Downloaded from http://journals.lww.com/ajg by BhDMf5ePHKbH4TTImqenVLIlg0cBmue4KF8qvYFVLHMU4mPjpDUhyZfGN6gjPVhvBrKx/bVn64E= on 07/05/2020 clinical monitoring. One week later the patient returned with similar symptoms. During this ad- mission the manufacturer of the capsule was unable to provide any safety data as it had not been studied in pregnant patients. The Obstetrics (OB) service discussed the risks and benefits of VCE during pregnancy. The risk of a retained capsule is that it may require an x-ray of the abdomen and/ or surgery. The patient was currently in the 2nd trimester which is the usual recommended trimester for any necessary surgery. Moreover the gestational age was beyond embryogenesis and per ACOG recommendations x-ray should be completed for maternal well-being. Since there were no safer alternatives and maternal wellbeing supersedes fetal health, VCE was performed. It found a small duodenal erosion but otherwise passed into the colon and was a normal examination of the small bowel. Hence recurrent bleeding was attributed to known gastric varices. She is now in her 30 th week, following up with OB and per their review the fetus is doing well. She has had no more admissions for gastrointestinal bleeding. DISCUSSION: Elective VCE in pregnant patients should ideally be postponed until after delivery due to a lack of safety data. Nevertheless, VCE may be considered in indications related to maternal symptoms that put the mother or child at risk, such as small bowel bleeding. Accordingly, the FDA has assessed pregnancy as a relative contraindication to VCE. 1953 Blue Rubber Bleb Nevus Syndrome: A Diagnostic and Therapeutic Conundrum in Patients With Gastrointestinal Involvement Causing Chronic Anemia Mamoon Ur Rashid, MD 1 , Faisal Inayat, MD 2 , Waseem Amjad, MD 3 , Muzammil Muhammad Khan, MD 4 , Waqas Ullah, MD 5 , Hammad Zafar, MD 1 , Ahmed Munir, MD 6 , Ishtiaq Hussain, MD 7 , Abu Hurairah, MD 1 . 1 Florida Hospital, Orlando, FL; 2 Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 3 Mercy Medical Center, Baltimore, MD; 4 Khyber Medical College, Peshawar, North-West Frontier, Pakistan; 5 Abginton Jefferson Health, Abington, PA; 6 Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 7 Cleveland Clinic Foundation, Weston, FL. INTRODUCTION: Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular anomaly syn- drome consisting of multifocal venous malformations. It frequently presents a diagnostic and ther- apeutic challenge in patients with gastrointestinal involvement. CASE DESCRIPTION/METHODS: A 55-year-old male presented with symptomatic anemia. Physical examination showed paleness and tachycardia. Laboratory studies showed hemoglobin 5.8 g/dL with normal white cell count. Peripheral blood smear showed microcytosis and hypochromia. Coagulation studies and routine biochemistry values were normal. He received packed-red cells and iron supplementation. He underwent upper and lower endoscopies. Colonoscopy showed multiple scattered venous blebs throughout the colon. They ranged in size from 2 mm to 8 mm. None of these blebs were actively bleeding. These lesions were not amenable to endoscopic treatment. Treatment was conservative with PPIs, blood transfusions and iron replacement. DISCUSSION: BRBNS is a rare, multifocal vascular malformation. According to a PubMed search, a total of around 200 cases are reported to date. Although data is sparse, it more commonly occurs in the skin (93%) and gastrointestinal tract (76%). A thorough physical examination and diagnostic workup for any symptomatic site should be performed in all suspected cases. Gastrointestinal in- volvement is a great masquerader as these patients experience severe anemia for years without diagnosis. In these patients, bleeding from the gastrointestinal tract is the most important clinical feature of BRBNS owing to the risk of excessive bleeding. Antiangiogenic agents such as interferon, corticosteroids, or sirolimus may be an effective treatment option for gastrointestinal BRBNS. In future, more cases should be reported in order to understand the etiological factors and treatment approaches. [1951] Figure 2. Ulcer at base of Zencker’s diverticulum. [1951] Figure 3. Hemostasis using clips at ulcer in Zencker’s diverticulum. [1952] Figure 1. Isolated gastric varices (IGV 1). The American Journal of GASTROENTEROLOGY VOLUME 00 | SUPPLEMENT | MONTH 2019 www.amjgastro.com Copyright © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited. Abstracts S1092