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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.
Summary
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.