Clinical Utility of Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Obscure Gastrointestinal Bleeding

Abstract

Background: Obscure gastrointestinal bleeding (OGIB) is a common but embarrassing problem for gastroenterologists. Most bleeding lesions associated with OGIB are present in the small intestine and sometimes cannot be identified due to the difficulty associated with physical accessibility. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have enabled in the process of diagnosing and have evolved to become approaches to treating OGIB. Summary: CE is a minimally invasive procedure and has a high diagnostic yield in patients with OGIB. DBE offers additional advantage of biopsy collection for pathological diagnosis and therapeutic intervention, but it should be noted that it sometimes causes severe adverse events such as acute pancreatitis, intestinal bleeding, and intestinal perforation. CE should be performed early in the workup course of OGIB. Positive CE findings enhance the diagnostic yield of subsequent DBE, and the effective therapeutic intervention improves the clinical outcomes of OGIB patients. On the contrary, there are no clear guidelines for further investigation of patients with negative CE findings at the present. Although patients in stable general condition may only require follow-up, repeated CE is useful to detect positive findings in patients with evidence of sustained bleeding and progressing anemia. We have revealed that repeated CE has higher positive finding rate than DBE in OGIB patients with negative CE findings in a preliminary study. Key Messages: CE and DBE have complementary roles in the management of OGIB, and the precise timing and proper sequence may be important for the approach to treating OGIB.

Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

“…It should be noted that effective management for bleeding in patients with OGIB by double-balloon endoscopy or other methods might prevent them from dying directly due to gastrointestinal bleeding. In fact, in a previous study, patients with OGIB were managed efficiently, and endoscopic hemostasis was performed for gastrointestinal bleeding [10].…”

A Single Small Bowel Hemangioma Detected by Video Capsule Endoscopy in a Patient Presenting with Iron-deficiency Anemia – Two Case Reports

“…We present two rare cases of solitary small bowel hemangioma causing irondeficiency anemia in two adult male patients. Small bowel hemangiomas are rare and account for 7-10% of all benign neoplasms of the small intestine (Takase et al, 2017;Otani et al, 2018). Most patients present with abdominal pain and intestinal bleeding with iron-deficiency anemia.…”

Gastrointestinal diagnosis using non-white light imaging capsule endoscopy

“…The use of DBE alone 7 has a poorer diagnostic yield (diagnostic yield 56%) than CE ( diagnostic yield 62%), but a complementary strategy 8 of DBE following positive CE has improved detection of OGIB ( diagnostic yield 75%) 12 and improved outcomes in 9 managing OGIB (reduced recurrent bleeding and requirement for blood transfusion) 13 . Taken together, these findings 10 suggest that performing DBE is a rational approach in patients with positive CE findings requiring biopsy or 11 therapeutic intervention 14 . 12…”

“…• Many of these capsules require further testing to determine their clinical efficacy fully due to the small sample 12 sizes of the reported studies. 13 • New diagnostic capsule designs will provide new opportunities for improved computer-aided diagnosis, virtual 14 biopsy and capsule localization that could benefit clinical practice in the future. Capsule endoscopy (CE) offers a minimally invasive method to visualize the gastrointestinal (GI) tract.…”