Undetected Gastric Angiodysplastic Lesion Causing Obscure Gastrointestinal Bleeding

Obscure gastrointestinal bleeding (OGIB) has traditionally been defined to as bleeding originating from the small intestine that is beyond the reach of esophagogastroduodenoscopy and colonoscopy. However, gastric lesions associated with chronic intermittent bleeding may be undetected if there is no overt bleeding during initial endoscopic examination, resulting in a diagnosis of OGIB and repeated complex follow-up investigations. Vascular lesions, including angiodysplasia, Dieulafoy’s lesion, and small vascular ectasias, are major causes of chronic intermittent gastrointestinal bleeding. Hematemesis is an important clue for identifying the upper gastrointestinal tract as the source of anemia. Even when these vascular lesions are small and undetected, or not recognized as foci of bleeding during the initial endoscopy, confirmation of interval changes in size and morphology on follow-up endoscopy may provide an opportunity for definitive treatment of the lesion. Herein, we report a case of a patient with chronic anemia accompanied by recurrent syncope in whom no bleeding focus was identified on the initial endoscopic examination. After the patient had overt hematemesis, upper gastrointestinal bleeding was strongly suspected. Follow-up end oscopy revealed an angiodysplastic lesion with interval changes in size and morphology, which was recognized as the source of bleeding, and it was successfully treated endoscopically.