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Obscure recurrent gastrointestinal bleeding: a revealed mystery?

Maria Elena Riccioni1, Riccardo Urgesi, Rossella Cianci

  • 1Digestive Endoscopy Unit, Catholic University of Rome , Rome , Italy.

Scandinavian Journal of Gastroenterology
|June 20, 2014
PubMed

Insights

Capsule endoscopy (CE) can identify upper or lower gastrointestinal bleeding sources missed by conventional endoscopy in about 28% of obscure gastrointestinal bleeding (OGIB) cases. This highlights CE

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Diagnostic Imaging

Background:

  • Capsule endoscopy (CE) is the primary diagnostic tool for obscure gastrointestinal bleeding (OGIB) after negative upper and lower gastrointestinal (GI) endoscopy.
  • A significant proportion of patients undergoing CE for OGIB have bleeding sources located in the stomach or colon, not just the small bowel.
  • Identifying missed lesions from conventional endoscopy is crucial for effective patient management in OGIB.

Purpose of the Study:

  • To determine the incidence of bleeding lesions in the upper or lower GI tract that were missed by prior gastroscopy and colonoscopy.
  • To evaluate the utility of CE in detecting these missed lesions in patients with obscure GI bleeding.
  • To assess the indications for repeating comprehensive endoscopic workup in patients with obscure bleeding before CE.

Main Methods:

  • Prospective review of data from 637 patients who underwent CE for obscure bleeding at a tertiary center.
  • All patients had previously negative gastroscopy and colonoscopy examinations.
  • Analysis focused on lesions identified by CE located outside the small bowel.

Main Results:

  • CE identified a cause of bleeding in the stomach in 21.7% (138/637) and in the colon in 6.4% (41/637) of patients with prior negative endoscopies.
  • Lesions outside the small bowel were detected in 8.5% (54/637) of patients.
  • In patients with upper/lower GI lesions, CE also frequently identified small-bowel abnormalities, and all patients received appropriate therapy.

Conclusions:

  • Approximately 28% of patients with obscure bleeding have upper or lower GI lesions missed by conventional endoscopy.
  • Capsule endoscopy plays a vital role in uncovering these missed lesions, improving diagnostic yield in OGIB.
  • CE can guide further endoscopic interventions or surgical management for non-small bowel lesions.
Abstract

Keywords:
capsule endoscopycolonoscopygastroscopyobscure gastrointestinal bleeding

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