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Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding
Fatma Ebru Akin1, Oyku Tayfur Yurekli2, Aylin Demirezer Bolat1
1Ankara Ataturk Research and Teaching Hospital Gastroenterology Department, 06800 Ankara, Turkey.
Insights
Video capsule endoscopy (VCE) is used for potential small bowel bleeding. However, this study found 7% of VCE cases revealed lesions within reach of conventional endoscopy, highlighting the need for thorough review.
Area of Science:
- Gastroenterology
- Endoscopy
- Digestive Diseases
Background:
- Unexplained gastrointestinal (GI) bleeding often necessitates further investigation beyond conventional upper and lower endoscopy.
- Potential small bowel bleeding (PSBB) refers to GI bleeding where the source remains unidentified after standard endoscopic procedures.
- Video capsule endoscopy (VCE) is a key tool for diagnosing PSBB, but its diagnostic yield and limitations require ongoing evaluation.
Purpose of the Study:
- To investigate the incidence of lesions detectable by conventional endoscopy in patients undergoing VCE for PSBB.
- To determine if VCE findings in PSBB patients could have been identified using standard upper and lower GI endoscopy.
- To assess the clinical significance of non-small bowel lesions identified during VCE in the context of PSBB.
Main Methods:
- Retrospective analysis of 114 patients who underwent VCE for PSBB between January 2009 and August 2015.
- Review of VCE findings to identify lesions located within the reach of conventional upper and lower GI endoscopy.
- Categorization of identified lesions by location (gastric, duodenal, colonic) and type.
Main Results:
- Of 114 patients, VCE identified a bleeding source in 58 (50.9%).
- Eight patients (7% of the total VCE cohort) had lesions within the scope of conventional endoscopy.
- These 8 patients presented with colonic lesions (angiodysplasia, polypoid lesion), gastric lesions (GAVE, anastomotic bleeding), and a duodenal bulb lesion.
Conclusions:
- Even when VCE is performed for potential small bowel bleeding, lesions in the stomach, duodenum, or colon may be the source.
- Gastroenterologists should meticulously review all VCE images, including those from non-small bowel segments, to ensure comprehensive diagnosis.
- Conventional endoscopic techniques remain relevant for diagnosing certain bleeding sources in patients evaluated with VCE for PSBB.
Abstract:
Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.
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