outcome of other techniques like angiographic embolization.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  a lesão de Dieulafoy (LD) é uma causa rara de hemorragia digestiva alta (HDA), podendo causar hemorragia grave e recorrente. Diagnosticar esta lesão através da endoscopia digestiva alta (EDA) pode ser um desafio e a ecoendoscopia (EUS) é uma ferramenta muito útil. Há apenas dois casos reportados de hemorragia digestiva por duas LD síncronas, mas não há casos descritos de doentes com duas HDA por LD metácronas.  Caso Clínico: homem de 28 anos, saudável, admitido por HDA grave, EDA inconclusiva. Mapeamento gástrico sistemático por EUS identificou LD gástrica. Várias tentativas ineficazes de hemostase endoscópica e guiada por EUS. Marcação da LD com clip guiada por EUS e referenciação para embolização arterial (EA), bem-sucedida. Três anos depois, nova HDA grave devido a uma segunda LD gástrica, em topografia diferente, diagnosticada e marcada com clip por EUS, tratada com EA. Até à data sem recidiva.  Discussão/Conclusão: relatamos um caso único de HDA grave recorrente, causada por duas LD gástricas metácronas. Salienta-se a importância de uma avaliação sistemática por EUS no diagnóstico destas lesões. Salientamos o papel desta técnica no diagnóstico e tratamento das LD e possibilidade de articulação com outras técnicas, nomeadamente a EA.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Gastrointestinal bleeding]]></kwd>
<kwd lng="en"><![CDATA[Dieulafoy&#8217;s lesion]]></kwd>
<kwd lng="en"><![CDATA[Endoscopic ultrasonography]]></kwd>
<kwd lng="en"><![CDATA[Endoscopic hemostasis]]></kwd>
<kwd lng="en"><![CDATA[Interventional radiology]]></kwd>
<kwd lng="pt"><![CDATA[Hemorragia digestiva]]></kwd>
<kwd lng="pt"><![CDATA[Lesão de Dieulafoy]]></kwd>
<kwd lng="pt"><![CDATA[Ecoendoscopia]]></kwd>
<kwd lng="pt"><![CDATA[Hemostase endoscópica]]></kwd>
<kwd lng="pt"><![CDATA[Radiologia de intervenção]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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