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Published on: July 21, 2023
Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal
Esteve Saperas1, Joan Dot, Sebastian Videla
1Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
Insights
Capsule endoscopy (CE) significantly improves the detection of obscure gastrointestinal bleeding sources compared to CT angiography and standard angiography. This advanced imaging technique impacts therapeutic decisions in nearly half of positive cases.
Area of Science:
- Gastroenterology
- Medical Imaging
- Diagnostic Endoscopy
Background:
- Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge.
- Capsule endoscopy (CE) is recognized for its efficacy in visualizing the small bowel.
- Previous studies indicate CE's superiority over push enteroscopy and barium radiography for OGIB.
Purpose of the Study:
- To compare the diagnostic yield of capsule endoscopy (CE) against CT angiography (CTA) and standard mesenteric angiography (ANGIO) for obscure GI bleeding.
- To evaluate the therapeutic impact of findings from CE in patients with OGIB.
Main Methods:
- Prospective study of 28 patients with OGIB from June 2004 to October 2005.
- Patients underwent both CTA and ANGIO, followed by CE within 7 days, performed by independent examiners.
- Diagnostic yield was defined as the detection rate of lesions with a high probability of bleeding.
Main Results:
- CE detected bleeding sources in 72% of patients, significantly higher than CTA (24%) and ANGIO (56%).
- CE identified lesions in all cases diagnosed by CTA and 86% of ANGIO cases.
- Therapeutic intervention was initiated in 47% of patients based on CE findings.
Conclusions:
- Capsule endoscopy demonstrates a superior diagnostic yield for obscure GI bleeding compared to CTA and ANGIO.
- CE findings directly influenced therapeutic management in a substantial proportion of patients.
- CE is a valuable tool for diagnosing and guiding treatment in obscure GI bleeding.
Background And Aims:
Capsule endoscopy (CE) is superior to push enteroscopy and small bowel barium radiography in detecting the source of obscure GI bleeding. We now compared whether CE has a superior diagnostic yield than CT angiography (CTA) or standard mesenteric angiography (ANGIO) in patients with obscure GI bleeding.
Methods:
From June 2004 to October 2005, consecutive patients admitted for OGIB underwent both CTA and ANGIO, followed by CE, performed blindly by independent examiners within the next 7 days. The primary end point of the study was the diagnostic yield for each technique, defined as the frequency of detection of lesions with a high probability of bleeding.
Results:
Twenty-eight patients (16 men and 12 women, mean age 74 +/- 2 yr) with OGIB (overt bleeding in 20 cases and chronic occult in 8) were prospectively evaluated. CTA or standard angiography could be performed in 25 of 28 patients (applicability 86%), because of contrast allergy (1 patient) and chronic renal failure (2 patients). A source of bleeding was detected by CE in a greater proportion of patients, 72% (18 of 25, 95% CI 50.6-87.9%), than CTA, 24% (6 of 25, 95% CI 9.4-45.1%, P= 0.005 vs CE), or ANGIO, 56% (14 of 25, 95% CI 34.9-75.6%, P= NS). Similarly, CE was able to diagnose 100% of patients diagnosed by CTA and 86% of patients diagnosed by ANGIO. Moreover, CE was positive in 12 of 19 (63%) negative cases on CTA and in 6 of 11 (55%) negative cases on ANGIO. As a result of the CE findings, therapeutic intervention was undertaken in 9 of 19 (47%) patients with positive results.
Conclusion:
CE detects more lesions than CTA or standard mesenteric angiography in patients with obscure GI bleeding and has a therapeutic impact in almost half of the patients with positive findings.
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