The Usefulness of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent bleeding for which no source has been identified by routine endoscopic and contrast studies. This study was performed to determine the utility of capsule endoscopy in patients with OGIB. METHODS: This retrospective study included 21 patients with GIB which were not identified by esophagogastroduodenoscopy and colonoscopy. Those were sixteen patients with overt OGIB (including 6 ongoing overt bleeding) and five with occult OGIB. All underwent capsule endoscopy with Given M2A video capsule system. RESULTS: Definite bleeding of small intestine were identified in 9 of 21 patients (42.9%) and 8 of 9 patients presenting as overt OGIB (50.0%, 8/16). Additionally, 5 of 6 patients with ongoing bleeding on the day of capsule endoscopy were found to have the lesion in small intestine (83.3%, 5/6). Ulcers were found in 6 patients, diverticulitis in 2 patients, and a tumor in 1 patients. CONCLUSIONS: Capsule endoscopy, providing a good visualization of small intestine, is safe and well tolerated. Capsule endoscopy is an useful diagnostic tool for OGIB, especially for ongoing overt bleeding, and can guide the subsequent therapy and expand diagnostic yield in OGIB.

A Case of Pancreatic Duct-Portal Vein Fistulae in Pancreatic Cancer / 대한소화기내시경학회지

Pancreatic fistulae follows pancreatic duct disruption and may develop as a complication of pancreatic disease or injury. The escaping fluid may be walled off by the surrounding viscera to form a pseudocyst or an abscess. Fistulae may drain spontaneously into adjacent hollow viscera or communicate with the body surface externally. Although internal pancreatic fistulas that communicate with adjacent internal organs are much less common, vascular communication with the pancreatic ductal system is especially unusual and generally represents a serious clinical situation. We experienced one case of pancreatic duct-portal vein fistula in a patient with pancreatic cancer. Endoscopic retrograde cholangiopancreatography revealed a large vascular structure representing the portal vein filled at the time of the contrast injection, indicating the presence of a pancreatic duct-portal vein fistulae.