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145 DOUBLE BALLOON ENTEROSCOPY OF THE SMALL BOWEL: ENDOSCOPIC DIAGNOSIS AND TREATMENT OF THE SMALL BOWEL PATHOLOGY MISSED BY CAPSULE ENDOSCOPY S Cho, S Zepeda-Gomez, N Basset, G Kandel, P Kortan, G May, N Marcon Double balloon enteroscopy (DBE) is a relatively new endoscopic technique developed to potentially examine the entire small bowel and allow endoscopic therapeutic options. It is currently being used for tissue sampling and endoscopic treatment of small bowel pathology encountered on capsule endoscopy (CE).
Division of Gastroenterology and Therapeutic Endoscopy, St Michael's Hospital, University of Toronto, Toronto, Ontario
CASE REPORT: A 29-year-old man presented with severe recurrent iron deficiency anemia and bleeding per rectum. Several upper and lower endoscopies, a small bowel series, a red cell scan and an abdominal CT scan failed to identify the source of the bleeding. He has had a laparotomy and the resection of Meckel's diverticulum for obstructive symptomatology 14 years prior. He has been previously well otherwise and was not on any medications including NSAIDs. CE was performed but the pillcam did not reach the caecum after 7 hours. The anastomosis from the previous surgery was not seen on CE but several small discrete erythematous spots were seen in proximal small bowel. DBEs were performed per oral and rectal routes and were able to examine the entire length of the small bowel and treat the lesions identified on CE. DBE per rectal route identified several ulcerations at the anastomosis from the previous Meckel's diverticulum resection and they were treated endoscopically with argon plasma coagulation and clips. The patient remains well without any evidence of further GI bleeding at 3 months follow up.
CE and DBE are complementary examinations. With increasing use of CE especially in patients with occult GI bleeding, more patients with small bowel lesions will be found and more directed endoscopic interventions such as DBE are likely to be required thereby minimize the aggressive explorative surgical options. False negative and incomplete CE examinations have been described and DBE should also be considered when there is a high clinical index of suspicion for small bowel pathology despite the lack of positive CE findings.