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What is the impact of capsule endoscopy in the long term period?
Asli Ormeci1, Filiz Akyuz1, Bulent Baran1
1Asli Ormeci, Filiz Akyuz, Bulent Baran, Suut Gokturk, Binnur Pinarbasi, Ozlem Mutluay Soyer, Sami Evirgen, Cetin Karaca, Kadir Demir, Sabahattin Kaymakoglu, Fatih Besisik, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34590 Capa, Istanbul, Turkey.
Insights
Capsule endoscopy (CE) is effective for diagnosing obscure gastrointestinal bleeding (OGIB). A negative CE result significantly reduces the risk of rebleeding during long-term follow-up.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Clinical Research
Background:
- Obscure gastrointestinal bleeding (OGIB) presents diagnostic challenges.
- Long-term clinical impact of capsule endoscopy (CE) in OGIB management requires further assessment.
Purpose of the Study:
- To evaluate the clinical impact of capsule endoscopy (CE) in the long-term follow-up of patients with obscure gastrointestinal bleeding (OGIB).
Main Methods:
- Retrospective analysis of 141 patients undergoing CE for OGIB (2009-2012), followed by prospective questioning.
- Data collected included demographics, comorbidities, medication use, prior tests, CE findings, and outcomes.
Main Results:
- CE was performed on 139 patients with a median follow-up of 32 months; overall diagnostic yield was 84.9%.
- Rebleeding occurred in 40.3% of patients. Negative CE findings correlated with a significantly lower rebleeding rate (4.8%) compared to positive findings (46.6%).
- Independent predictors of rebleeding included NSAID/anticoagulant use and vascular ectasia on CE.
Conclusions:
- Capsule endoscopy (CE) is a reliable diagnostic tool for obscure gastrointestinal bleeding (OGIB).
- A negative CE result is associated with a substantially reduced risk of rebleeding in long-term follow-up.
Aim:
To assess the clinical impact of capsule endoscopy (CE) in the long-term follow-up period in patients with obscure gastrointestinal bleeding (OGIB).
Methods:
One hundred and forty-one patients who applied CE for OGIB between 2009 and 2012 were retrospectively analyzed, and this cohort was then questioned prospectively. Demographic data of the patients were determined via the presence of comorbid diseases, use of non-steroidal anti-inflammatory drugs anticoagulant-antiaggregant agents, previous diagnostic tests for bleeding episodes, CE findings, laboratory tests and outcomes.
Results:
CE was performed on 141 patients because of OGIB. The capsule was retained in the upper gastrointestinal (GI) system in two of the patients, thus video monitoring was not achieved. There were 139 patients [62% male, median age: 72 years (range: 13-93 years) and a median follow-up duration: 32 mo (range: 6-82 mo)]. The overall diagnostic yield of CE was 84.9%. Rebleeding was determined in 40.3% (56/139) of the patients. The rebleeding rates of patients with positive and negative capsule results at the end of the follow-up were 46.6% (55/118) and 4.8% (1/21), respectively. In the multivariate analysis, usage of NSAIDs, anticoagulant-antiaggregant therapies (OR = 5.8; 95%CI: 1.86-18.27) and vascular ectasia (OR = 6.02; 95%CI: 2.568-14.146) in CE were detected as independent predictors of rebleeding. In the univariate analysis, advanced age, comorbidity, and overt bleeding were detected as predictors of rebleeding.
Conclusion:
CE is a reliable method in the diagnosis of obscure GI bleeding. Negative CE correlated with a significantly lower rebleeding risk in the long-term follow-up period.
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