EndoCollab Weekly Summary
WhatsApp Group (Feb 7 - Feb 14, 2025)
Weekly Summary – Gastroenterology & Endoscopy WhatsApp Group (Feb 7 - Feb 14, 2025)
This week’s discussions covered complex GI pathology, rare endoscopic cases, and management strategies for various conditions. Below is a detailed breakdown of key discussions.
1️⃣ Case Discussion: Multiple Colonic Lesions in a 70-Year-Old Male
Presentation & Differential Diagnoses
• 70-year-old male with numerous colonic lesions.
• Possible diagnoses considered:
• Colonic venous blebs
• Blue Rubber Bleb Nevus Syndrome (Bean Syndrome)
• Flebectasias
• Possible melanoma
• Blue Rubber Bleb Nevus Syndrome (BRBNS): A rare venous malformation disorder affecting the GI tract and skin, often presenting with GI bleeding and requiring endoscopic or surgical intervention.
• No further follow-up or biopsy results shared.
2️⃣ Endometriosis-Related Bowel Obstruction
Clinical Insights & Discussion
• Colorectal endometriosis predominantly involves the rectum and sigmoid colon.
• Mucosal involvement is rare (only 3% of resected specimens).
• A case of intestinal endometriosis requiring hemicolectomy was shared.
• Symptoms may mimic malignancy or GIST, and in some cases, can present with cyclical rectal bleeding coinciding with menstruation.
• One case was referred after a laparotomy, where endometriosis was diagnosed intraoperatively.
Key Takeaways
• Endometriosis should be considered in female patients with recurrent bowel symptoms, particularly if cyclical in nature.
• Imaging and preoperative suspicion can help guide surgical decision-making.
• Intestinal endometriosis may present as a mass, leading to bowel obstruction and requiring surgical intervention.
3️⃣ Ogilvie Syndrome (Acute Colonic Pseudo-Obstruction) Post-C-Section
Case Presentation & Imaging Findings
• 41-year-old female, post C-section, with severe colonic dilation (caecum: 12 cm).
• Symptoms: Progressive abdominal distension with delayed passage of stool and gas.
• Imaging: Marked stomach, small bowel, and colonic dilation, particularly caecal dilation, with an empty rectum.
• No evidence of mechanical obstruction on radiology.
Management & Outcome
• Stepwise conservative approach was successful:
1. Nasogastric decompression & IV fluids.
2. Neostigmine administration (2.5 mg) under cardiac monitoring.
3. Knee-elbow positioning was highly effective in expelling gas.
4. Electrolyte correction and laxative therapy (PEG).
5. No need for colonic decompression; symptoms resolved within 3 days.
Discussion Points Raised
• Could this patient have an underlying neuropathy or myopathy causing predisposition to pseudo-obstruction?
• Previous pregnancy history revealed similar but milder episodes.
• Role of genetic testing in recurrent cases?
• Risk of recurrence in future abdominal surgeries?
Key Learnings
• Ogilvie Syndrome can present postpartum and may be managed conservatively.
• Knee-elbow position can enhance gas evacuation.
• Electrolyte imbalance correction and early intervention improve outcomes.
• Consider long-term motility evaluation in patients with recurrent presentations.
4️⃣ Vincristine-Induced Acute Colonic Pseudo-Obstruction
Case Presentation
• 17-year-old female with T-cell lymphoblastic leukemia on BMF 90 regimen, post-induction chemotherapy (Prednisone, Vincristine, L-asparaginase, Daunorubicin).
• Developed abdominal distension, vomiting, absent bowel sounds.
Management
• Colonic decompression tube placed.
• Tube was removed after 6-7 days once peristalsis returned.
• Likely cause: Vincristine-induced autonomic neuropathy affecting colonic motility.
Key Takeaways
• Vincristine can induce Ogilvie syndrome by disrupting autonomic control of colonic motility.
• Colonic decompression tube placement can be effective in restoring motility.
• Monitor for recurrence in future chemotherapy cycles.
5️⃣ GAVE vs. Isolated Gastric Varices (IGV2) Debate
Case Discussion & Endoscopic Findings
• A nodular gastric lesion raised differential diagnoses:
• Gastric Antral Vascular Ectasia (GAVE)
• Isolated Gastric Varices (IGV2)
• Initial diagnosis was gastritis, but no resolution over 3 months.
• Histology ruled out malignancy, confirming GAVE.
Management Strategies Discussed
• APC (Argon Plasma Coagulation) vs. Endoscopic Band Ligation (EBL) for GAVE.
• Tissue adhesives (cyanoacrylate/thrombin) recommended for acute variceal bleeding.
• EUS was suggested to differentiate IGV from GAVE before biopsy.
Key Takeaways
• Histology is crucial to confirm GAVE vs. IGV.
• APC and EBL are viable treatment options for GAVE, though EBL may be more effective for nodular variants.
6️⃣ Post-Cardiac Arrest GI Findings & Stress-Related Gastric Ulcers
Case Presentation
• Patient post-resuscitation (CPR) presented with hematin in the gastric tube and dropping hemoglobin.
• Endoscopic findings:
• Multiple gastric ulcers and erosions.
• Possible ischemic injury due to low perfusion during cardiac arrest.
Discussion & Theoretical Mechanisms
• Ischemic gut injury due to hypoperfusion during cardiac arrest.
• Catecholamine surge leading to mucosal damage (“Mir sign”).
• Potential role of chronic renal failure in predisposing patients to ulceration (platelet dysfunction, malnutrition, heparin use during dialysis).
Key Takeaways
• Gastric stress ulcers post-CPR are likely due to ischemic damage & catecholamine surge.
• Consider prophylactic acid suppression in critically ill post-cardiac arrest patients.
7️⃣ Restarting Anticoagulation Post-GAVE Treatment
Clinical Dilemma
• Patient with AF treated for GAVE via EBL. When to restart anticoagulation (OAK)?
• Guidelines suggest delaying anticoagulation for at least 1 week post-procedure.
• Concerns over risk of rebleeding vs. thrombotic events.
Key Takeaways
• For high-risk AF patients, bridging with LMWH may be considered.
• Post-banding ulcers heal in ~2-3 weeks; rebleeding risk highest in the first week.
• No established guidelines for anticoagulation resumption post-GAVE treatment—requires individualized risk assessment.
Conclusion & Key Learnings
✅ Endometriosis can mimic malignancy in bowel obstruction cases—surgical intervention may be required.
✅ Ogilvie syndrome in post-C-section patients can often be managed conservatively; recurrence risk needs further study.
✅ Vincristine can induce pseudo-obstruction; decompression is effective.
✅ Histology is key in differentiating GAVE vs. IGV; EBL and APC are viable treatments.
✅ Gastric stress ulcers post-CPR likely result from ischemia and catecholamine surge.
✅ Anticoagulation resumption post-EBL remains a clinical challenge—risk-benefit assessment needed.
This week’s discussions provided valuable insights into complex GI pathologies, endoscopic decision-making, and rare presentations. Looking forward to next week’s cases! 🚀