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Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding
Bing-Ling Zhang1, You-Hong Fang, Chun-Xiao Chen
1Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Insights
Capsule endoscopy (CE) effectively diagnoses obscure gastrointestinal bleeding (OGIB), with findings varying by age but not bleeding status. This safe and accurate procedure visualizes the small intestine, identifying tumors and angioectasias.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
- Medical Imaging
Background:
- Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge, often requiring advanced imaging techniques.
- Traditional endoscopic methods may fail to identify the source of bleeding in the small intestine.
Purpose of the Study:
- To evaluate the diagnostic yield of capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB).
- To assess the impact of different bleeding statuses (massive vs. chronic recurrent overt) on CE diagnostic accuracy.
Main Methods:
- A retrospective chart review and internal database analysis of 309 patients undergoing CE for OGIB.
- Patients had prior negative gastric and colonic endoscopy results.
- Data stratified by bleeding status: 49 massive bleeding and 260 chronic recurrent overt bleeding cases.
Main Results:
- CE achieved visualization of the entire small intestine in 81.88% of cases.
- Clinically positive findings were observed in 53.72% of patients, with no significant difference between bleeding groups.
- Small intestinal tumors and angioectasias were common findings, with prevalence varying by age and bleeding status. The complication rate was 1.3%.
Conclusions:
- Capsule endoscopy is a safe, comfortable, and effective tool for diagnosing OGIB.
- The procedure demonstrates a high accuracy rate in identifying the source of obscure gastrointestinal bleeding.
Aim:
To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status.
Methods:
Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE findings.
Results:
Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common finding in the entire cohort, these accounted for 30% of clinically significant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleeding group, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%.
Conclusion:
In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.
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