Diagnostic Yield of Repeat Capsule Endoscopy and the Effect on Subsequent Patient Management

Svarta, Sigrid; Segal, B. Scott; Law, Joanna K.; Sandhar, Ajit; Kwok, Ricky; Jacques, Andrew; Lakzadeh, Pardis; Enns, Robert

doi:10.1155/2010/382301

Cited by 24 publications

(16 citation statements)

References 21 publications

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“…A role for repeat capsule endoscopy has also been suggested, with recent studies showing diagnostic yield of 20-75%, depending on the reason for the repeat exam. 25,26 In addition, endoscopic techniques of visualizing the deep small bowel have improved over recent years; most notably, double-balloon enteroscopy allows the potential for endoscopic visualization of the entire small bowel. The diagnostic yield of double-balloon enteroscopy is comparable to that of wireless capsule endoscopy, and in some studies exceeds the sensitivity of wireless capsule endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of dual‐phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non‐diagnostic capsule endoscopy

Agrawal

Travis

Mortelé

et al. 2012

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Diagnostic yield of dual‐phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non‐diagnostic capsule endoscopy

Agrawal

Travis

Mortelé

et al. 2012

J of Gastro and Hepatol

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“…Nonetheless, VCE does miss clinically important duodenal and proximal jejunal lesions (64)(65)(66)(67), and thus cannot be solely relied upon for exclusion of bleeding lesions in these areas. However, there are studies to suggest that repeat VCE may be of benefi t and increase the diagnostic yield, even when the fi rst study is negative (68)(69)(70). A prospective study again showed that repeat VCE may be beneficial, particularly when the bleeding changes from occult to overt or there is a hemoglobin drop ≥4 g/dl ( 71 ).…”

Section: Push Enteroscopymentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

562

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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“…In patients with negative CE who have ongoing or recurrence of obscure bleeding, repeat investigations can yield positive findings and result in a change in management. [72][73][74][75] In RCTs comparing different capsules in patients who underwent 2 consecutive CE examinations, discordant results between the 2 CE procedures were reported in approximately 16% of cases. 76,77 In a small cohort study, the diagnostic yield of the single CE was 37.5% for the first CE, 43.8% for the second CE, and 62.5% for the combined findings of the back-to-back CEs within a 24-hour interval.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

et al. 2017

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Diagnostic Yield of Repeat Capsule Endoscopy and the Effect on Subsequent Patient Management

Abstract: Due to the high diagnostic yield and noninvasive nature of CE, repeat CE appears to be of benefit and should be considered for specific patients before other types of small bowel studies.

Cited by 24 publications

References 21 publications

Diagnostic yield of dual‐phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non‐diagnostic capsule endoscopy

Diagnostic yield of dual‐phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non‐diagnostic capsule endoscopy

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

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