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Direct percutaneous endoscopic jejunostomy in pregnancy is an option in patients in whom intragastric feeding is contraindicated and may offer a more secure approach than percutaneous gastrojejunostomy.

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Background: Capsule endoscopy (CE) is an emerging tool in the diagnosis and management of occult bleeding and overt obscure gastrointestinal bleeding (OOGIB). Maximizing efficiency of CE can lead to rapid bleeding localization and shorter time to therapy. We investigated whether a trained registered nurse (RN) can accurately interpret bleeding by CE in real time by measuring inter-observer agreement between RN and physician interpretation. Methods: We conducted a prospective study of patients admitted for OOGIB who underwent live-view capsule endoscopy (LVCE) between 12/2016 and 11/2017. A match control group who underwent standard CE was obtained through retrospective review. An RN received a 2-day training program for CE interpretation. RN bedside interpretation for bleeding was followed by interpretation by 2 GI physicians blinded to LVCE findings. Outcomes were compared between groups using t-tests and chi-square tests. Cohen’s kappa measured agreement between physician and RN. Results: Ten subjects were in the LVCE group, and 12 subjects were in the standard of care group. The agreement between the physicians and RNs was 9/10 (90%) with a kappa of 0.73 (95% CI: 0.26-1.00; p=0.016). Patients in the LVCE group had shorter duration to physician interpretation (0.6 vs 0.7 days (p=0.50), duration to endoscopy (1.8 days vs 3 days (p=0.240) and length of stay (8.1 vs. 11.4 days (p=0.26) compared to the standard of care group. Conclusion: This study utilizing an RN for LVCE interpretation found interobserver agreement between RN and physician findings. Larger studies are needed to assess whether this RN-physician team approach can translate to improved outcomes.

Symptomatic gastrointestinal (GI) amyloidosis is a rare manifestation of systemic amyloid light chain amyloidosis. Further, the presentation of primary GI amyloidosis without previously diagnosed systemic amyloidosis is exceptionally rare. We describe a case of a patient presenting with abdominal pain, nausea, vomiting, and weight loss later to be diagnosed with localized GI amyloidosis from underlying multiple myeloma. Unfortunately, the GI disease was insurmountable leading to her death. Amyloidosis exerts its pathology at the level of the mucosa, soft tissue, nerves, and vascular supply of the GI tract. No specific treatments for the GI complications of amyloidosis are available and supportive measures are universally employed. GI amyloidosis is not only infrequently amenable to systemic and symptomatic treatment, but has a negative impact on both quality of life and survival.

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