Combined ERCP and endoscopic ultrasonography: a new treatment for rare hemorrhage from a duodenal papillary vascular malformation

Vascular malformation is the main cause of gastrointestinal bleeding, especially in patients with hemorrhage of unknown origin, accounting for approximately 10 % – 40 % of cases [1]. Endoscopic treatment is common; techniques include epinephrine injection [2], contact coagulation [3], and band ligation [4]. However, hemorrhage from a duodenal papillary vascular malformation is rare and challenging to treat; it has always been treated with papillectomy [5]. We present a new treatment using endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) for cases of this kind.