Is there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostic first test?

• Published in: Gastrointestinal endoscopy Vol. 69; no. 4; pp. 850 - 856
• Main Authors: Viazis, Nikos, MD, Papaxoinis, Kostis, MD, Vlachogiannakos, John, MD, Efthymiou, Alkiviadis, MD, Theodoropoulos, Ioannis, MD, Karamanolis, Dimitrios G., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.04.2009; Elsevier
• Subjects: Biological and medical sciences; Capsule Endoscopy - statistics & numerical data; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - diagnosis; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prospective Studies; Reproducibility of Results; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; nonsteroidal anti-inflammatory drugs; obscure GI bleeding; CE; double-balloon enteroscopy; OGIB; DBE; NSAIDs; capsule endoscopy; Human; Digestive diseases; Intestinal disease; Gastrointestinal bleeding; Capsule endoscopy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.05.053

Background Long-term follow-up data on patients with obscure GI bleeding subjected to capsule endoscopy (CE) are missing. Objective Our purpose was to follow up patients with a nondiagnostic test and determine whether a second-look CE would be beneficial. Patients We enrolled 293 subjects. CE studies were classified as diagnostic (positive findings) or nondiagnostic (findings of uncertain significance/no findings). Patients were followed up for a mean (SD) 24.8 (5.2) months. Outcome was defined as continued or complete resolution of bleeding. Interventions Patients with a nondiagnostic test were subjected to a repeat CE if they manifested a new bleeding episode or a drop in hemoglobin ≥2 g/dL. Results Positive findings, findings of uncertain significance, and no findings were identified in 41.6%, 16.0%, and 42.3% of our patients, respectively. Therapeutic intervention was possible in 72.1% of those with positive findings and in 30% of those with findings of uncertain significance. Complete resolution of bleeding occurred more often in patients with a diagnostic test (65.2%) compared with those with a nondiagnostic test (35.4%, P < .001). Second-look CE was performed in a subgroup of our patients (n = 76) and was diagnostic in those whose presentation changed from occult to overt or those whose hemoglobin dropped ≥4 g/dL. Conclusions In patients with obscure GI bleeding, a diagnostic CE leads to therapeutic interventions and a favorable outcome. Patients with a nondiagnostic test would definitely benefit from a second-look CE if the bleeding presentation changes from occult to overt or if the hemoglobin value drops ≥4 g/dL.