Diagnostic Yield of Capsule Endoscopy in Obscure Gastrointestinal Bleeding

Abstract

Objectives:Chronic occult blood loss from the gastrointestinal tract is a recognized major cause of iron-deficiency anemia. After conventional investigation of the upper and lower parts of the gastrointestinal tract, the source of bleeding remains unidentified in ~10% of these patients. We evaluated the diagnostic yield of capsule endoscopy from patients enrolled in clinical studies due to persistent or recurrent iron-deficiency anemia. Methods: In this large cohort study, patients with obscure gastrointestinal bleeding were identified in a company-sponsored clinical study (Given Imaging, Ltd.) database which contains data from >50 clinical studies. Information on suitable patients was derived from 31 of them. Each subject swallowed an M2A^® Given Capsule containing a miniature video camera, batteries, a transmitter and an antenna. Recording time was ~8 h. The capsule was excreted naturally in the patient’s bowel movement, and the data it transmitted were retrieved and interpreted the next day. Results: 293 patients were studied (135 males, 46.1%, mean age 59.4 ± 16.8 years) whose mean number of bleeding episodes was 4.3 ± 5.5 and mean hemoglobin level was 9.8 ± 2.4 g/dl. The average number of diagnostic procedures per patient prior to the capsule endoscopy study was 5.59. Capsule endoscopy detected definitive findings in 213/293 patients (72%) and findings missed by other diagnostic procedures in 22/293 patients (8%). Neither capsule endoscopy nor the other diagnostic procedures yielded diagnoses in 58/293 patients (20%). Conclusions: Capsule endoscopy has a high diagnostic yield in evaluating patients with obscure gastrointestinal bleeding.

Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

“…16,[27][28][29][30] In this study, we reported a relatively high diagnostic yield of 47.56% and 68.66% for MSCT and CE, respectively. Despite a lower overall diagnostic yield than CE, MSCT examination in our study achieved a similar diagnostic capability to CE.…”

Capsule Endoscopy of the Upper Gastrointestinal Tract – The Need for a Second Endoscopy

“…These lesions were identified by CE and were indicative of a second endoscopy. In another study [24], CE detected findings in 1% (oesophagus) and 17.8% (stomach) of patients evaluated for both obscure and overt GI bleeding. In the same study, CE missed lesions in the oesophagus (32%) and the stomach (43%), further underpinning the need of a repeat endoscopy.…”

Capsule endoscopy examination identifies different leading causes of obscure gastrointestinal bleeding in patients of different ages

“…Obscure gastrointestinal bleeding (OGIB) is generally characterized as persistent or recurrent GIB, which cannot be identified by conventional gastrointestinal endoscopy and/or conventional radiological examinations of the small intestine (1). Pathological changes in the small intestine account for 2-10% of all causes for OGIB; however, they are poorly identified by conventional approaches.…”