Small Bowel-ORIFICE TO ORIFICE EVALUATION IN A SINGLE EXAM

Video Transcription

Authors are Naina Riyat, M.D., Rahman Naqshbandi, M.D., Jagpal Sinclair, M.D., and Rami El-Abyad, M.D. Our authors have no relevant financial disclosures.  Background on this case is a 50-year-old Caucasian male with Pewts-Jagers syndrome presented with GI bleeding. He had a history of right hemicolectomy  for a large polyp and small bowel resection for interception of a jejunal polyp. Prior video capsule revealed multiple small bowel polyps  for which therapeutic entroscopy was performed. Our video demonstrates the feasibility of complete enterocolonoscopy dictated by necessity.  A therapeutic double-balloon entroscope was advanced using push-and-pull technique. Multiple polyps were observed in the small bowel ranging in size from 5 to 25 millimeters,  some of which were oozing. Larger polyps that were thought to be the cause of bleeding were resected. In the distal jejunum, the stiffening wire snapped  in the biopsy channel at the boot of the insertion tube of the entroscope.  Given a significant amount of time had already been invested in the procedure, an attempt at reaching the anus was pursued with success.  The stiffening wire was pushed out of the channel using a biopsy forcep and pulled from the distal end using a hemostat. Then the procedure was resumed and completed  with no adverse events. The patient's oral cavity was cleaned using hydrogen peroxide swab before he was extubated and sent to recovery.  Our clinical implications for this case include that it is feasible and safe to perform through and through enterocolonoscopies in specific scenarios.  In the United States, panendoscopy in one encounter may not always be achievable in patients without a history of bowel resection. In conclusion, complete anterograde double balloon  enteroscopy to the colon and beyond is safe and achievable, especially in patients with prior history of bowel resection. To clear an obstructed biopsy channel,  advancing the entroscope outside the anus may be considered as an option to salvage a long procedure.

Video Summary

The video demonstrates a case of a 50-year-old male with Pewts-Jagers syndrome who presented with gastrointestinal bleeding. The video shows the feasibility of performing a complete enterocolonoscopy using a therapeutic double-balloon entroscope. Multiple polyps in the small bowel were observed and resected, with some causing bleeding. During the procedure, the stiffening wire snapped, but was successfully retrieved and the procedure was completed without complications. The video highlights the importance and safety of performing through-and-through enterocolonoscopies, particularly in patients with a history of bowel resection. Advancing the entroscope outside the anus may be an option to salvage a long procedure. No financial disclosures were made by the authors.

Asset Subtitle

Honorable Mention

Keywords

Pewts-Jagers syndrome

gastrointestinal bleeding

complete enterocolonoscopy

therapeutic double-balloon entroscope

small bowel polyps