1. David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C.

2. Case Report 50 year-old male Intermittent abdominal pain Recurrent partial small bowel obstructions Mild weight loss

3. Case Report Unremarkable exam Normal labs, guaiac positive stool Negative EGD Negative CT scan Negative colonoscopy Negative CT enterography

4. Case Report Capsule endoscopy performed…. See video Still images follow

9. Case # 2 Capsule endoscopy findings: Submucosal mass Ulceration on surface with central umbilication (arrow) Blanching of mucosa A subsequent CT scan of the abdomen/pelvis performed…

10. Computerized Tomography of Abdomen: Illustrating metastatic liver lesions.

11. Case Report Liver biopsy performed Stromal tumor on histology CD 117/c-kit positive

12. Case Report Diagnosis: Metastatic gastrointestinal stromal tumor (GIST) The patient started on imatinib Disease has been stable

13. Case Report Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal malignancy in the gastrointestinal tract Pathogenesis based on gain-of-function mutations in the c-kit proto-oncogene Tyrosine kinase inhibitor imatinib mesylate (Gleevac™) has had a major impact on treatment outcomes and survival for these patients with GIST

14. Case Report Capsule endoscopy identified the primary site in the gastrointestinal tract when other methods failed. Findings explained the gastrointestinal bleeding and intermittent bowel obstructions. Unfortunately, metastatic disease was already present by the time a diagnosis was made.

15. References Arch Pathol Lab Med. 2006 Oct;130(10):1466-78. World J Gastrointest Endosc. 2011 Feb 16;3(2):40-5. Eur J Cancer. 2002 Sep;38 Suppl 5:S39-51. J Natl Comp Canc Netw 2008;5(Suppl 2):S1-29.