Largo Medical Center Saint Petersburg, FL, United States
Gilad Shapira, DO1, Daniel Golpanian, MD2, Itamar Shapira, 3, Mukul Arya, MD2, Meir Mizrahi, MD4 1Largo Medical Center, Huntsville, AL; 2New York Methodist Hospital, Brooklyn, NY; 3University of Alabama at Birmingham School of Medicine, Birmingham, AL; 4HCA Largo Medical Center, Largo, FL
Introduction: Video Capsule Endoscopy (VCE) as well as Double Balloon Enteroscopy (DBE) were invented in response to difficulty in visualization of deep portions of the small bowel with conventional endoscopy. These modalities have shown higher diagnostic yield in relation to conventional methods such as push enteroscopy, radiologic methods, and intraoperative enteroscopy. As approximately 5% of gastrointestinal bleeding occur between the ligament of Treitz and the IC valve, diagnosing lesions in this area areas is of utility in clinic practice. Here we present a case of an unusual small bowel bleed where VCE lead to diagnosis and ultimately treatment.
Case Description/Methods: Our patient is a 38 year old Asian female who presented with black stools for 3 days along with dizziness, fatigue, and shortness of breath. She originally had a hemoglobin of 6.0 with repeated drops after multiple transfusions. Bidirectional endoscopy included an unremarkable EGD, but a colonoscopy revealing blood throughout the colon and TI. A post-procedure CTA Abdomen and Pelvis was unremarkable. A Meckel Scan was also unrevealing. A VCE showed a polypoid lesion in the mid-distal jejunum with blood distal to the region. Thereafter a diagnostic laparoscopy revealed intussusception of the small bowel with the polypoid lesion as the lead point. Resection of 11 cm of small bowel was performed with an end-end anastomosis. Pathology showed a 2.2cm hamartoma negative for dysplasia. Post-operatively the patient had an uncomplicated course with a stable hemoglobin and no further bleeding episodes.
Discussion: With the advent of VCE, evaluation of bowel that is not seen on conventional endoscopy is now able to be directly visualized. The yield in evaluation of bleeding sources utilizing both VCE or DBE appears greatest for patients with active, overt bleeding. VCE has benefits over DBE including safety, diagnostic yield, patient satisfaction, as well as that it’s noninvasive. In addition, DBE is limited in availability due to its technical aspect. That said, VCE does come with limitations including its lack of therapeutic intervention and precision in localization of lesions. With its high cost and studies showing increased intrahospital retention rates as well as increased lengths of stay, many centers do not utilize VCE on the inpatient side. Our case reinforces that VCE does have utility and should be a consideration on hospitalized patients.
Figure: Polyp visualized on VCE which lead to intussusception
Disclosures: Gilad Shapira indicated no relevant financial relationships. Daniel Golpanian indicated no relevant financial relationships. Itamar Shapira indicated no relevant financial relationships. Mukul Arya indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships.
Gilad Shapira, DO1, Daniel Golpanian, MD2, Itamar Shapira, 3, Mukul Arya, MD2, Meir Mizrahi, MD4. P1533 - Capsule Culture: A Case Where an Often Cancelled Inpatient Modality Proves Beneficial, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.