Using capsule endoscopy to identify GI tract lesions in cirrhotic patients with portal hypertension and chronic anemia.
OBJECTIVE
We aimed to evaluate the ability of capsule endoscopy (CE) to detect small intestine (SI) lesions, especially SI varices, in patients with intrahepatic cirrhosis, portal hypertension (PHTN), and chronic anemia.


BACKGROUND
Gastroesophageal variceal bleeding is a well-recognized complication of cirrhosis and PHTN, yet methods of identifying lesions in the SI that may contribute to covert bleeding and anemia, such as small bowel enteroscopy and angiography, are invasive and may be inadequate.


METHODS
In this observational pilot study, 19 consecutive patients presenting to a tertiary care, liver transplantation referral center with cirrhosis, PHTN, and chronic anemia after obliterative esophageal variceal therapy were evaluated with wireless CE using the GIVEN Pillcam SB M2A capsule. Two independent and blinded examiners reviewed the CE examinations.


RESULTS
SI varices were identified in 15.8% (3/19) of patients. Other PHTN-related findings included portal hypertensive gastropathy (13/19, 68.4%), portal hypertensive enteropathy (12/19, 63.1%), and portal hypertensive colopathy (3/19, 15.8%). Two patients had nonbleeding esophageal varices (2/19, 10.5%). A potential source of gastrointestinal blood loss was identified in 89.5% (17/19) of patients. Active bleeding sites were identified in 15.8% (3/19).


CONCLUSIONS
CE can identify potential bleeding sources and could have diagnostic utility in patients with end-stage liver disease and chronic anemia after obliterative esophageal variceal therapy.
Canlas
Karen R
KR
Division of Gastroenterology and Hepatology, Duke University Medical Center, Durham, NC 27705, USA.
Dobozi
Brian M
BM
Lin
Sauyu
S
Smith
Alastair D
AD
Rockey
Don C
DC
Muir
Andrew J
AJ
Agrawal
Naurang M
NM
Poleski
Martin H
MH
Patel
Keyur
K
McHutchison
John G
JG
D000328:Adult; D000740:Anemia / Q000150:complications / Q000473:pathology*; D053704:Capsule Endoscopy; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged