Usefulness of Plural Capsule Endoscopies and Double Balloon Endoscopies for Treatment of Obscure Gastrointestinal Bleeding

Abstract

We report on a 70-year-old man with recurrent bloody bowel discharge. We detected angiectasia at the distal ileum at initial capsule endoscopy. The angioectasia was treated with double balloon endoscopy. After treatment, bloody bowel discharge recurred. At a second capsule endoscopy after treatment of the distal ileum with double balloon endoscopy, another angiectasia and a bleeding ulcer were detected on the proximal jejunum. The bleeding ulcer was re-treated with double balloon endoscopy. After re-treatment, bloody bowel discharge again recurred. At a third capsule endoscopy, active bleeding was detected at the proximal jejunum. We were then able to diagnose the angiectasia on the proximal jejunum detected at the second capsule endoscopy and to determine that it was the source of bleeding. The angiectasia was detected and was treated with double balloon endoscopy. After treatment, the bloody bowel discharge has not recurred. We should carefully treat patients with multiple angiectasias, because most angiectasias can be sources of bleeding.