Video Capsule Endoscopy in the Localization of Dieulafoy's Lesions
Abstracts
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Dieulafoy's lesions (DL) are a cause of obscure GI bleeding. Noninvasive examination of much of the mucosa of the small intestine, stomach, and cecum is now possible with Video Capsule Endoscopy (VCE). We describe the identification of DL in five patients who underwent VCE for obscure GI bleeding. Methods: As a consecutive series, forty-six patients with obscure GI bleeding were referred for VCE (M2A Capsule, Given Imaging Ltd) after standard methods failed to reveal a source. Coffee grounds, clot or bright red blood was found in thirteen patients (28%). Five of these thirteen patients were noted to have a bleeding site without surrounding ulceration and were diagnosed with DL. Results: VCE identified 5 patients out of 46 (8.7%) with DL. One was female, 4 were male with a mean age of 77 yrs (range: 70 - 91). Pre-VCE work-up included EGD (n=8), colonoscopy (n=13), GI series (n=4), and push enteroscopy (n=3). Patients had received a minimum mean of 11 units of blood over an average period of 14 mo (range: 3 - 48). Mean transit time for the capsule was 250 min (range: 148 - 389). DL were noted in the stomach (n=1), the jejunum (n=2), the ileum (n=1), and the cecum (n=1). The gastric lesion, one jejunal lesion, and the cecal lesion were cauterized during gastroscopy, push enteroscopy and colonoscopy, respectively. The second jejunal DL was tattooed during push enteroscopy and subsequently resected. No histologic abnormality was noted. The fifth patient with an ileal lesion is considering surgery. Conclusion: VCE provides a noninvasive method of detecting obscure sources of GI bleeding. Five cases of DL were localized using VCE. |
