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Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding
Taya Kitiyakara1, Warwick Selby
1Wycombe General Hospital, High Wycombe, Bucks, UK.
Insights
Capsule endoscopy can detect gastrointestinal bleeding sources in the stomach or colon, not just the small intestine. These findings, often missed by conventional methods, can lead to successful endoscopic or surgical treatment.
Area of Science:
- Gastroenterology
- Endoscopy
- Diagnostic Imaging
Background:
- Capsule endoscopy typically identifies small intestine abnormalities in two-thirds of obscure GI bleeding cases.
- This study highlights 9 patients with obscure bleeding whose source was found in the stomach or colon via capsule endoscopy.
Purpose of the Study:
- To report on the utility of capsule endoscopy in identifying non-small bowel sources of obscure gastrointestinal bleeding.
- To describe the specific lesions found in the stomach and colon.
Main Methods:
- Prospective database review of 140 consecutive patients undergoing capsule endoscopy for obscure GI bleeding.
- Identification of patients with bleeding sources within reach of conventional endoscopy or colonoscopy.
Main Results:
- Nine patients had non-small bowel bleeding sources identified: gastric antral vascular ectasia (3), pyloric canal polyp (1), cecal carcinoma (2), cecal angiodysplasia (2), and cecal inflammation (1).
- Two cecal carcinomas were missed during prior colonoscopies.
- The suspected blood indicator feature aided lesion identification.
Conclusions:
- Capsule endoscopy can identify treatable lesions in the stomach and colon, similar to push enteroscopy.
- These findings suggest capsule endoscopy is valuable for obscure GI bleeding, even when lesions are outside the small intestine.
- The reasons for conventional endoscopy missing these lesions require further investigation.
Background:
Approximately two thirds of patients undergoing capsule endoscopy for obscure GI bleeding will have an abnormality found in the small intestine. This report describes 9 patients (4 men, 5 women) of 140 with obscure bleeding in whom a source of their blood loss was found in the stomach or the colon at capsule endoscopy.
Methods:
A review was made of a prospective database of 140 consecutive patients undergoing capsule endoscopy for obscure GI bleeding at a single center. Patients with a definite or likely cause of bleeding within reach of conventional upper or lower GI endoscopy were identified.
Results:
Three patients had gastric antral vascular ectasia and another an inflamed pyloric canal polyp. Two patients had actively bleeding cecal carcinoma, missed at previous colonoscopies. Two others had bleeding cecal angiodysplasia. The final patient had severe nonspecific cecal inflammation. The identification of these lesions was aided by the suspected blood indicator. All patients underwent endoscopic therapy or surgery for their non-small-bowel lesions.
Conclusions:
Like push enteroscopy, capsule endoscopy also can identify lesions within reach of conventional endoscopy and colonoscopy. These subsequently can be treated successfully. The reasons why these lesions have been missed are unclear.
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