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Impact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients
Jörg G Albert1, Romy Schülbe, Leonore Hahn
1First Department of Medicine, Martin-Luther-University Hospitals and Clinics, Halle, Saale, Germany. joerg.albert@medizin.uni-halle.de
Insights
Capsule endoscopy (CE) aids in diagnosing small intestinal bleeding, guiding treatment, and predicting rebleeding risk. Complete cauterization of angiectasias significantly lowers relapse rates, improving patient outcomes.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Endoscopic Imaging
Background:
- Capsule endoscopy (CE) is effective for detecting small bowel bleeding sources.
- The long-term impact of CE on patient outcomes remains unclear.
Purpose of the Study:
- To evaluate the influence of capsule endoscopy on the long-term outcomes of patients with small intestinal bleeding.
- To identify risk factors for rebleeding and assess the effectiveness of therapeutic interventions.
Main Methods:
- Retrospective analysis of capsule endoscopy (CE) investigations from five tertiary hospitals over three years.
- Inclusion of patients with intestinal bleeding and negative bidirectional endoscopy.
- Recording of bleeding relapses and hospital readmissions during follow-up.
Main Results:
- CE detected a bleeding source in 76.8% of patients.
- Rebleeding occurred in 27.1% of patients, with angiectasias being a significant risk factor (RR=5.0).
- Complete cauterization of angiectasias reduced relapse rates from 85.7% to 11.8%.
Conclusions:
- Capsule endoscopy (CE) effectively guides therapeutic decisions and predicts rebleeding risk in small intestinal bleeding.
- Aggressive cauterization of all identified angiectasias is crucial for minimizing rebleeding.
- CE plays a vital role in managing long-term outcomes for patients with obscure gastrointestinal bleeding.
Background:
Capsule endoscopy (CE) sensitively detects the bleeding source in the small bowel. However, the influence of CE on long-term outcome is not well established.
Methods:
In five tertiary hospitals, all CE investigations were retrospectively identified dating back to 3 years. Patients with intestinal bleeding and negative bidirectional endoscopy were included, and relapse of bleeding was recorded.
Results:
A bleeding source was detected in 219 of 285 patients (76.8%); CE provided the diagnosis in 175 of 219 (79.9%) and other, repeated investigations in 44 cases (20.1%). Follow-up (mean+/-SD=20.7+/-9.4 months) in 240 patients identified rebleeding in 65 (27.1%), and readmission to a hospital in 42 (17.5%). Hospital readmission was most frequent in patients with angiectasias (31.3%, relative risk (RR)=5.0; 95% confidence interval (CI)=2.4-10.4). Other risk factors included patients being older than 60 years of age (RR=3.8; 95% CI=1.5-9.5), and anticoagulant medication (RR=3.0; 95% CI=1.5-6.0). Therapeutic measures had a mean recurrence rate of 3.7% in surgical candidates (Meckel's diverticulum, tumor), 40% in endoscopically treated and 16% in medically treated patients. In case all the detected angiectasias had been cauterized, the relapse rate was low (11.8%), but in incompletely treated patients, it was high (85.7%). Bleeding relapse was never lethal.
Conclusion:
CE guides therapeutic measures and predicts the risk of recurrent bleeding in small intestinal bleeding. High risk of rebleeding in angiectasias is significantly reduced by the cauterization of all demonstrable lesions.
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