title: Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy.
abstract: OBJECTIVE
  To compare the diagnostic capabilities between capsule endoscopy (CE) and multislice CT (MSCT) enterography in combination with MSCT angiography for assessment of obscure gastrointestinal bleeding (OGIB).
  
  
  METHODS
  A total of 127 patients with OGIB were looked at in this study. 82 patients (aged 42.7 ± 19.1 years; 34 males) were assigned to receive MSCT diagnosis and 67 patients to (aged 53.9 ± 16.2 years; 28 males) receive CE diagnosis. Among them, 22 patients (aged 54.1 ± 19.1 years; 12 males) received both examinations. Oral isotonic mannitol and intramuscular injection of anisodamine were performed; non-ionic contrast (iopromide, 370 mg I ml(-1)) was intravenously administered; and then multiphase scanning was conducted at arterial, small intestinal and portal venous phases in MSCT. The results were compared with findings of reference standards including double balloon enteroscopy, digital subtraction angiography, intraoperative pathological examination and/or clinical diagnosis.
  
  
  RESULTS
  Administration of anisodamine markedly increased the satisfaction rate of bowel filling (94.67% vs 28.57%; p < 0.001) but not the diagnostic yield (p = 0.293) of MSCT. Compared with MSCT, CE showed an improved overall diagnostic yield (68.66% vs 47.56%; p = 0.010), which was also observed in overt bleeding patients (i.e. patients with continued passage of visible blood) (76.19% vs 51.02%; p = 0.013) and in patients aged younger than 40 years of age (85% vs 51.28%; p = 0.024). However, CE had similar positive rates to MSCT (p > 0.05). Among the 22 cases in whom both examinations were conducted, CE showed no significantly different diagnostic capability compared with MSCT (p = 0.4597).
  
  
  CONCLUSIONS
  Both CE and MSCT are safe and effective diagnostic methods for OGIB.
  
  
  CONCLUSIONS
  CE is preferred for overt bleeding or patients aged younger than 40 years. The combined use of CE and MSCT is recommended in OGIB diagnosis.
authors.affiliation: 1 Department of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu, China.
authors.forename: B
authors.initials: B
authors.lastname: He
authors.forename: S
authors.initials: S
authors.lastname: Gong
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.forename: J
authors.initials: J
authors.lastname: Fan
authors.forename: J
authors.initials: J
authors.lastname: Qian
authors.forename: S
authors.initials: S
authors.lastname: Huang
authors.forename: L
authors.initials: L
authors.lastname: Cui
authors.forename: Y
authors.initials: Y
authors.lastname: Ji
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods* / Q000451:nursing*; D053704:Capsule Endoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies