Combined use of band ligation and detachable snares (endoloop) in a patient with blue rubber bleb nevus syndrome
A 20-year-old woman was admitted with iron deficiency anemia and history of melena. Upper endoscopy demonstrated normal esophagus, stomach and proximal duodenum. At colonoscopy, two bluish pedunculated angiectatic polypoid lesions (1 to 2 cm in diameter) were noted due to BRBNS (). The small intestine was screened for further lesions with the use of capsule endoscopy. The capsule identified four more lesions at the proximal jejunum. The small bowel lesions were smaller (0.5 to 1 cm in diameter at their bases). She had a similar venous malformation at the gingival area which was embolized. CT scan of abdomen, chest and brain did not reveal any other lesion.\nWe performed enteroscopy to approach the jejunal lesions (). All lesions were ligated in one session using the band ligation technique with a multi-band ligator device (Fig. , ). In order to avoid entrapment of all intestinal layers, high suction pressure was not used. In addition, two trigger cords, tied together, were used in order to match the length of the colonoscope's channel. A colonoscopy was performed and detachable snares - endoloops were inserted at the colonic lesions (Fig. , ).\nA tissue specimen was obtained using the snare after endoloop insertion from one of the lesions. No bleeding occurred during the procedure. Histopathological examination revealed submucosal large blood-filled spaces lined by a single layer of endothelial cells with presence of some thrombi in the cavernous spaces ().\nThe patient made an uneventful recovery and was discharged 3 days later without any abdominal pain or signs of bleeding. Three weeks following the interventions further endoscopic evaluations were performed; these revealed scars at all sites treated with either technique. No bleeding or new venous malformations were observed ().