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Pan-enteric capsule for bleeding high-risk patients. Can we limit endoscopies?
Cristina Carretero1, César Prieto de Frías2, Ramón Angós3
1Gastroenterology, Clínica Universidad de Navarra, España.
Insights
Capsule panendoscopy is a safe and effective tool for diagnosing obscure gastrointestinal bleeding in high-risk patients. This method can identify small bowel and colonic lesions, potentially avoiding unnecessary diagnostic endoscopies.
Area of Science:
- Gastroenterology
- Medical Devices
- Diagnostic Imaging
Background:
- Obscure gastrointestinal bleeding (GIB) is defined as bleeding from an unidentified source after standard upper and lower endoscopy.
- Capsule endoscopy is a crucial next step for diagnosing GIB, especially in patients unsuitable for conventional procedures.
- Pan-enteric capsule endoscopy as a first-line approach may reduce the overall number of invasive endoscopic procedures and associated risks.
Purpose of the Study:
- To evaluate the clinical utility and safety of capsule endoscopy in the management of patients with obscure gastrointestinal bleeding.
- To assess the diagnostic yield of capsule endoscopy in identifying small bowel and colonic lesions.
- To determine the potential of capsule endoscopy to obviate the need for further conventional endoscopic examinations.
Main Methods:
- Retrospective review of the first 100 pan-enteric capsule endoscopy procedures performed between August 2011 and December 2016.
- Analysis of patient data, including previous endoscopic findings and comorbidities.
- Assessment of electrolyte and creatinine levels before and after capsule endoscopy, particularly in high-risk patients receiving sodium phosphate preparation.
Main Results:
- Positive findings were reported in 61.2% of patients, with capsule endoscopy detecting small bowel lesions in 67.7% and colonic findings in 80.64%.
- In patients with a prior negative gastroscopy (46.26%), capsule endoscopy identified significant lesions.
- Electrolyte and creatinine levels remained stable post-procedure, indicating safety in high-risk individuals.
- The study suggests that conventional endoscopy could have been avoided in 68.6% of cases based on capsule findings.
Conclusions:
- Capsule panendoscopy is a valuable and safe diagnostic tool for high-risk patients experiencing obscure gastrointestinal bleeding.
- This technology aids in selecting patients who require therapeutic endoscopy, thereby optimizing resource utilization.
- A significant proportion of diagnostic endoscopies (up to 68.6%) could potentially be circumvented by employing capsule endoscopy.
Introduction:
obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy and capsule endoscopy is the next step in these patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule panendoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk.
Aim:
to analyze our experience with capsule endoscopy in the bleeding setting.
Methods:
the first 100 panendoscopic capsule procedures performed in our center from August 2011 until December 2016 were retrospectively reviewed.
Results:
positive findings were observed in 61.2 % of patients; 46.26 % had a previous negative gastroscopy and the capsule detected small bowel lesions in 67.7 % and colonic findings in 80.64 %. Taking into consideration that our population were high-risk patients (mainly because of comorbidities) and that we used up to 45 ml of sodium phosphate, sodium, potassium and creatinine changes were analyzed before and after procedure. The mean "before" values were 140.68, 4.04 and 1.36, respectively. The mean "after" values were 140.28, 3.9 and 1.35 (p = n.s.). According to our findings, no other endoscopic studies would be needed in 64.5 % of patients with negative gastroscopy. According to capsule results, conventional endoscopy could have been avoided in 68.6 % of cases.
Conclusion:
panendoscopy with a capsule may be useful and safe in bleeding high-risk patients, by selecting those who need therapeutic endoscopy, avoiding up to 68.6 % of diagnostic endoscopies in our series.
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