Brief:

Role of Single Balloon Enteroscopy in accurate diagnosis and treatment of Occult G.I Bleed leading to Anemia in a 78yrs female patient

Description:

• A 78 yrs female patient came to us for the favor of endotherapy for a single angiomatous lesion seen on previous capsule endoscopy performed elsewhere. Patient has h/o occult G.I. blood loss that required blood transfusions and iron preparation repeatedly for the last 2 years.

• Antegrade Single Balloon Enteroscopy was performed under general anaesthesia.

• Scope was passed almost upto 90 cms beyond the DJ flexure and multiple (in total 7) angiodysplastic lesions were seen. No other lesions were seen distal to the last lesion.

• All the lesions were fulgurated with bipolar heater probe coagulation and Coag grasper forceps to achieve complete haemostasis.

TAKE HOME MESSAGE

Patients with Occult or Obscure G.I. Bleeding should undergo Capsule Endoscopy first to plan for the Enteroscopy with intention of treatment. As we can see here in this case, though capsule endoscopy could only see one lesion, enteroscopy actually managed to detect 7 lesions which were effectively fulgurated. Hence in vast majority of the patients Enteroscopy is effective in diagnosis and treatment of Occult / Obscure G.I. Bleeding.

Image:

1. SBE showed angioplastic lesion seen in the Jejunum

2. Narrow band imaging showed classical spider like appearance of the angiodysplastic lesion

3. SBE showed multiple angioplastic lesion seen in the Jejunum

4.Bipolar heater probe coagulation was then performed on the lesion

5.Coag grasper forceps to achieve complete haemostasis.

6.Post fulguration appearance of the treated lesion