title: Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: a prospective randomized study with long-term follow-up.
abstract: OBJECTIVE
  Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram.
  
  
  METHODS
  Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality.
  
  
  RESULTS
  A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P = 0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P = 0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality.
  
  
  CONCLUSIONS
  In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.
authors: Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China. waikleung@hku.hk
authors: Wai K
authors: WK
authors: Leung
authors: Simon S M
authors: SS
authors: Ho
authors: Bing-Yee
authors: BY
authors: Suen
authors: Larry H
authors: LH
authors: Lai
authors: Simon
authors: S
authors: Yu
authors: Enders K W
authors: EK
authors: Ng
authors: Simon S M
authors: SS
authors: Ng
authors: Philip W Y
authors: PW
authors: Chiu
authors: Joseph J Y
authors: JJ
authors: Sung
authors: Francis K L
authors: FK
authors: Chan
authors: James Y W
authors: JY
authors: Lau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D053704:Capsule Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008551:Melena / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008875:Middle Aged