Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding.
BACKGROUND
The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated.


OBJECTIVE
To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB.


METHODS
A single-center prospective study.


METHODS
During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding.


RESULTS
CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%).


CONCLUSIONS
This study had a limited number of patients.


CONCLUSIONS
CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management.
Apostolopoulos
Periklis
P
Department of Gastroenterology, Army Share Fund (NIMTS) Hospital, Athens, Greece.
Liatsos
Christos
C
Gralnek
Ian M
IM
Kalantzis
Chrissostomos
C
Giannakoulopoulou
Eleftheria
E
Alexandrakis
Georgios
G
Tsibouris
Panagiotis
P
Kalafatis
Evagelos
E
Kalantzis
Nikolaos
N
D000328:Adult; D000368:Aged; D053705:Capsule Endoscopes / Q000639:trends*; D002214:Capsules; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014741:Video Recording / Q000295:instrumentation*
D002214:Capsules