Diagnosis of angiodysplasia on the caudal aspect of the pylorus: need for side-viewing endoscopy

Abstract

Recurrent gastrointestinal bleeding in patients with upper gastrointestinal angiodysplasia is common after treatment. This probably is related to the difficulty identifying all the lesions because they frequently are multiple and can be located in areas not easily visualized with forward-viewing endoscopy. We report two cases of patients with gastrointestinal bleeding in whom angiodysplasia as found at surgical enteroscopy on the caudal aspect of the pylorus that could not be identified with forward-viewing endoscopy. The lesions were ablated at the time of surgery or subsequently after location with side-viewing endoscopy, and no further bleeding occurred.

Role of video endoscopy in managing small bowel disease

“…A side viewing duodenoscope is occasionally helpful in viewing periampullary or duodenal abnormalities, 26 which are not well seen with a forward viewing endoscope, or for assessing whether bleeding is from the biliary or pancreatic duct. 27 Diagnostic laparoscopy can be especially valuable in children with suspected small intestinal bleeding 28 and probably should be used early in young males with recurrent bleeding as Meckel's diverticulum is the cause in two thirds of male patients under 25 years.…”