CapsoCam: An Alternative Method of “Second Look” Endoscopy in a Patient With a Duodenal GIST and Upper GI Bleeding

Abstract

Video capsule endoscopy (VCE) is the gold standard for small bowel(SB) evaluation in obscure gastrointestinal bleeding. We present a case of a patient in which CapsoCam©, a novel VCE system with a panoramic view, was used for second-look endoscopy (SLE) in an elderly patient with multiple comorbidities. An 87-year-old woman, with a known GIST tumor of the duodenum, presented to the ED with melena and jaundice. On admission, she was found to be hypotensive with a hemoglobin of 4 mg/d and an INR of 4. A computerized tomography revealed a 5cm GIST tumor in the duodenum, compressing the common bile duct. EGD failed to allow for good visualization of the tumor and duodenoscopy could not be performed because of hemodynamic instability. The patient underwent percutaneous transhepatic cholangioscopy with internal and external stent placement with clinical improvement of her coagulopathy and bleeding. After discharge, due to a drop in her hemoglobin without any overt bleeding, EGD was requested by hematology. Due to the patient's age and comorbidiites, however, the test was deferred. VCE was performed with the CapsoCam©. The GIST was visualized with a large ulceration but no active bleeding. Appropriate stent placement was also noted. VCE has become the gold standard for primary SB evaluation. VCE is indicated for the evaluation of obscure GI bleeding, Crohn's disease and evaluation of SB tumors.A new small bowel capsule, capsule, CapsoCam© provides the ability for 360° imaging (panoramic view) with a larger number of images captured per second than standard VCE. This technology allows for better visualization of the duodenum and duodenal papilla making it ideal for diagnosing difficult-to-visualize areas, like the duodenal sweep This case highlights the use of the CapsoCam© capsule for a SLE in a patient with a GIST tumor of the duodenum, a drop in hemeglobin and a potential overt bleed. Due to its ability to provide a 360° view, the capsule enabled us to visualize the second portion of the duodenum, rule out active tumor bleeding and avoid traditional endoscopy in a high-risk patient. Further studies will be needed to determine if the CapsoCam© capsule can consistently provide a reliable alternative to endoscopy for “second-look” evaluation of duodenal lesions.Figure: CT scan showing GIST.Figure: Capsule endoscopy image GIST.Figure: Capsule endoscopy image GIST.