Capsule Endoscopy for Obscure Gastrointestinal Bleeding in the Tropics: Report From India

Ghoshal, Uday C; Lakshmi, Chandrasekharan Padma; Kumar, Sunil; Das, Kshaunish; Misra, Asha; Rai, Praveer; Mohindra, Samir; Saraswat, Vivek A.; Kumar, Ashok; Choudhuri, Gourdas

doi:10.1111/j.1443-1661.2010.01035.x

Cited by 18 publications

(14 citation statements)

References 34 publications

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“…The finding that small bowel ulcer, instead of angiodysplasia was the most common cause of OGIB in this study needs attention. Angiodysplasia is well-known to be the most common cause of OGIB among Western patients but no convincing data to show that this holds true among Asians [18][19][20][21] . Some [18,20] reported angiodysplasia as a main cause of OGIB, while others [19,21] report ulcers to be the main etiology.…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

“…Angiodysplasia is well-known to be the most common cause of OGIB among Western patients but no convincing data to show that this holds true among Asians [18][19][20][21] . Some [18,20] reported angiodysplasia as a main cause of OGIB, while others [19,21] report ulcers to be the main etiology. However, when considered large studies that include more than 100 patients, one study from India [21] and two double-balloon enteroscopy studies from Japan [22,23] , all showed that small bowel ulcers were the most common cause of OGIB (41%-53%), more common than angiodysplasia (23%-24%).…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

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Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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AIM:To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB). METHODS:The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients' medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients' outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients. RESULTS:Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy's (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001). CONCLUSION:In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

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Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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“…3 The detection rate for source of bleed for CE among patients with obscure GI in our study is similar to already published literature. [4][5][6][7] In our study angioectasia was the commonest etiology in patients presenting withOGIB.Hookworm infestation was diagnosed in two out the nine patients with OGIB which is an interest finding that is not being reported in similar studies in western population. Among the two patients with hookworm infestation, one presented with overt GI bleed in the form of melena with severe anemia which required multiple packed red blood cell transfusion and the other presented with occult GI bleed with iron deficiency anemia.…”

Section: Discussionmentioning

confidence: 42%

“…Ghoshal et al evaluated CE in obscure GI bleed in 86 patients and found hookworm infestation in 7.8%. 5 The diagnostic yield of CE endoscopy depends on the optimum timing which is ideally within the 48 hours of the bleed but can be extended up to a maximum of 2 weeks and the presence of overt or occult GI bleed where the diagnostic yield were much higher (87% vs 46%) in patients presenting with overt GI bleed . 4 The remaining cases in our study with regard to obscure GI bleed had more than one lesion noted such as a combination of angioectasia with small bowel ulcers or polyp.…”

Section: Discussionmentioning

confidence: 99%

Experience of omom capsule 2 endoscopy system for suspected small bowel pathology in a tropical country

George¹,

K²,

Mohamed³

et al. 2017

Int j curr adv res

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“…Most series showed that lesions are detected more often in patients with obscure overt than occult gastrointestinal bleeding [25], [26] though a few series did contradict this observation. [27] It has also been shown that if capsule endoscopy is performed early after a bleeding episode, it detects lesion more frequently than if it is done late. In some studies, authors showed that second capsule endoscopy may pick-up some of the lesions missed by first study.…”

Section: Small Bowel Capsule Endoscopy: the Methodsmentioning

confidence: 99%

Capsule Endoscopy: A New Era of Gastrointestinal Endoscopy

Ghoshal¹

2013

Endoscopy of GI Tract

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Capsule Endoscopy for Obscure Gastrointestinal Bleeding in the Tropics: Report From India

Abstract: CE is safe and is equally effective in detecting lesion(s) in occult and overt OGIB. Worm infestation and small bowel tuberculosis are unique and important causes of OGIB in the tropics.

Cited by 18 publications

References 34 publications

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Experience of omom capsule 2 endoscopy system for suspected small bowel pathology in a tropical country

Capsule Endoscopy: A New Era of Gastrointestinal Endoscopy

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