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Diagnostic yield of capsule endoscopy in obscure gastrointestinal bleeding
1Department of Gastroenterology, Hillel-Yaffe Medical Center, Hadera, Israel. fireman@hillel-yaffe.health.gov.il
Insights
Capsule endoscopy is effective for diagnosing obscure gastrointestinal bleeding, a common cause of iron-deficiency anemia. This method identified the bleeding source in 72% of patients when other tests failed.
Area of Science:
- Gastroenterology
- Medical Devices
- Diagnostic Imaging
Background:
- Chronic occult gastrointestinal bleeding is a significant cause of iron-deficiency anemia.
- Conventional diagnostic methods fail to identify bleeding sources in about 10% of patients.
- Persistent or recurrent iron-deficiency anemia necessitates advanced diagnostic approaches.
Purpose of the Study:
- To evaluate the diagnostic yield of capsule endoscopy in patients with persistent or recurrent iron-deficiency anemia.
- To assess the effectiveness of capsule endoscopy in identifying obscure gastrointestinal bleeding sources.
- To compare the diagnostic capabilities of capsule endoscopy with conventional investigations.
Main Methods:
- A large cohort study involving 293 patients with obscure gastrointestinal bleeding.
- Patients underwent capsule endoscopy using a miniature video camera capsule.
- Data transmission and interpretation were performed the day after capsule ingestion.
Main Results:
- Capsule endoscopy detected definitive findings in 72% (213/293) of patients.
- It identified bleeding sources missed by other diagnostic procedures in 8% (22/293) of patients.
- Diagnoses remained elusive in 20% (58/293) of patients despite capsule endoscopy.
Conclusions:
- Capsule endoscopy demonstrates a high diagnostic yield for evaluating obscure gastrointestinal bleeding.
- It is a valuable tool for patients with unexplained iron-deficiency anemia due to gastrointestinal blood loss.
- The procedure offers significant advantages over conventional diagnostic methods in specific patient populations.
Objectives:
Chronic occult blood loss from the gastrointestinal tract is a recognized major cause of iron-deficiency anemia. After conventional investigation of the upper and lower parts of the gastrointestinal tract, the source of bleeding remains unidentified in approximately 10% of these patients. We evaluated the diagnostic yield of capsule endoscopy from patients enrolled in clinical studies due to persistent or recurrent iron-deficiency anemia.
Methods:
In this large cohort study, patients with obscure gastrointestinal bleeding were identified in a company-sponsored clinical study (Given Imaging, Ltd.) database which contains data from >50 clinical studies. Information on suitable patients was derived from 31 of them. Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter and an antenna. Recording time was approximately 8 h. The capsule was excreted naturally in the patient's bowel movement, and the data it transmitted were retrieved and interpreted the next day.
Results:
293 patients were studied (135 males, 46.1%, mean age 59.4 +/- 16.8 years) whose mean number of bleeding episodes was 4.3 +/- 5.5 and mean hemoglobin level was 9.8 +/- 2.4 g/dl. The average number of diagnostic procedures per patient prior to the capsule endoscopy study was 5.59. Capsule endoscopy detected definitive findings in 213/293 patients (72%) and findings missed by other diagnostic procedures in 22/293 patients (8%). Neither capsule endoscopy nor the other diagnostic procedures yielded diagnoses in 58/293 patients (20%).
Conclusions:
Capsule endoscopy has a high diagnostic yield in evaluating patients with obscure gastrointestinal bleeding.
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