Atypical Blue Rubber Bleb Nevus in an African-American Male

Blue Rubber Bleb Nevus Syndrome (BRBNS), also known as Bean Syndrome, is a rare condition characterized by vascular ectasias that typically present systemically. Most diagnoses are made in early childhood due to cutaneous lesions in Caucasians with familial inheritance. Treatment is usually patient centered due to the wide variance in clinical presentation of the disease. Here, we present a case of BRBNS in a 65-year-old African-American patient with episodic gastrointestinal (GI) bleeding with no previous history. This case emphasizes the need for a higher clinical suspicion of the disease in patients with recurrent GI bleeding.

A Case Report of Vascular Ectasias of GI Tract Presenting as Occult Gastro-Intestinal Bleed Diagnosed on Capsule Endoscopy

Not Available J MEDICINE JUL 2020; 21 (2) : 117-118

Management of Multiple Arteriovenous Malformations of the Small Bowel

A 62-year-old Japanese female was referred to our hospital with gastrointestinal bleeding. Although small-bowel bleeding was suspected, no bleeding source was identified by enhanced computed tomography (CT), video capsule endoscopy (VCE), and double-balloon enteroscopy (DBE). Five years later, the patient had recurrent intermittent bloody stools with a significant decrease in hemoglobin levels. Although no active bleeding was observed on antegrade DBE, we detected a pulsatile submucosal uplift accompanied by a small red patch on the top of the uplift in the jejunum. Arteriovenous malformation (AVM) was suspected as the cause of small-bowel bleeding. Multiple-phase CT showed a number of small vascular ectasias during the arterial phase in the jejunum, and we confirmed the presence of multiple AVMs in the jejunum by selective angiography. To identify the location of the lesions and determine the minimal surgical margins, we performed intraoperative selective angiography with indocyanine green (ICG) injection. This technique allowed us to clearly observe the region and perform segmental small-bowel resection with minimal surgical margin. The patient reported that she has had no gastrointestinal bleeding at the two years follow-up visit.

Endoscopic Management of Lower Gastrointestinal Hemorrhage

Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency. Colonoscopy is the initial diagnostic and therapeutic procedure for most patients with LGIB. The optimal timing of colonoscopy is uncertain, but earlier examinations are associated with higher diagnostic yield. In patients with severe bleeding, colonoscopy should be performed within 24 hours of presentation after an adequate orally administered colon preparation. Additional washing during colonoscopy and careful inspection should be performed to identify high-risk stigmata. Endoscopic therapy should be attempted if high-risk bleeding stigmata are identified. The endoscopic treatment modality depends on the bleeding source, location, operator expertise, and the need for ongoing anticoagulation or antiplatelet therapy. This review 5 tables, 5 figures, and 50 references. Keywords: argon plasma coagulation, clipping, colonoscopy, diverticular bleeding, endoscopic band ligation, endoscopic hemostasis, postpolypectomy bleeding, stigmata of recent hemorrhage, vascular ectasias

Endoscopic Management of Lower Gastrointestinal Hemorrhage

Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency. Colonoscopy is the initial diagnostic and therapeutic procedure for most patients with LGIB. The optimal timing of colonoscopy is uncertain, but earlier examinations are associated with higher diagnostic yield. In patients with severe bleeding, colonoscopy should be performed within 24 hours of presentation after an adequate orally administered colon preparation. Additional washing during colonoscopy and careful inspection should be performed to identify high-risk stigmata. Endoscopic therapy should be attempted if high-risk bleeding stigmata are identified. The endoscopic treatment modality depends on the bleeding source, location, operator expertise, and the need for ongoing anticoagulation or antiplatelet therapy. This review 5 tables, 5 figures, and 50 references. Keywords: argon plasma coagulation, clipping, colonoscopy, diverticular bleeding, endoscopic band ligation, endoscopic hemostasis, postpolypectomy bleeding, stigmata of recent hemorrhage, vascular ectasias

Study on Gastrointestinal Evaluation of Iron Deficiency Anaemia Patients Attending at BIRDEM Hospital

Background: Anaemia is common among general population in developing Asian countries. Iron deficiency anaemia (IDA) is the commonest type of anaemia. It is usually due to chronic gastrointestinal blood loss. The standard of care for these patients with IDA includes evaluation of the Gastrointestinal (GI) tract for bleeding lesions. Iron deficiency anemia is considered as an alarm sign for the presence of possible GI malignancies, and inadequate evaluation of patients with IDA may delay the diagnosis of GI tumors especially colorectal cancer.Objective: To identify the gastrointestinal lesions endoscopically in patients with iron deficiency anaemia. To determine the usefulness of endoscopic procedures (both upper and lower GI) in diagnosis of underlying cause of iron deficiency.Method: This cross-sectional study was conducted to evaluate Iron deficiency anaemia in patients with or without GI symptoms during the period of July 2010 to December 2010 in the department of Gastroenterology, BIRDEM General Hospital. Sixty eight adult eligible patients with iron deficiency anaemia were taken as per inclusion criteria. All study subjects were underwent endoscopy and colonoscopic procedure after adequate preparation along with examination of their stool. Data were collected through faceto- face interview, observation and document review. Data were recorded and analyzed.Results: Majority of patients were 55 to 64 years age group (33.8%). Mean age ± SD of this study subject was 54.00 ±11.792 with maximum and minimum age 86 and 27 years respectively. More than half of the patients were female (51.5%) and rests were male 33 (48.5%). Among the study subjects, 70.58% patients had GI symptoms, 29.42% had non-GI symptoms. On stool examination, 17.64% patients had ova/cyst of helminthes; 82.36% were normal. Stool OBT revealed 11.8% positive and 88.2% negative. On upper GI endoscopy 32.4% had normal findings, 67.6% had some lesions. Majority of these lesions were ulcers and erosions (30.9%), malignancy (ca stomach) was 4.41%; others (which includes congestive gastropathy, reflux oesophagitis, vascular ectasias and helminthiasis) were 32.4%. On colonoscopy, 30.88% patients had normal colon; 69.12% had lesions. Among the lesions, most common lesion was hemorrhoids (36.76%); ca colon was 5.88% and others (includes ulcers, polyps, vascular ectasias and helminthes) were 26.47%. Patients with normal upper GI endoscopy- 50% had GI symptoms and 50% had non-GI symptoms whereas patients having lesions on upper GI endoscopy 80.4% had GI symptoms and 19.6% had non-GI symptoms. This difference was statistically significant (p<0.05). Patients with normal colonoscopy- 42.9% had GI symptoms and 57.1% had non-GI symptoms. On the other hand, patients having lesions on colonoscopy 70.6% had GI symptoms and 29.4% had non-GI symptoms. This was also statistically significant.Conclusion: Majority of the study population had lesions on endoscopy (both upper GI endoscopy and colonoscopy) including malignant lesions. Study showed that lesions are more common in patients with GI symptoms than those without GI symptoms (non-GI symptoms). Therefore, Routine endoscopic (both upper and lower GI) procedures is valuable in evaluating patients with iron deficiency anaemia- for diagnostic as well as therapeutic purposes. Effective treatment of patients with IDA is predicated on the identification of a specific lesion.J Bangladesh Coll Phys Surg 2015; 33(3): 126-132

Hemorrhage from Extra-Antral Gastric Antral Vascular Ectasia in a Patient with Duodenal Heterotopic Gastric Mucosa

Gastric antral vascular ectasias (GAVE) have been increasingly recognized as an uncommon cause of chronic gastrointestinal bleeding and anemia, although their underlying pathogenesis is not completely well understood. Heterotopic gastric mucosa (HGM) has been reported to occur at various sites along the gastrointestinal tract and although relatively common, it is often asymptomatic. We report a case of a 60-year-old woman with a prior history of GAVE who developed melena and symptomatic anemia during her hospitalization following cardiac catheterization. Initial EGD demonstrated nonbleeding antral GAVE and a newly discovered duodenal mass. Duodenal mass biopsies were ultimately notable for HGM along with histologic features of extra-antral GAVE. The patient required blood transfusions and consequently had a small bowel endoscopy notable for fresh blood in the proximal small bowel. The patient underwent a small bowel push enteroscopy which demonstrated active bleeding of the duodenal mass and overlying oozing GAVE, which was cauterized with Argon-Plasma Coagulation with adequate hemostasis. We present for the first time a novel association between GAVE and HGM. Our case illustrates that extra-antral GAVE may occur with HGM in the duodenum. We explore potential mechanisms by which HGM may be involved in the pathogenesis of GAVE.

Spiral Enteroscopy Utilizing Capsule Location Index for Achieving High Diagnostic and Therapeutic Yield

Background and Aim. Spiral enteroscopy (SE) is a new small bowel endoscopic technique. Our aim is to review the diagnostic and therapeutic yield, safety of SE, and the predictive role of prior capsule endoscopy (CE) at an academic center. Methods. A retrospective review of patients undergoing SE after prior CE between 2008 and 2013 was performed. Capsule location index (CLI) was defined as the fraction of total small bowel transit time when the lesion was seen on CE. Results. A total of 174 SEs were performed: antegrade (147) and retrograde (27). Abnormalities on SE were detected in 65% patients. The procedure was safe in patients with surgically altered bowel anatomy (n=12). The diagnostic yield of antegrade SE decreased with increasing CLI range. The diagnostic yield of retrograde SE decreased on decreasing CLI range. A CLI cutoff of 0.6 was derived that determined the initial route of SE. Vascular ectasias seen on CE were detected in 83% cases on SE; p<0.01. Conclusions. SE is safe with a high diagnostic and therapeutic yield. CLI is predictive of the success of SE and determines the best route of SE. The type of small bowel pathology targeted by SE may affect its utility and yield.