Push Enteroscopy: A Useful Diagnostic Modality for Proximal Small-Bowel Mass Lesions

Small-bowel mass lesions (SBMLs) are responsible for obscure gastrointestinal bleeding (OGIB) in up to 10 % of cases [1–3]. The detection of SBMLs has been difficult due to limited visualization of the small bowel by esophagogastroduodenoscopy (EGD) and colonoscopy [1, 4]. Furthermore, imaging modalities including computerized tomography (CT) and small-bowel series fail to detect small-bowel neoplasms in up to 50 % of cases [1, 5, 6]. Consequently, malignant neoplasms of the small bowel are often diagnosed at a later stage of the disease compared to upper gastrointestinal and colorectal cancers [1]. Capsule endoscopy (CE) is now considered to be the method of choice for starting the diagnostic workup in patients with suspected small-bowel pathology [4, 7, 8]. However, CE has major limitations including the inability to obtain tissue samples and therapeutic incapability [1, 7, 9]. Prior studies have shown that CE fails to visualize the entire small bowel in up to 30 % of cases [1, 7, 9]. We report a case of a gastrointestinal stromal tumor (GIST) presenting as OGIB which initially was missed on CT scan and CE but subsequently diagnosed by push enteroscopy. Case Report

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