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Capsule Endoscopy: Clinical Case Vignettes

Capsule Endoscopy: Clinical Case Vignettes . David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C. Case Report. 50 year-old male Intermittent abdominal pain Recurrent partial small bowel obstructions

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Capsule Endoscopy: Clinical Case Vignettes

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  1. Capsule Endoscopy:Clinical Case Vignettes David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C.

  2. Case Report • 50 year-old male • Intermittent abdominal pain • Recurrent partial small bowel obstructions • Mild weight loss

  3. Case Report • Unremarkable exam • Normal labs, guaiac positive stool • Negative EGD • Negative CT scan • Negative colonoscopy • Negative CT enterography

  4. Case Report • Capsule endoscopy performed…. • See video • Still images follow

  5. Case # 2 • Capsule endoscopy findings: • Submucosal mass • Ulceration on surface with central umbilication (arrow) • Blanching of mucosa • A subsequent CT scan of the abdomen/pelvis performed…

  6. Computerized Tomography of Abdomen:Illustrating metastatic liver lesions.

  7. Case Report • Liver biopsy performed • Stromal tumor on histology • CD 117/c-kit positive

  8. Case Report • Diagnosis: • Metastatic gastrointestinal stromal tumor (GIST) • The patient started on imatinib • Disease has been stable

  9. Case Report • Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal malignancy in the gastrointestinal tract • Pathogenesis based on gain-of-function mutations in the c-kit proto-oncogene • Tyrosine kinase inhibitor imatinibmesylate (Gleevac™) has had a major impact on treatment outcomes and survival for these patients with GIST

  10. Case Report • Capsule endoscopy identified the primary site in the gastrointestinal tract when other methods failed. Findings explained the gastrointestinal bleeding and intermittent bowel obstructions. Unfortunately, metastatic disease was already present by the time a diagnosis was made.

  11. References • Arch Pathol Lab Med. 2006 Oct;130(10):1466-78. • World J GastrointestEndosc. 2011 Feb 16;3(2):40-5. • Eur J Cancer. 2002 Sep;38 Suppl 5:S39-51. • J Natl Comp CancNetw 2008;5(Suppl 2):S1-29.

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