[Diagnostic utility and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding. Preliminary results].
BACKGROUND
Obscure gastrointestinal bleeding (OGIB) represents from 5 to 10% of all episodes of gastrointestinal bleeding. The diagnosis is difficult to make because in most cases it originates in the small bowel. Radiological methods have low sensitivity and push enteroscopy does not allow for examination of the whole length of the small bowel. Capsule endoscopy is a recently introduced method which allows for the complete examination of the small bowel. Only a few studies have assessed its clinical impact.


OBJECTIVE
To evaluate the diagnostic yield and the clinical impact of capsule endoscopy in patients with OGIB.


METHODS
28 patients were studied: 9 with iron deficiency anemia (32%), 14 with melena (50%) and 5 with melena and hematochezia (32%). They were 16 men and 12 women. Median values were: age 53 years (range 18-87), hemoglobin 7 g/dL (4-11), endoscopic and radiologic studies 4 (2-8), hospital admissions 3 (1-5) and transfused blood units 5 (0-52).


RESULTS
Capsule endoscopy detected bleeding and nonbleeding lesions in 23 patients (82%). The diagnoses were: angiodysplasia in 10 patients (36%); ulcers in 7 (25%) and neoplasm in 6 (21%). In 12 patients (43%) findings motivated the performance of other diagnostic or therapeutic procedures: 8 patients were operated on (6 with neoplasm and 2 with stenotic ulcers); 3 received endoscopic treatment for angiodysplasia and ulcers; and one patient was submitted to ileoscopy with biopsy for Crohn's disease. There were no complications and good tolerance was observed.


CONCLUSIONS
Capsule endoscopy had a diagnostic yield of 82% and a clinical impact of 43% in this highly selected group of patients with OGIB in whom no other endoscopic or radiologic procedures could lead to the diagnosis.
García-Compean
Diego
D
Centro Regional para el Estudio de Enfermedades Digestivas. Hospital Universitario "Dr. José E González". Universidad Autónoma de Nuevo León. Monterrey, N.L. (Mexico). digarcia@ccr.dsi.uanl.mx
Armenta
Jesús Arturo
JA
González
José Alberto
JA
Maldonado
Hector
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002214:Capsules; D003952:Diagnostic Imaging / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D002214:Capsules