Contribution of Capsule Endoscopy Early in a Bleeding Episode to Treatment of Small Bowel Angioectasia: A Case Report.

Seiji Arihiro,Maiko Ogawa,Atsushi Hokari,Masayuki Kato,Yosuke Kawahara,Keiko Shimoyama,Hiroko Inomata,Yoshinori Arai,Ichiro Sugawara,Rikako Arimoto,Yoshitaka Ando,Daisuke Endo,Hiroshi Yokoyama,Tatsuya Nakada,Masayuki Saruta

doi:10.3390/medicina57040321

Abstract

Background: Recent advances in endoscopic devices such as small bowel capsule endoscopy and balloon-assisted endoscopy have improved the level of medical care for small bowel bleeding. However, treating small bowel angioectasia remains challenging because repeated intermittent bleeding can occur from the multiple minute lesions (about 1 mm in size) that develop in a synchronous and metachronous manner. Here, we report a case of small bowel angioectasia in which capsule endoscopy performed early in a bleeding episode contributed to treatment. Case Summary: A 66-year-old man with suspected small bowel bleeding underwent small bowel capsule endoscopy and balloon-assisted endoscopy with argon plasma coagulation hemostasis for a small intestinal angioectasia. Because small bowel bleeding recurred intermittently after the treatment, small bowel capsule endoscopy and balloon-assisted endoscopy were repeated when there was no bleeding, but no abnormalities were found. Subsequent small bowel capsule endoscopy during a bleeding episode revealed bloody intestinal fluid in the proximal small intestine. Peroral balloon-assisted endoscopy was performed 2 days after SBCE for detailed observation of the small intestinal mucosa at the suspected bleeding site, and there a 1-mm Dieulafoy’s lesion with no active bleeding was identified. We performed argon plasma coagulation, and no bleeding was observed thereafter. Conclusions: Small bowel capsule endoscopy immediately after bleeding onset can identify the bleeding source of multiple minute lesions in small bowel angioectasia.

Highlights

Can still be challenging in daily clinical practice because repeated intermittent bleeding can occur from the multiple minute lepractice because repeated intermittent bleeding can occur from the multiple minute lesions sions that develop in a synchronous and metachronous manner
Should be performed for deis an important finding indicating the bleeding site; balloon-assisted endoscopy (BAE) should be performed for tailed observation of the small intestinal mucosa at the suspected bleeding site, enabling detailed observation of the small intestinal mucosa at the suspected bleeding site, enabling the bleeding bleeding source source to to be be identified identified and and treated treated from from among among multiple multiple minute minute lesions lesions in in the small bowel angioectasia
small bowel capsule endoscopy (SBCE) during active bleeding is useful in identifying the bleeding site, BAE should be performed for detailed observation of the small intestinal mucosa at the suspected bleeding site, enabling the bleeding source to be identified and treated from among the multiple minute lesions in small bowel angioectasia

Summary

Introduction

Medicina 2021, 57, 321 tract and diagnostic evaluation and treatment of hemorrhagic lesions has become possible with the full use of upper gastrointestinal endoscopy, colonoscopy, small bowel capsule endoscopy (SBCE), and balloon-assisted endoscopy (BAE). Can still be challenging in daily clinical practice because repeated intermittent bleeding can occur from the multiple minute lepractice because repeated intermittent bleeding can occur from the multiple minute lesions sions (about 1 mm in size) that develop in a synchronous and metachronous manner. Detection of blood or bloody intestinal by SBCE important finding indicating the bleeding site; BAE should be performed for deis an important finding indicating the bleeding site; BAE should be performed for tailed observation of the small intestinal mucosa at the suspected bleeding site, enabling detailed observation of the small intestinal mucosa at the suspected bleeding site, enabling the bleeding bleeding source source to to be be identified identified and and treated treated from from among among multiple multiple minute minute lesions lesions in in the small bowel angioectasia

Case Presentation

Findings

Discussion

Conclusions