title: A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding.
abstract: BACKGROUND
  Capsule endoscopy enables noninvasive diagnostic examination of the entire small intestine. However, sensitivity and specificity of capsule endoscopy have not been adequately defined. We, therefore, compared capsule endoscopy by using intraoperative enteroscopy as a criterion standard in patients with obscure GI bleeding.
  
  
  METHODS
  Forty-seven consecutive patients with obscure GI bleeding (11 with ongoing overt bleeding, 24 with previous overt bleeding, and 12 with obscure-occult bleeding) from two German gastroenterologic centers were included. All patients who had a prior nondiagnostic evaluation, including upper endoscopy, colonoscopy with a retrograde examination of the distal ileum, and push enteroscopy, underwent capsule endoscopy followed by intraoperative enteroscopy.
  
  
  RESULTS
  Capsule endoscopy identified lesions in 100% of the patients with ongoing overt bleeding, 67% of the patients with previous overt bleeding, and 67% of the patients with obscure-occult bleeding. Angiectasias were the most common source of bleeding (n = 22). Capsule endoscopy showed the source of bleeding in 74.4% of all patients. The method was more effective in patients with ongoing bleeding. Compared with intraoperative enteroscopy sensitivity, specificity, and positive and negative predictive values of capsule endoscopy were 95%, 75%, 95%, and 86%, respectively.
  
  
  CONCLUSIONS
  Capsule endoscopy has high sensitivity and specificity to detect a bleeding source in patients with obscure GI bleeding. Thus, wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure GI bleeding.
authors.affiliation: Department of Gastroenterology, Academic Teaching Hospital, Ludwigshafen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hartmann
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Georg
authors.initials: G
authors.lastname: Bolz
authors.forename: Dieter
authors.initials: D
authors.lastname: Schilling
authors.forename: Frank
authors.initials: F
authors.lastname: Kinzel
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
authors.forename: Winfried
authors.initials: W
authors.lastname: Huschner
authors.forename: Kathleen
authors.initials: K
authors.lastname: Möller
authors.forename: Ralf
authors.initials: R
authors.lastname: Jakobs
authors.forename: Peter
authors.initials: P
authors.lastname: Reitzig
authors.forename: Uwe
authors.initials: U
authors.lastname: Weickert
authors.forename: Klaus
authors.initials: K
authors.lastname: Gellert
authors.forename: Harald
authors.initials: H
authors.lastname: Schultz
authors.forename: Klaus
authors.initials: K
authors.lastname: Guenther
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hollerbuhl
authors.forename: Klaus
authors.initials: K
authors.lastname: Schoenleben
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schulz
authors.forename: Juergen F
authors.initials: JF
authors.lastname: Riemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008551:Melena / Q000175:diagnosis; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015642:Radiology, Interventional; D012680:Sensitivity and Specificity; D013684:Telangiectasis / Q000175:diagnosis