[Evaluation of diagnostic yield and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding].
OBJECTIVE
The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding.


METHODS
During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months.


RESULTS
A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding.


CONCLUSIONS
Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.
Kovács
Márta
M
Vaszary Kolos Kórház, II. Belgyógyászati Osztály, Esztergom. drmarta.kovacs@axelero.hu
Németh
Artur
A
Pák
Péter
P
Uhlyarik
Andrea
A
Pák
Gábor
G
Rácz
István
I
D016888:Angiodysplasia / Q000175:diagnosis; D003251:Constriction, Pathologic / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006373:Helminthiasis / Q000175:diagnosis; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D007414:Intestinal Neoplasms / Q000175:diagnosis; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014743:Videotape Recording