Jejunal Dieulafoy's lesion: challenging diagnosis and treatment, and an even greater challenge for clinical pathways.

Regarding the article by João Carlos Gonçalves et al. on a rare case of Dieulafoy's lesion in an atypical jejunal location, we would like to highlight the potential of real-time capsule viewing, integrated into a dedicated clinical pathway allowing early device-assisted enteroscopy. The identification of an active bleeding during within the first hour after pyloric passage of emergency real-time capsule may help select the most appropriate approach for emergency enteroscopy, usually the oral route in this setting, and may increase the diagnostic yield and endoscopic therapy. Once the patient has been hemodynamically stabilized, such a strategy requires a dedicated and streamlined clinical pathway for emergency DAE, including prompt access to a specialized endoscopy unit, appropriately trained staff, and the resources required for deep sedation or general anesthesia. The same pathway should also anticipate early rebleeding after endoscopic therapy. In our experience, rebleeding may occur in up to 25% of cases, most frequently within the first 48 hours.