title: Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  Capsule endoscopy (CE) is superior to push enteroscopy and small bowel barium radiography in detecting the source of obscure GI bleeding. We now compared whether CE has a superior diagnostic yield than CT angiography (CTA) or standard mesenteric angiography (ANGIO) in patients with obscure GI bleeding.
  
  
  METHODS
  From June 2004 to October 2005, consecutive patients admitted for OGIB underwent both CTA and ANGIO, followed by CE, performed blindly by independent examiners within the next 7 days. The primary end point of the study was the diagnostic yield for each technique, defined as the frequency of detection of lesions with a high probability of bleeding.
  
  
  RESULTS
  Twenty-eight patients (16 men and 12 women, mean age 74 +/- 2 yr) with OGIB (overt bleeding in 20 cases and chronic occult in 8) were prospectively evaluated. CTA or standard angiography could be performed in 25 of 28 patients (applicability 86%), because of contrast allergy (1 patient) and chronic renal failure (2 patients). A source of bleeding was detected by CE in a greater proportion of patients, 72% (18 of 25, 95% CI 50.6-87.9%), than CTA, 24% (6 of 25, 95% CI 9.4-45.1%, P= 0.005 vs CE), or ANGIO, 56% (14 of 25, 95% CI 34.9-75.6%, P= NS). Similarly, CE was able to diagnose 100% of patients diagnosed by CTA and 86% of patients diagnosed by ANGIO. Moreover, CE was positive in 12 of 19 (63%) negative cases on CTA and in 6 of 11 (55%) negative cases on ANGIO. As a result of the CE findings, therapeutic intervention was undertaken in 9 of 19 (47%) patients with positive results.
  
  
  CONCLUSIONS
  CE detects more lesions than CTA or standard mesenteric angiography in patients with obscure GI bleeding and has a therapeutic impact in almost half of the patients with positive findings.
authors.affiliation: Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Saperas
authors.forename: Joan
authors.initials: J
authors.lastname: Dot
authors.forename: Sebastian
authors.initials: S
authors.lastname: Videla
authors.forename: Agustí
authors.initials: A
authors.lastname: Alvarez-Castells
authors.forename: Mercedes
authors.initials: M
authors.lastname: Perez-Lafuente
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: Armengol
authors.forename: Juan-R
authors.initials: JR
authors.lastname: Malagelada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D053704:Capsule Endoscopy; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed