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Patients on Antithrombotic Agents with Small Bowel Bleeding -Yield of Small Bowel Capsule Endoscopy and Subsequent
Sofi Damjanovska1, Daniel Karb2, Allen Chen3
1Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. sofi.damjanovska@gmail.com.
Insights
Small bowel capsule endoscopy (SBCE) is highly effective for diagnosing obscure gastrointestinal bleeding in patients taking antithrombotic medications. Performing SBCE during inpatient stays improves diagnostic yield for these individuals.
Area of Science:
- Gastroenterology
- Endoscopy
- Internal Medicine
Background:
- Small bowel gastrointestinal bleeding (GIB) significantly impacts patient quality of life and healthcare resource utilization.
- Antithrombotic medications are frequently associated with an increased risk of small bowel GIB.
Purpose of the Study:
- To determine the diagnostic yield of small bowel capsule endoscopy (SBCE) in patients on antithrombotic therapy.
- To assess the impact of SBCE on the subsequent treatment course for small bowel GIB.
Main Methods:
- Retrospective review of electronic medical records for 1986 patients who underwent SBCE.
- Analysis of diagnostic yield based on antithrombotic medication use and inpatient vs. outpatient setting.
Main Results:
- Higher diagnostic yield for SBCE in detecting bleeding stigmata in patients on antiplatelet agents (21.6%) and anticoagulation (22.5%) compared to those not on these medications (12.1% and 13.5%, respectively).
- Inpatient SBCE showed a higher diagnostic yield (21.8%) than outpatient SBCE (12%).
- SBCE findings led to further endoscopic evaluation in 25.2% of positive cases, with hemostasis attempted in 52.5%.
Conclusions:
- SBCE is crucial for evaluating suspected small bowel bleeding, especially in patients on antithrombotic therapy.
- Performing SBCE during inpatient hospitalization enhances diagnostic capabilities for this patient group.
Background And Aims:
Small bowel gastrointestinal bleeding (GIB) is associated with multiple blood transfusions, prolonged and/or multiple hospital admissions, utilization of significant healthcare resources, and negative effects on patient quality of life. There is a well-recognized association between antithrombotic medications and small bowel GIB. We aimed to identify the diagnostic yield of small bowel capsule endoscopy (SBCE) in patients on antithrombotic medications and the impact of SBCE on treatment course.
Methods:
The electronic medical records of nineteen hundred eighty-six patients undergoing SBCE were retrospectively reviewed.
Results:
The diagnostic yield for detecting stigmata of recent bleeding and/or actively bleeding lesions in SBCE was higher in patients that were on antiplatelet agents (21.6%), patients on anticoagulation (22.5%), and in patients that had their SBCE performed while they were inpatient (21.8%), when compared to the patients not on antiplatelet agents (12.1%), patients not on anticoagulation (13.5%), and with patients that had their SBCE performed in the outpatient setting (12%). Of 318 patients who had stigmata of recent bleeding and/or actively bleeding lesion(s) identified on SBCE, SBCE findings prompted endoscopic evaluation (small bowel enteroscopy, esophagogastroduodenoscopy (EGD), and/or colonoscopy) in 25.2%, with endoscopic hemostasis attempted in 52.5%.
Conclusions:
Our study, the largest conducted to date, emphasizes the importance of performing SBCE as part of the evaluation for suspected small bowel bleeding, particularly in patients taking antithrombotic therapy, and especially during their inpatient hospital stay.
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