Small Bowel Metastatic Melanoma: An Emblematic “Coal-Black” Appearance at Videocapsule Endoscopy

A 80-year-old woman underwent vulvar melanoma resection and segmental lung resection for pulmonary metastasis. Immunotherapy with Nivolumab was performed. One year later, the patient was admitted for gastrointestinal (GI) recurrent bleeding and severe anemia. Esophagoastroduodenoscopy and colonoscopy did not show any abnormality, while videocapsule endoscopy (VCE) revealed an irregular and exophytic whitish area with a “coal-black” central depression. Small bowel resection was performed and histological examination revealed S100 protein strongly positive melanoma metastasis. The patient died six months later from disease progression. A “coal-black” appearance of intestinal metastatic melanoma has been described only twice before this report. In one case the patient had been treated by immunotherapy with interferon A and dendritic cell-based vaccination. In our patient, it is presumable that the picture we observed was a consequence of Nivolumab treatment inducing the disappearance of melanocytes in the area surrounding the metastasis with the onset of the central coal-black lesion encircled by whitish tissue. This picture should be emblematic of intestinal metastatic melanoma in subjects treated with immunotherapy showing occult/obscure bleeding.

A130 VIDEOCAPSULE ENDOSCOPY VERSUS DOUBLE-BALLOON ENTEROSCOPY: WHICH ONE WINS?

Background Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two endoscopic exams that permit the investigation of the small intestinal mucosa. There exists few studies that compare the diagnostic performance and results between these two diagnostic modalities. Aims To compare the diagnostic performance between VCE and DBE. Methods Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing both VCE and DBE were recruited. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the two endoscopic exams. The patients with an incomplete endoscopy report or who were unable to complete both VCE and DBE were excluded. The results of both VCE and DBE were compared using univariate analysis. Results In total, 126 patients underwent VCE. Of those patients, 15 further underwent DBE (average age: 69±17, 53% female). In total, 11 patients underwent upper DBE, 3 patients underwent lower DBE, and one patient underwent both upper and lower DBE. The indications for endoscopy were: gastrointestinal bleeding (47%), iron deficient anemia (40%), and other (13%). The VCE findings were: angiodysplasia (35%), inflammation (35%), polyp/neoplasia (20%), and other (10%). The DBE findings were: angiodysplasia (41%), normal (35%), polyp/neoplasia (12%), stenosis (6%) and other (6%). In 53% of cases there was at least one finding concordant between VCE and DBE. In only 20% of cases, DBE found a new lesion that was not seen by VCE. In comparison, 33% of DBE exams were normal despite a positive findings by VCE. The discordance between exams was possibly due to the delay between both exams (average 125 days). Conclusions In over half of cases, there is at least one lesion consistent between both endoscopic modalities. DBE finds a new lesion that was not seen by VCE in only 20% of cases. Therefore, VCE should be the first choice in the investigation of the small intestine mucosa even though both exams seem to be complementary. Funding Agencies None

A129 VIDEOCAPSULE ENDOSCOPY RETENTION: WHAT ARE THE RISK FACTORS?

Background The most feared complication of videocapsule endoscopy (VCE) is retention in the intestine. It is estimated to occur in 1.4% of cases but the risk factors are not well known. Aims To determine the prevalence of VCE retention at a tertiary care centre as well the associated risk factors. Methods Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing VCE were recruited. The patients with an incomplete endoscopy report or who were unable to complete VCE were excluded. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the endoscopic procedure. VCE retention, evaluated by radiography or CT scan, was defined as persistence of the videocapsule in the gastrointestinal tract for ≥14 days or the need for an intervention for removal. Results In total, 126 patients underwent VCE (average age: 66±16, 52% female). There was 6% of patients with Crohn’s disease, and 40% of patients had a previous abdominal surgery. The indications for endoscopy were: iron deficient anemia (48%), gastrointestinal bleeding (32%), suspicion/follow up of IBD (10%), and other (11%). The VCE findings (n=146) were: angiodysplasia (30%), inflammation (30%), normal (20%), polyp (5%), and other (15%). 77% of results were not previously found by conventional endoscopy or imaging. The prevalence of VCE retention was 1.6%. The patient risk factors for retention were Crohn’s disease (OR 19.67; 95CI 1.09–354.11; p<0.05) and corticosteroid use in the previous 2 weeks (OR 19.67; 95CI 1.09–354.11; p<0.05). There was no risk of retention associated with ulcerative colitis, sex, abdominal surgery, or opioid use. The finding of stenosis on VCE was associated with an increased risk of retention (OR 123; 95% CI 4.11-3683.43; p<0.01). Conclusions VCE retention remains a rare complication. There is increased risk of retention in patients with known Crohn’s disease or recent use of corticosteroids. Funding Agencies None

ACTUAL QUESTIONS OF PREPARATION TO VIDEOCAPSULE ENDOSCOPY

AIM to show on the results of our study the influence of the quality of preparationfor videocapsule endoscopy (VCE) on the accuracy of diagnosis of diseases of the small and large intestine. MATERIALS AND METHOD. During the period from September 2014 to December 2016, a videocapsule study was performed on 100 patients of treatment at the State Scientific Center of Coloproctology. Final data processing was carried out based on the results of a survey of 96 patients (52 men and 44 women aged 18 to 78 years). To adequately prepare patients for the study, we used a specific scheme with the use of a «splitdose» of intestinal cleansers based on polyethylene glycol and stimulation solutions. The quality of preparation of the small and / or large intestine for the study was assessed according to the scale of Leighton J.A., Rex D.K. RESULTS. The completeness of the study and the full examination (the ability to visualize all the sections of the small and / or large intestine) are important criteria for conducting the VCE. In our study, a complete study of the small and large intestine was performed in 87 (91 %)patients, and a full study was performed in 86 (90 %) of 96 patients. In the study of the small and large intestine using small intestine or large intestinal videocapsules, in 87 (91 %) patients the intestinal preparation was rated «good» or «excellent». CONCLUSION. The experience of our study showed that in order to obtain reliable and informative results, careful follow-up of the methodology of preparation for the study should be done.