title: Bleeding lesions within reach of conventional endoscopy in capsule endoscopy examinations for obscure gastrointestinal bleeding: is repeating endoscopy economically feasible?
abstract: BACKGROUND
  Most tertiary gastroenterology centers currently offer an open-access capsule endoscopy (CE) service, including patients with obscure gastrointestinal bleeding. However, CE may identify lesions missed by conventional endoscopy.
  
  
  OBJECTIVE
  To determine the incidence of bleeding lesions missed by the preceding gastroscopy/colonoscopy that were revealed by CE and compare potential differences in the rate of identifying such lesions in patients that we investigated as opposed to those investigated elsewhere.
  
  
  METHODS
  We prospectively reviewed data from patients subjected to CE for obscure bleeding. We analyzed all cases where a source of bleeding was located in the stomach, duodenum, or colon.
  
  
  RESULTS
  A total of 317 consecutive patients were subjected to CE for obscure gastrointestinal bleeding within 28 months. Prior to CE examination, 174 patients had gastroscopy and colonoscopy in our institutions and 143 were referrals, all with negative endoscopic investigation. We identified 11 (3.5%) cases where the source of bleeding was found in the stomach (n = 4) or the cecum (n = 7). There was a significant difference of extra small intestinal lesions diagnosed by CE between referrals (9/143, 6.3%) and endoscopic investigation performed in our institutions (2/174, 1.15%), (p = 0.026). The estimated cost of re-endoscoping in our institution all CE referrals would be 50,050 euro (143 patients × 350 euro), to avoid unnecessary CE examinations (9 patients × 600 euro = 5,400 euro).
  
  
  CONCLUSIONS
  Reading the whole CE video is important, because small-bowel CE may identify lesions responsible for obscure bleeding missed by the preceding gastroscopy and colonoscopy. Repeating conventional endoscopy by experts before CE is not a cost-effective approach.
authors.affiliation: Hepatogastroenterology Unit, First Department of Medicine, Propaedeutic, Medical School, Athens University, Laiko General Hospital, Athens, 17 Agiou Thoma Street, 11527 Athens, Greece. jvlachog@hotmail.com
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Kostis
authors.initials: K
authors.lastname: Papaxoinis
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kegioglou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Binas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karamanolis
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000191:economics*; D003113:Colonoscopy / Q000191:economics*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005773:Gastroscopy / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult