title: Follow-up of patients with obscure gastrointestinal bleeding after capsule endoscopy and intraoperative enteroscopy.
abstract: OBJECTIVE
  Capsule endoscopy (CE) is highly sensitive to detect the bleeding source in patients with obscure gastrointestinal bleeding compared with intraoperative enteroscopy (IOE). Long-term follow-up information of patients undergoing CE and IOE for investigation and treatment of chronic gastrointestinal bleeding is lacking.
  
  
  METHODS
  50 patients with obscure gastrointestinal bleeding underwent CE and IOE. Follow-up data of 47 patients (30 men, 17 women, mean age 60.9 +/- 16.8 years) were available (3 patients lost in follow-up). Clinical outcome was assessed with a standardized patient questionnaire and personal communication with referring physicians.
  
  
  RESULTS
  Bleeding sources were detected and effective treated during intraoperative enteroscopy (argon plasma coagulation or surgical resection) in 34 patients [(angiodysplasias (n = 22), ulcers (n = 5), malignant tumors (n = 3), Meckel's diverticulum (n = 1), jejunal varices (n = 1), bleeding ileum diverticulosis (n = 1), hyperplastic polyp (n = 1)]. Mean follow-up was 346.3 days (range 253-814 days). Clinical signs of recurrent gastrointestinal bleeding occurred in 12 of 47 patients (25.5%) [positive fecal occult blood test (n = 2), anemia (n = 2), melena (n = 3), hematochezia (= 5)]. In 3 patients (6.4%) no further therapy was necessary, 9 patients (19.1%) needed blood transfusions (range 2-62 units), endoscopic or surgical interventions to control rebleeding.
  
  
  CONCLUSIONS
  The results of the present study support the proposal that capsule endoscopy could be used as the first-choice investigation in patients with obscure gastrointestinal bleeding.
authors.affiliation: Department of Gastroenterology, Academic Teaching Hospital, Ludwigshafen, Germany. medcluhartmann@t-online.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Hartmann
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Dieter
authors.initials: D
authors.lastname: Schilling
authors.forename: Frank
authors.initials: F
authors.lastname: Kinze
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
authors.forename: Uwe
authors.initials: U
authors.lastname: Weickert
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schulz
authors.forename: Juergen F
authors.initials: JF
authors.lastname: Riemann
mesh_terms: D000368:Aged; D053704:Capsule Endoscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged