DIAGNOSIS AND TREATMENT OF BLUE RUBBER BLEB NEVUS SYNDROME WITH DOUBLE BALLOON ENTEROSCOPY AND ENDOSCOPIC ULTRASOUND

Abstract

Double balloon enteroscopy (DBE) is a new method that can identify and treat intestinal bowel diseases. Endoscopic ultrasound (EUS) can explore lesions of the different layers of the gastrointestinal tract. Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder with high morbidity and mortality. We describe a case of BRBNS that was diagnosed and treated with these two methods. A 13‐year‐old child presented to our department with a 9‐month history of chronic anemia. Eight months ago he was admitted to the emergency department with melena and upper endoscopy revealed two vascular lesions, one with active bleeding which was treated with sclerotherapy. The patient continued with anemia and intermittent melena. Other diagnostic tests were negative. Physical examination revealed one oral hemangioma. An initial DBE was performed and three small lesions in the antrum were found and treated. Two more jejunal lesions were observed and its vascular origin was confirmed with the aid of a 15 MHz miniprobe that was passed through the biopsy channel. Combined treatment was applied with polidocanol at 1.5% and argon plasma coagulation. Other lesions were found and treated. The control DBE did not show active hemangiomas. The patient was followed for 3 months and no more bleeding was seen and the anemia was corrected to a level of 11 g/dL. DBE with EUS can diagnose and effectively treat patients with vascular lesions, such as BRBNS. The combined treatment offered was safe and no complications were observed. The prognosis has been excellent.