Capsule endoscopy: a dangerous but diagnostic tool

Incidental Small Bowel Adenocarcinoma Upon Surgical Evaluation of a Retained Endoscopic Video Capsule in a Patient With Crohn's Disease

A 28-year-old male with Crohn’s disease presented with hematochezia and severe anemia. Upon evaluation, no source of bleeding was identified with colonoscopy or esophagogastroduodenoscopy; therefore, a video capsule was placed. Following capsule placement, the patient developed severe abdominal pain. Abdominal X-ray revealed the capsule at the ileocecal valve, indicating it was possibly stuck in a stricture. To reduce inflammation, intravenous steroids were started to assist with capsule passage. Following unsuccessful passage and continual abdominal pain, surgical investigation visualized a mass arising from a jejunal Crohn’s stricture. Despite multiple inspections of the resected small bowel, the capsule was not located. Intraoperative X-ray revealed the capsule inside the large bowel, indicating capsule passage through the stricture. Final pathology revealed metastatic poorly differentiated adenocarcinoma. This case demonstrates management of a retained capsule in Crohn’s patients and emphasizes the importance of considering small bowel adenocarcinoma in Crohn’s patients with obstructive signs.

Obscure gastrointestinal bleeding with negative abdominal computed tomography study: The importance of enteroscopy for early diagnosis of small bowel malignancy

Small bowel tumors are rare among all gastrointestinal (GI) cancers. The most common histological subtype is adenocarcinoma. Adenocarcinoma of the small bowel is difficult to diagnose, often presents at a late stage, and has a poor prognosis. We describe a case of a patient with adenocarcinoma of the small intestine who presented to the hospital with nonspecific GI symptoms and obscure GI bleeding. An initial examination using abdominal computed tomography revealed negative findings. The patient underwent subsequent enteroscopy with capsule endoscopy and double‐balloon endoscopy, and an early‐stage jejunal adenocarcinoma was finally diagnosed.

NASPGHAN Capsule Endoscopy Clinical Report

Wireless capsule endoscopy (CE) was introduced in 2000 as a less invasive method to visualize the distal small bowel in adults. Because this technology has advanced it has been adapted for use in pediatric gastroenterology. Several studies have described its clinical use, utility, and various training methods but pediatric literature regarding CE is limited. This clinical report developed by the Endoscopic and Procedures Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition outlines the current literature, and describes the recommended current role, use, training, and future areas of research for CE in pediatrics.

Small Bowel Adenocarcinoma as the Cause of Gastrointestinal Bleeding in Celiac Disease: A Rare Malignancy in a Common Disease

Introduction. Celiac disease is associated with an increased risk of small bowel malignancies, particularly lymphoma. Its association with small bowel carcinoma is less known. Case Description. We report a case of an 89-year-old woman with celiac disease who experienced recurrent episodes of gastrointestinal bleeding and was ultimately found to have adenocarcinoma of the small intestine. Discussion and Evaluation. Diagnosis of small bowel adenocarcinoma is often delayed because of the need for specialized modalities, which are often deferred in the inpatient setting. Although resection is the modality of choice for small bowel tumors, a majority is either locally advanced or metastatic at diagnosis, and even localized cancers have worse prognosis than stage-matched colorectal tumors. The role of adjuvant chemotherapy is uncertain, but it is often offered extrapolating data from other gastrointestinal cancers. Small bowel carcinomas occurring in the context of celiac disease appear to be associated with higher rates of microsatellite instability than sporadic tumors, although other specific genomic abnormalities and mechanisms of carcinogenesis in celiac disease remain unknown. Conclusion. Recurrent episodes of gastrointestinal bleeding in a patient with celiac disease should prompt an early evaluation of the small bowel to assure timely diagnosis of carcinoma at an early curable stage.

Unawareness of a Prolonged Retained Capsule Endoscopy: The Importance of Careful Follow-Up and Cooperation between Medical Institutions

A 50-year-old man with anemia was referred to our hospital to undergo capsule endoscopy (CE), which revealed small intestinal ulcers. After 5 months of CE, he returned because of recurrent anemia without abdominal symptoms. Abdominal X-ray and computed tomography showed capsule retention in the small intestine at the pelvic cavity. The capsule remained at the same place for 7 days. We performed capsule retrieval by laparoscopy-assisted surgery with resection of the involved small intestine, including an ileal stricture. Resected specimen showed double ulcers with different morphologies, an ulcer scar with stricture, and a wide ulcer at the proximal side of the others. Each ulcer had different histopathological findings such as the degree of fibrosis and monocyte infiltration. These differences led us to consider that the proximal ulcer may have been secondarily induced by capsule retention. Our experience indicated that careful follow-up and the cooperation between medical institutions after CE examination should be undertaken for patients with incomplete examination, unknown excretion of the capsule, and/or ulcerative lesions despite the lack of abdominal symptoms. Additionally, a retained CE remaining over long periods and at the same place in the small intestine may lead to secondary ulceration.