title: Comparison of urgent video capsule endoscopy and urgent double-balloon endoscopy in massive obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  Urgent video capsule endoscopy (VCE) and urgent double-balloon endoscopy (DBE) provide high diagnostic yields in overt obscure gastrointestinal bleeding (OGIB). However, no studies have specifically compared VCE and DBE in massive OGIB. The aim of this study was to compare the diagnostic yield and clinical outcomes of the two approaches.
  
  
  METHODS
  Between October 2010 and March 2013, there were 1,672 consecutive patients with gastrointestinal bleeding and 30 massive OGIB were identified. After non-diagnostic EGD and colonoscopy, VCE and DBE were performed in tandem within 72hr after hospitalization.
  
  
  RESULTS
  Of these, 30 patients were identified as massive OGIB. DBE identified more bleeding lesions than VCE (26(87%) vs. 18(60%), p<0.05). Only DBE was positive in 8 patients (27%). No patient had positive VCE and negative DBE. VCE demonstrated only fresh blood without identifiable lesions in 8 (27%) patients, and all had bleeding lesions identified subsequently by DBE. The number of patients with therapeutic intervention guided by DBE was higher than those with VCE-guided intervention (17(57%) vs. 11(37%); p<0.05). Four patients (13%) had a negative study by both tests, and no further bleeding was reported.
  
  
  CONCLUSIONS
  In massive OGIB, urgent DBE had a higher diagnostic yield than VCE. (ClinicalTrials.gov number, NCT01654770)
authors.forename: Satimai
authors.initials: S
authors.lastname: Aniwan
authors.forename: Vichai
authors.initials: V
authors.lastname: Viriyautsahakul
authors.forename: Phonthep
authors.initials: P
authors.lastname: Angsuwatcharakon
authors.forename: Pradermchai
authors.initials: P
authors.lastname: Kongkam
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.forename: Pinit
authors.initials: P
authors.lastname: Kullavanijaya
mesh_terms: D053704:Capsule Endoscopy; D058582:Double-Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006489:Hemostatic Techniques; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013785:Thailand; D013997:Time Factors