title: Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding?
abstract: OBJECTIVE
  The position of capsule endoscopy (CE) relative to push enteroscopy (PE) in the diagnostic algorithm of obscure gastrointestinal bleeding is unclear, as previous studies involved the use of both techniques in all patients. We therefore conducted a trial in which patients were randomized to undergo one or other exploration.
  
  
  METHODS
  All consecutive patients referred for obscure gastrointestinal bleeding were randomized between CE and PE as the first-line exploration. The alternative method was only used if the first-line method revealed no definite bleeding source, or if required for clinical reasons during follow-up.
  
  
  RESULTS
  CE and PE, used as the first-line exploration, identified a bleeding source in 20 of 40 patients and 9 of 38 patients, respectively (50% vs 24%; P = .02). CE missed lesions in 8% of patients, and all these lesions were located in sites accessible to standard endoscopy. PE missed lesions in 26% of patients. At the end of the 12-month follow-up period, the strategy based on CE as first-line exploration followed by PE if necessary only was similar to PE followed by CE in terms of diagnostic yield, clinical outcome, and therapeutic impact, but reduced the percentage of patients needing the alternative exploration (25% vs 79%; P < .001).
  
  
  CONCLUSIONS
  CE has a higher diagnostic yield than PE in obscure gastrointestinal bleeding, and a strategy based on CE as first-line exploration avoids unnecessary explorations.
authors.affiliation: Department of Gastroenterology, Hôpital Européen Georges Pompidou and Paris 5 University, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: de Leusse
authors.forename: Kouroche
authors.initials: K
authors.lastname: Vahedi
authors.forename: Joël
authors.initials: J
authors.lastname: Edery
authors.forename: Djamel
authors.initials: D
authors.lastname: Tiah
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fery-Lemonnier
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Raymond
authors.initials: R
authors.lastname: Jian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D053704:Capsule Endoscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors