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Esophageal multichannel intraluminal impedance and manometry (MII-EM) in 2 patients with eosinophilic esophagitis: can it help the diagnosis?
S140
Abstracts
AJG – Vol. 98, No. 9, Suppl., 2003
the first six days of the admission. Total gastrectomy was deferred due to her advanced liver disease. Cap assisted EGD with clipping was attempted. Epi was injected in and a few centimeters away from the ulcer base. The cap at the end of the endoscope was used to retract and expose the bleeding site sufficiently long enough for accurate deployment of the first hemoclip to the visible vessel. Subsequently, five more clips were deployed around the first clip, with the hope of cutting off the feeding vessel, if any in the adjacent submucosal plane. There was no recurrence of bleeding following the cap assisted hemoclipping. Her PSE slowly improved and she was discharged home, without any further recurrence of bleeding. Conclusion: These 2 cases indicate that a broad spectrum of esophageal function findings occur in patients with EoE.
409 DEMONSTRATION OF CAPILLARY REFILLING SIGN BY CAPSULE ENDOSCOPY Gottumukkala S. Raju, M.D., FACG, F.A.C.P.* Keith Morris, M.D. Bincy Abraham, M.D. Sharon Boening, B.S.N. Debbie Carpenter, R.N. Guillermo Gomez, M.D. University of Texas Medical Branch, Galveston, TX.
Conclusions: Cap at the end of an endoscope can be used like a surgical retractor to expose and stabilize the area. Endoclips provide hemostasis without any further tissue injury. This case demonstrates the benefits of cap-assisted endoscopy with hemoclipping in controlling bleeding that is refractory to conventional hemostatic therapy.
408 ESOPHAGEAL MULTICHANNEL INTRALUMINAL IMPEDANCE AND MANOMETRY (MII-EM) IN 2 PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: CAN IT HELP THE DIAGNOSIS? Amine Hila, M.D. Donald O. Castell, M.D., M.A.C.G.* Medical University of South Carolina, Charleston, SC. Background: Eosinophilic esophagitis (EoE) is a rare disorder defined by the presence of more than 24 eosinophils per high powered field within the esophageal squamous epithelium or deeper tissue levels, and presenting with dysphagia in young adult males. Minimal information is available on the effect of EoE on esophageal function. Objective: Contrast esophageal function in 2 EoE patients. Methods: 2 patients with histologically proven EoE, evaluated with barium swallow (BS), 24-hr esophageal pH monitoring (24-hr pH) and MII-EM. Results: Patient # 1: 29 year old male with solid food dysphagia. EGD showed a mildly narrowed distal esophageal lumen and friable mucosa with slight corrugated appearance. BS was normal. 24-hr pH showed abnormal recumbent reflux (3.2%). MII-EM found normal esophageal motility with complete bolus transit. Patient # 2: 41 year old male with solid food dysphagia. EGD showed a corrugated esophagus. BS found a diffusely narrowed distal esophagus. 24-hr pH showed abnormal esophageal acid exposure in upright (9.4%) and recumbent positions (2.8%). MII-EM found total absence of peristalsis and incomplete bolus transit (see figure).
Introduction: We describe a patient in whom the capsule endoscopy (CE) demonstrated capillary blanching followed by refilling of red lesions in the gastric antrum, which was mistaken as hemorrhagic gastritis, indicating a vascular, rather than an inflammatory pathology underlying the problem. Case Report: A 72-year-old man with iron deficiency anemia was referred for CE to evaluate occult gastrointestinal bleeding. Work-up prior to referral for CE included the following: a) He remained anemic despite six months of iron replacement. b) EGD: A diagnosis of hemorrhagic gastritis was made; antral biopsies revealed HP negative gastritis; duodenal biopsies were normal. c) Colonoscopy was normal. d) CT scan showed chronic splenic vein thrombosis with venous collaterals in the left upper quadrant. e) Enteroclysis was normal. He was referred to us for a CE to evaluate the small intestine for a source of bleeding. Capsule Endoscopy: Extensive red patches were seen in the stomach (fig 1). As the capsule kept pressing against the walls of the stomach, blanching of the red lesions followed by quick refilling was seen on CE. Finally, eruption of the capillaries AND fresh bleeding was seen as the capsule was propelled through the pylorus (fig 2).
