Impact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients.
BACKGROUND
Capsule endoscopy (CE) sensitively detects the bleeding source in the small bowel. However, the influence of CE on long-term outcome is not well established.


METHODS
In five tertiary hospitals, all CE investigations were retrospectively identified dating back to 3 years. Patients with intestinal bleeding and negative bidirectional endoscopy were included, and relapse of bleeding was recorded.


RESULTS
A bleeding source was detected in 219 of 285 patients (76.8%); CE provided the diagnosis in 175 of 219 (79.9%) and other, repeated investigations in 44 cases (20.1%). Follow-up (mean+/-SD=20.7+/-9.4 months) in 240 patients identified rebleeding in 65 (27.1%), and readmission to a hospital in 42 (17.5%). Hospital readmission was most frequent in patients with angiectasias (31.3%, relative risk (RR)=5.0; 95% confidence interval (CI)=2.4-10.4). Other risk factors included patients being older than 60 years of age (RR=3.8; 95% CI=1.5-9.5), and anticoagulant medication (RR=3.0; 95% CI=1.5-6.0). Therapeutic measures had a mean recurrence rate of 3.7% in surgical candidates (Meckel's diverticulum, tumor), 40% in endoscopically treated and 16% in medically treated patients. In case all the detected angiectasias had been cauterized, the relapse rate was low (11.8%), but in incompletely treated patients, it was high (85.7%). Bleeding relapse was never lethal.


CONCLUSIONS
CE guides therapeutic measures and predicts the risk of recurrent bleeding in small intestinal bleeding. High risk of rebleeding in angiectasias is significantly reduced by the cauterization of all demonstrable lesions.
Albert
Jörg G
JG
First Department of Medicine, Martin-Luther-University Hospitals and Clinics, Halle, Saale, Germany. joerg.albert@medizin.uni-halle.de
Schülbe
Romy
R
Hahn
Leonore
L
Heinig
Detlef
D
Schoppmeyer
Konrad
K
Porst
Heiner
H
Lorenz
Reinhard
R
Plauth
Mathias
M
Dollinger
Matthias M
MM
Mössner
Joachim
J
Caca
Karel
K
Fleig
Wolfgang E
WE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D053705:Capsule Endoscopes / Q000009:adverse effects; D053704:Capsule Endoscopy / Q000009:adverse effects; D002648:Child; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000473:pathology*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010359:Patient Readmission; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013276:Stomach Ulcer / Q000473:pathology; D016896:Treatment Outcome
D000925:Anticoagulants