title: Obscure recurrent gastrointestinal bleeding: a revealed mystery?
abstract: OBJECTIVE
  Nowadays, capsule endoscopy (CE) is the first-line procedure after negative upper and lower gastrointestinal (GI) endoscopy for obscure gastrointestinal bleeding (OGIB). Approximately, two-thirds of patients undergoing CE for OGIB will have a small-bowel abnormality. However, several patients who underwent CE for OGIB had the source of their blood loss in the stomach or in the colon. The aim of the present study is to determine the incidence of bleeding lesions missed by the previous gastroscopy/colonoscopy with CE and to evaluate the indication to repeat a new complete endoscopic workup in subjects related to a tertiary center for obscure bleeding before CE.
  
  
  METHODS
  We prospectively reviewed data from 637/1008 patients underwent to CE for obscure bleeding in our tertiary center after performing negative gastroscopy and colonoscopy.
  
  
  RESULTS
  CE revealed a definite or likely cause of bleeding in stomach in 138/637 patients (yield 21.7%) and in the colon in 41 patients (yield 6.4%) with a previous negative gastroscopy and colonoscopy, respectively. The lesions found were outside the small bowel in only 54/637 (8.5%) patients. In 111/138 patients, CE found lesions both in stomach and small bowel (small-bowel erosions in 54, AVMs in 45, active small-bowel bleeding in 4, neoplastic lesions in 3 and distal ileum AVMs in 5 patients). In 24/41 (58.5%) patients, CE found lesions both in small bowel and colon (multiple small-bowel erosions in 15; AVMs in 8 and neoplastic lesion in 1 patients. All patients underwent endoscopic therapy or surgery for their nonsmall-bowel lesions.
  
  
  CONCLUSIONS
  Lesions in upper or lower GI tract have been missed in about 28% of patients submitted to CE for obscure bleeding. CE may play an important role in identifying lesions missed at conventional endoscopy.
authors.affiliation: Digestive Endoscopy Unit, Catholic University of Rome , Rome , Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Riccioni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Urgesi
authors.forename: Rossella
authors.initials: R
authors.lastname: Cianci
authors.forename: Clelia
authors.initials: C
authors.lastname: Marmo
authors.forename: Domenico
authors.initials: D
authors.lastname: Galasso
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods; D003106:Colon / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007421:Intestine, Small / Q000473:pathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology
keywords: capsule endoscopy; colonoscopy; gastroscopy; obscure gastrointestinal bleeding