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Management of obscure gastrointestinal bleeding based on the classification of capsule endoscopic bleeding findings
Mitsunori Maeda1, Kazunari Kanke, Akira Terano
1Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan. maedas42@dokkyomed.ac.jp
Insights
Capsule endoscopy (CE) findings classification helps select patients for double-balloon endoscopy (DBE) in obscure gastrointestinal bleeding (OGIB). This classification aids in determining appropriate indications and timing for DBE, improving patient management.
Area of Science:
- Gastroenterology
- Endoscopy
- Diagnostic Imaging
Background:
- Obscure gastrointestinal bleeding (OGIB) management often involves capsule endoscopy (CE) and double-balloon endoscopy (DBE).
- DBE is invasive and time-consuming, necessitating selective indications.
- Evaluating CE findings classification is crucial for optimizing DBE use in OGIB.
Purpose of the Study:
- To assess the utility of a CE bleeding findings classification system.
- To determine if this classification can guide the indications and timing for DBE in OGIB patients.
Main Methods:
- 123 OGIB patients undergoing CE between 2003-2009 were analyzed.
- CE findings were classified (Type I-IV, 0) based on bleeding source (active, previous, lesions, extra-intestinal, none).
- Diagnostic yield and outcomes were compared between CE classification and DBE/enteroclysis findings.
Main Results:
- Higher CE classification types (I > II > III > IV > 0) correlated with increased positive findings on DBE/enteroclysis.
- Treatment rates and rebleeding rates also showed a trend of being higher for higher CE classification types.
- Specific rates varied by classification: CE-Ia (100% positive, 50% treatment, 33.3% rebleeding); CE-III (100% positive, 9.5% treatment, 8.3% rebleeding); CE-0 (0% for all).
Conclusions:
- The CE bleeding findings classification provides valuable information for OGIB management.
- This classification aids in judiciously selecting patients and determining the optimal timing for DBE.
- It helps refine the indications for invasive procedures like DBE in the context of CE findings.
Background:
Double-balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time-consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB.
Methods:
From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE-I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis.
Results:
Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE-Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively.
Conclusions:
The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE-I>II>III>IV>0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE.
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