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Wireless capsule endoscopy for obscure gastrointestinal bleeding: a single-centre, one-year experience
Shou-jiang Tang1, Dimitrios Christodoulou, Simon Zanati
1Center for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, University of Toronto, Toronto, Ontario M5B 1W8, Canada.
Insights
Wireless capsule endoscopy (CE) aids obscure gastrointestinal bleeding diagnosis. However, consider conventional endoscopy first, especially with local expertise, as some CE-identified lesions are reachable by standard procedures.
Area of Science:
- Gastroenterology
- Medical Imaging
- Diagnostic Endoscopy
Background:
- Capsule endoscopy (CE) is a common tool for investigating obscure gastrointestinal (GI) bleeding.
- Some studies indicate that many lesions found by CE are accessible via conventional endoscopic methods.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical utility of CE in patients with obscure GI bleeding.
- To determine the proportion of CE-diagnosed lesions that could have been treated with conventional endoscopy.
Main Methods:
- Retrospective review of capsule endoscopy (CE) results over a 12-month period for obscure GI bleeding.
- Analysis of patient data to identify the location and accessibility of diagnosed bleeding lesions.
Main Results:
- CE identified a definite, probable, or possible cause of bleeding in 63% of 46 patients with obscure GI bleeding.
- One to four lesions per patient were found to be within reach of conventional gastroscopy, push enteroscopy, colonoscopy, or retrograde enteroscopy.
- The rate of missed accessible lesions was higher when initial endoscopy was performed in the community compared to the authors' center.
Conclusions:
- Capsule endoscopy (CE) is valuable for diagnosing bleeding sources in the small bowel, stomach, and colon.
- "Second-look" endoscopy should be considered before CE for obscure GI bleeding, particularly when local expertise is available.
- CE's effectiveness is enhanced when integrated with appropriate pre-procedural endoscopic evaluations.
Background:
Wireless capsule endoscopy (CE) is increasingly being used in the investigation of obscure gastrointestinal (GI) bleeding, but some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy.
Methods:
The results of CE performed in the authors' centre in a 12 month period for obscure GI bleeding were retrospectively reviewed.
Results:
Of the 46 patients with obscure GI bleeding, CE found a definite or probable cause in 19 (41%) and a possible cause in another 10 (22%), with an overall diagnostic yield of 63%. One of these lesions was found to be within reach of conventional gastroscopy, two were within reach of push enteroscopy, four were within reach of colonoscopy and one was within reach of retrograde enteroscopy through a stoma. The percentage of patients with a bleeding source within reach of routine endoscopy but missed during pre-CE endoscopy was significantly higher for those patients having endoscopy only in the community (30% [eight of 27]) versus in the authors' centre (0% [zero of 19]).
Conclusions:
CE was valuable for diagnosing bleeding lesions not only within the small bowel, but also in the stomach and colon. However, "second-look" endoscopy may be considered before ordering CE for obscure GI bleeding when local expertise is available.
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