Sa1865 Colon Cancer Diagnosis by Multiple Biomarker Electrobiochemical Detection in Biopsy Slices

Abstract

Back ground: Deep enteroscopy for the evaluation and treatment of small bowel pathology has undergone significant technology advancements over the last ten years. Studies directly comparing single (SBE) and double balloon enteroscopy (DBE) with spiral enteroscopy (SE) are few but suggest that the three techniques are comparable. Method: Retrospective review of Spirus® small bowel endoscopy cases over 12 months Results: A single experienced endoscopist completed all cases. The patient characteristics are listed in Table 1. Two patients had strictures (one was dilated) and one had multiple arteriovenous malformations (coagulated with Argon Plasma). Two patients experienced complications. Case 1: A 77 year old female with remote radiation treatment for endometrial carcinoma being evaluated for anemia had several slightly narrowed areas; all judged to be spacious enough to accommodate the overtube except one. The last area appeared tight and the overtube was unlocked as soon as it engaged the location and the scope alone was advanced further. Surprisingly the cecum was reached without difficulty. Upon endoscope withdrawal, bleeding was noted and a perforation was suspected. A tense abdomen was decompressed with a needle, rapidly stabilizing a low blood pressure. Perforation was identified and the segment with several strictures was resected. Case 2: A 44 year old female with cirrhosis secondary to primary sclerosing cholangitis status post hepaticojejunostomy had recurrent anastomotic strictures. On SE assisted ERCP, a perforation was suspected on radiography. ERCP was completed and exam was continued under water without gas insufflation. The perforation was found on the biliary limb and was not favorable for endoclip closure. The spilled intestinal contents were suctioned and pneumoperitoneum was decompressed allowing the patient to be comfortable and stable until laparotomy. A guidewire was placed endoscopically which allowed easy identification of the site during surgery (Figure 1). Conclusion: Patients with known or occult small bowel strictures and surgically altered anatomy with possible adhesional fixation may be at a higher risk of complications and we suggest caution with use of SE in these scenarios. When perforations occur, early recognition and immediate management are of benefit. Despite suffering complications, both patients benefited from their procedures. In case 1, the resection of the diseased intestine led to resolution of anemia. In Case 2, the bile duct stricture was successfully treated and she was bridged to transplant. Table 1: Patient characteristics