Abstracts
AJG – Vol. 98, No. 9, Suppl., 2003
the first six days of the admission. Total gastrectomy was deferred due to her advanced liver disease. Cap assisted EGD with clipping was attempted. Epi was injected in and a few centimeters away from the ulcer base. The cap at the end of the endoscope was used to retract and expose the bleeding site sufficiently long enough for accurate deployment of the first hemoclip to the visible vessel. Subsequently, five more clips were deployed around the first clip, with the hope of cutting off the feeding vessel, if any in the adjacent submucosal plane. There was no recurrence of bleeding following the cap assisted hemoclipping. Her PSE slowly improved and she was discharged home, without any further recurrence of bleeding. Conclusion: These 2 cases indicate that a broad spectrum of esophageal function findings occur in patients with EoE.
409 DEMONSTRATION OF CAPILLARY REFILLING SIGN BY CAPSULE ENDOSCOPY Gottumukkala S. Raju, M.D., FACG, F.A.C.P.* Keith Morris, M.D. Bincy Abraham, M.D. Sharon Boening, B.S.N. Debbie Carpenter, R.N. Guillermo Gomez, M.D. University of Texas Medical Branch, Galveston, TX.
Conclusions: Cap at the end of an endoscope can be used like a surgical retractor to expose and stabilize the area. Endoclips provide hemostasis without any further tissue injury. This case demonstrates the benefits of cap-assisted endoscopy with hemoclipping in controlling bleeding that is refractory to conventional hemostatic therapy.
408 ESOPHAGEAL MULTICHANNEL INTRALUMINAL IMPEDANCE AND MANOMETRY (MII-EM) IN 2 PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: CAN IT HELP THE DIAGNOSIS? Amine Hila, M.D. Donald O. Castell, M.D., M.A.C.G.* Medical University of South Carolina, Charleston, SC. Background: Eosinophilic esophagitis (EoE) is a rare disorder defined by the presence of more than 24 eosinophils per high powered field within the esophageal squamous epithelium or deeper tissue levels, and presenting with dysphagia in young adult males. Minimal information is available on the effect of EoE on esophageal function. Objective: Contrast esophageal function in 2 EoE patients. Methods: 2 patients with histologically proven EoE, evaluated with barium swallow (BS), 24-hr esophageal pH monitoring (24-hr pH) and MII-EM. Results: Patient # 1: 29 year old male with solid food dysphagia. EGD showed a mildly narrowed distal esophageal lumen and friable mucosa with slight corrugated appearance. BS was normal. 24-hr pH showed abnormal recumbent reflux (3.2%). MII-EM found normal esophageal motility with complete bolus transit. Patient # 2: 41 year old male with solid food dysphagia. EGD showed a corrugated esophagus. BS found a diffusely narrowed distal esophagus. 24-hr pH showed abnormal esophageal acid exposure in upright (9.4%) and recumbent positions (2.8%). MII-EM found total absence of peristalsis and incomplete bolus transit (see figure).
Introduction: We describe a patient in whom the capsule endoscopy (CE) demonstrated capillary blanching followed by refilling of red lesions in the gastric antrum, which was mistaken as hemorrhagic gastritis, indicating a vascular, rather than an inflammatory pathology underlying the problem. Case Report: A 72-year-old man with iron deficiency anemia was referred for CE to evaluate occult gastrointestinal bleeding. Work-up prior to referral for CE included the following: a) He remained anemic despite six months of iron replacement. b) EGD: A diagnosis of hemorrhagic gastritis was made; antral biopsies revealed HP negative gastritis; duodenal biopsies were normal. c) Colonoscopy was normal. d) CT scan showed chronic splenic vein thrombosis with venous collaterals in the left upper quadrant. e) Enteroclysis was normal. He was referred to us for a CE to evaluate the small intestine for a source of bleeding. Capsule Endoscopy: Extensive red patches were seen in the stomach (fig 1). As the capsule kept pressing against the walls of the stomach, blanching of the red lesions followed by quick refilling was seen on CE. Finally, eruption of the capillaries AND fresh bleeding was seen as the capsule was propelled through the pylorus (fig 2).