Rapid alternating recorder exchange in capsule endoscopy allows early detection of bleeding source in acute GI bleeding of obscure origin

Abstract

Capsule endoscopy has provided significant advances in the visualization of the small bowel. Since the introduction of this modality, there has been an increasing interest in its use to increase diagnostic yield for a variety of small bowel disorders. Of particular interest is the role of capsule endoscopy in obscureGI bleeding. SevereGI bleeding of obscure origin, which is uncommon, is defined by bleeding not identified by standard endoscopic and radiologic techniques. Although push enteroscopy has been used in the setting of active bleeding of obscure origin, it has significant limitations. We present a case of an 83-year-old patient with a history of obscure GI bleeding who presented with severe acute bleeding of obscure origin. Despite prior endoscopy, colonoscopy, and a small bowel series, no source had been identified previously. At admission, the patient was hemodynamically unstable, preventing an endoscopic investigation. During the resuscitation phase, we evaluated the patient’s small bowel with capsule endoscopy, utilizing a novel technique in which two recording devices were exchanged every 15 to 30 minutes, downloaded immediately, and viewed by the endoscopist, allowing a more rapid review of the findings. This method allowed the successful identification and treatment of a rapidly bleeding arteriovenous malformation (AVM).