Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding

• Published in: Gastrointestinal endoscopy Vol. 66; no. 6; pp. 1174 - 1181
• Main Authors: Apostolopoulos, Periklis, MD, Liatsos, Christos, MD, Gralnek, Ian M., MD, MSHS, Kalantzis, Chrissostomos, MD, Giannakoulopoulou, Eleftheria, MD, Alexandrakis, Georgios, MD, Tsibouris, Panagiotis, MD, Kalafatis, Evagelos, MD, Kalantzis, Nikolaos, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2007; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Capsule Endoscopes - trends; Capsules; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - pathology; Gastrointestinal Hemorrhage - therapy; Humans; Intestinal Diseases - diagnosis; Intestinal Diseases - pathology; Intestinal Diseases - therapy; Intestine, Small - pathology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Video Recording - instrumentation; arteriovenous malformation; GIB; CE; DBE; NSAID; capsule endoscopy; obscure GI bleeding; double-balloon enteroscopy; APC; OGIB; argon plasma coagulation; AVM; GI bleeding; nonsteroidal anti-inflammatory drug; Human; Angiodysplasia; Gastrointestinal bleeding; Capsule endoscopy; Digestive diseases; Intestinal disease; Tumor; Ulcer; Diagnosis
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.06.058

Background The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated. Objective To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB. Design A single-center prospective study. Patients During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding. Results CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%). Limitations This study had a limited number of patients. Conclusions CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management.