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DOI: 10.1055/a-2208-2500
A tricky gastric lesion diagnosed by small-bowel capsule endoscopy
Small-bowel capsule endoscopy (SBCE) is the first-line method for investigating overt gastrointestinal bleeding (OGB), ideally within 48 hours after the episode [1]. However, SBCE can also evaluate lesions outside the small bowel, even though that is not its original purpose. This is extremely important when considering the prevalence of lesions outside the small bowel that are missed by conventional esophagogastroduodenoscopy (EGD) or push enteroscopy, a rate that ranges from 3.5% to more than 30% [2].
We report on a 70-year-old woman who was referred for evaluation using SBCE following recurrent episodes of OGB. She had already undergone two EGDs and a colonoscopy, neither of which identified the source of bleeding. At the time of the current examination, she presented with melena.
After swallowing the device, the capsule endoscope quickly reached the stomach, where it was possible to visualize hematinic residues ([Fig. 1]). An EGD was subsequently performed and identified a Dieulafoy’s lesion along the anterior wall of the gastric body. A hemostatic clip was placed ([Fig. 2]). The bleeding stopped immediately, and the patient was discharged after 2 days.
Subsequent analysis of the SBCE allowed the visualization of active bleeding in the stomach. [Video 1] shows the diagnostic steps and treatment of the Dieulafoy’s lesion.
Qualität:
Reading of an SBCE examination should include prereading, landmarking, findings and clip selection, and reporting, as well as evaluating other segments beyond the small bowel [3]. However, this case demonstrates the need to observe the capsule’s real-time display, if available, in patients under investigation for OGB. Dieulafoy’s lesion, as presented here, is a submucosal vascular lesion identified endoscopically as a bleeding point not associated with erosions or ulcers, making its endoscopic diagnosis challenging [4].
Endoscopy_UCTN_Code_TTT_1AP_2AB
E-Videosis an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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Publikationsverlauf
Artikel online veröffentlicht:
05. Dezember 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Pennazio M, Rondonotti E, Despott EJ. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2023; 55: 58-95
- 2 Koffas A, Laskaratos FM, Epstein O. Non-small bowel lesion detection at small bowel capsule endoscopy: a comprehensive literature review. World J Clin Cases 2018; 6: 901-907
- 3 Rondonotti E, Pennazio M, Toth E. et al. How to read small bowel capsule endoscopy: a practical guide for everyday use. Endosc Int Open 2020; 8: E1220-E1224
- 4 Kolli S, Dang-Ho KP, Mori A. et al. The Baader–Meinhof phenomenon of Dieulafoy’s lesion. Cureus 2019; 11: e4595