Diagnostic yield of capsule endoscopy in obscure gastrointestinal bleeding.
OBJECTIVE
Chronic occult blood loss from the gastrointestinal tract is a recognized major cause of iron-deficiency anemia. After conventional investigation of the upper and lower parts of the gastrointestinal tract, the source of bleeding remains unidentified in approximately 10% of these patients. We evaluated the diagnostic yield of capsule endoscopy from patients enrolled in clinical studies due to persistent or recurrent iron-deficiency anemia.


METHODS
In this large cohort study, patients with obscure gastrointestinal bleeding were identified in a company-sponsored clinical study (Given Imaging, Ltd.) database which contains data from >50 clinical studies. Information on suitable patients was derived from 31 of them. Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter and an antenna. Recording time was approximately 8 h. The capsule was excreted naturally in the patient's bowel movement, and the data it transmitted were retrieved and interpreted the next day.


RESULTS
293 patients were studied (135 males, 46.1%, mean age 59.4 +/- 16.8 years) whose mean number of bleeding episodes was 4.3 +/- 5.5 and mean hemoglobin level was 9.8 +/- 2.4 g/dl. The average number of diagnostic procedures per patient prior to the capsule endoscopy study was 5.59. Capsule endoscopy detected definitive findings in 213/293 patients (72%) and findings missed by other diagnostic procedures in 22/293 patients (8%). Neither capsule endoscopy nor the other diagnostic procedures yielded diagnoses in 58/293 patients (20%).


CONCLUSIONS
Capsule endoscopy has a high diagnostic yield in evaluating patients with obscure gastrointestinal bleeding.
Fireman
Zvi
Z
Department of Gastroenterology, Hillel-Yaffe Medical Center, Hadera, Israel. fireman@hillel-yaffe.health.gov.il
Friedman
Shosh
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D002214:Capsules; D002648:Child; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged
D002214:Capsules