Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.
OBJECTIVE
Capsule endoscopy (CE) has been shown to have a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB). It is not known if repeating CE improves diagnostic yield or changes patient management when the initial CE is negative or nondiagnostic. The aims of this study are (1) to understand the reasons for repeat CE, (2) to determine the diagnostic yield of repeat CE, and (3) to establish if findings on repeat CE resulted in a change in patient management.


METHODS
Between August 2001 and October 2003, we performed 391 capsule studies. Of these, 24 were repeat studies in patients with OGIB. We retrospectively reviewed the charts of these 24 patients.


RESULTS
The reasons for repeat CE were: recurrent gastrointestinal bleeding (13), limited visualization on first exam due to poor prep or blood (10), complication (1) (capsule impaction at cricopharyngeus). Eighteen of 24 (75%) repeat capsule studies revealed additional findings (7 arteriovenous malformations, 2 gastropathy, 2 erosions, 2 masses, 1 ulcer, 2 red spots, 1 linear streak, 1 erythema). These findings led to changes in patient management in 15 of the 24 (62.5%) cases.


CONCLUSIONS
Indications for repeat CE most commonly include recurrent gastrointestinal bleeding and limited visualization on initial study. Repeat CE results in a high yield of new findings that lead to changes in patient management. Repeat CE should be considered in patients with persistent OGIB when the initial study is negative or inconclusive.
Jones
Bradford H
BH
Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA.
Fleischer
David E
DE
Sharma
Virender K
VK
Heigh
Russell I
RI
Shiff
Arthur D
AD
Hernandez
Jose L
JL
Leighton
Jonathan A
JA
D000368:Aged; D000369:Aged, 80 and over; D001165:Arteriovenous Malformations / Q000175:diagnosis; D020776:Endoscopes, Gastrointestinal / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004867:Equipment Design; D004890:Erythema / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis; D007421:Intestine, Small / Q000098:blood supply; D007580:Jejunal Neoplasms / Q000175:diagnosis; D007583:Jejunum / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D012008:Recurrence; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis; D014741:Video Recording