Refuse to Give Up; A Case of Recurrent Gi Bleeding Solved with Full Spectrum Endoscopy

Full-spectrum endoscopy (FUSE®) is a novel technology developed to enhance detection of adenomatous polyps during colonoscopy. While research has shown FUSE® to be superior to standard forward-viewing colonoscopy for adenomatous polyp detection, it has not been studied in the setting of gastrointestinal (GI) bleeding. We present a case of recurrent GI bleeding solved utilizing FUSE®. A 75 year old female with a history of hepatitis c, hypertension, and right hemicolectomy presented in June of 2015 with recurrent melena for one year. Prior to her presentation, she underwent a workup at another institution which included upper endoscopy, push enteroscopy, colonoscopy and video capsule endoscopy (VCE) without identifying a source of bleeding. Upon her initial presentation to our institution, exam was notable for melena on rectal exam and laboratory workup for hemoglobin 7.0 g/dL, hematocrit 21.5%, platelet count 136 K/UL, and an MCV 79.3FL. Over the next six months, the patient required three hospitalizations for overt, obscure GI bleeding during which she underwent three colonoscopies, two endoscopies, two single balloon enteroscopies, and three VCEs. Initial colonoscopy revealed blood 40cm into the terminal ileum without a source. Subsequently, VCE revealed red blood starting at the distal-jejunum. A follow up small bowel enteroscopy was unremarkable. The bleeding resolved and the patient was discharged home. The patient presented one month later and underwent colonoscopy, enteroscopy and capsule endoscopy without a source. The distal and proximal extents reached within the small bowel were tattooed. Once again, the bleeding resolved. During the third hospitalization, a discussion to perform surgical assisted enteroscopy occurred but a final VCE was performed and demonstrated a possible lesion at the ileocolonic anastomosis (Figure 1). The decision was made to perform a final colonoscopy using FUSE®, which demonstrated a large, non-bleeding angiodysplastic lesion distal to the ileocolonic anastomosis on the right sided camera (Figure 2) between two folds. Argon plasma coagulation was performed and three hemostatic clips were placed. Since the procedure one year ago, the patient has not experienced further bleeding. In conclusion, FUSE® has been studied for adenoma detection in colon cancer prevention; however this case highlights a possible additional use of FUSE® in diagnosing the etiology of overt, obscure GI bleeding.Figure 1Figure 2