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Is there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostic first
Nikos Viazis1, Kostis Papaxoinis, John Vlachogiannakos
1Second Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. Nikos.Viazis@gmail.com
Insights
A diagnostic capsule endoscopy (CE) aids therapeutic interventions for obscure GI bleeding. A second-look CE is beneficial for patients with nondiagnostic initial tests if bleeding presentation changes or hemoglobin drops significantly.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Endoscopy
Background:
- Long-term follow-up data for obscure GI bleeding patients undergoing capsule endoscopy (CE) is limited.
- Understanding the long-term outcomes and the utility of repeat procedures is crucial.
Purpose of the Study:
- To assess long-term outcomes in patients with obscure GI bleeding after capsule endoscopy (CE).
- To determine the benefit of a second-look CE in patients with initially nondiagnostic findings.
Main Methods:
- 293 patients with obscure GI bleeding were enrolled.
- Capsule endoscopy (CE) studies were classified as diagnostic or nondiagnostic.
- Patients were followed for a mean of 24.8 months, with outcomes defined as continued or resolved bleeding.
Main Results:
- Diagnostic CE yielded positive findings in 41.6%, uncertain significance in 16.0%, and no findings in 42.3%.
- Therapeutic intervention was successful in 72.1% of diagnostic cases and 30% of uncertain cases.
- Complete bleeding resolution was significantly higher in patients with diagnostic CE (65.2%) versus nondiagnostic CE (35.4%).
- Repeat CE was diagnostic in 76 patients with significant changes in bleeding presentation or hemoglobin drop (≥4 g/dL).
Conclusions:
- Diagnostic capsule endoscopy (CE) in obscure GI bleeding facilitates therapeutic interventions and improves patient outcomes.
- A second-look CE is recommended for patients with nondiagnostic initial tests if bleeding presentation evolves or hemoglobin levels decrease substantially.
Background:
Long-term follow-up data on patients with obscure GI bleeding subjected to capsule endoscopy (CE) are missing.
Objective:
Our purpose was to follow up patients with a nondiagnostic test and determine whether a second-look CE would be beneficial.
Patients:
We enrolled 293 subjects. CE studies were classified as diagnostic (positive findings) or nondiagnostic (findings of uncertain significance/no findings). Patients were followed up for a mean (SD) 24.8 (5.2) months. Outcome was defined as continued or complete resolution of bleeding.
Interventions:
Patients with a nondiagnostic test were subjected to a repeat CE if they manifested a new bleeding episode or a drop in hemoglobin >or=2 g/dL.
Results:
Positive findings, findings of uncertain significance, and no findings were identified in 41.6%, 16.0%, and 42.3% of our patients, respectively. Therapeutic intervention was possible in 72.1% of those with positive findings and in 30% of those with findings of uncertain significance. Complete resolution of bleeding occurred more often in patients with a diagnostic test (65.2%) compared with those with a nondiagnostic test (35.4%, P < .001). Second-look CE was performed in a subgroup of our patients (n = 76) and was diagnostic in those whose presentation changed from occult to overt or those whose hemoglobin dropped >or=4 g/dL.
Conclusions:
In patients with obscure GI bleeding, a diagnostic CE leads to therapeutic interventions and a favorable outcome. Patients with a nondiagnostic test would definitely benefit from a second-look CE if the bleeding presentation changes from occult to overt or if the hemoglobin value drops >or=4 g/dL.
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