A Case of a Patient with a Benign Cyst Presenting as a Submucosal Small Bowel Mass on Wireless Capsule Endoscopy Prompting Double Balloon Endoscopy

Abstract

Purpose: An 82-year-old female with a one year history of iron deficiency anemia. She underwent an EGD and colonoscopy by an outside gastroenterologist which revealed erythema throughout the stomach and a healing ulcer. Colonoscopy revealed a non-bleeding cecal AVM. Twice daily proton pump inhibitor was continued, but one month later, the patient was admitted to an outside hospital with syncope and a hematocrit of 26 requiring blood transfusion. Her aspirin was held. A follow-up EGD was unremarkable. Subsequently, a wireless capsule enteroscopy found a submucosal mass in the mid-small bowel. She was referred to our institution for consideration of double balloon endoscopy. She reported a good appetite without pyrosis or nausea and a 20 lb weight loss earlier in the year, but a stable weight within the past few months. She denied any visible blood in her stools or black stools. Her hematocrit had stabilized at 37. A double-balloon endoscopy was performed from oral route under general anesthesia. The scope was advanced to 200cm and a soft, yellow, submucosal lesion, measuring approximately 2 cm of similar appearance to the video capsule image was identified. The lesion was biopsied with immediate collapse of the lesion suggesting a submucosal cyst. The total procedure time took 2 hours. Tissue biopsy showed small intestinal mucosa with a thin band of fibrotic tissue suggesting a simple cyst that was incidentally discovered on video capsule. Discussion: In 2001, the FDA approved the first wireless capsule endoscopy to detect small bowel pathology. Previously, small bowel access had been limited. Double balloon endoscopy is now being performed in certain specialized tertiary care centers. It may be used in conjunction with wireless capsule endoscopy, particularly if a small bowel mass or bleeding source is identified. We present a case report of a patient who underwent double balloon endoscopy after wireless capsule endoscopy demonstrated a submucosal mass. After biopsy, the lesion collapsed and pathology confirmed this benign, simple cyst in the small bowel to be an incidental finding which was not felt to be contributing to her iron deficiency anemia.Figure