Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study

144 Assessment of Multi-Modality Evaluations of Obscure Gastrointestinal Bleeding

“…This is similar to prior studies [18] . The commonest findings at VCE with negative DBE were AVMs and blood; it is possible that these abnormalities had subsided by the time of the DBE since the time interval between the tests in our study could be up to 1 year [11,19] . This would be characteristic of AVMs which often bleed intermittently, and could artificially increase the apparent false positive rate.…”

Suspected blood indicator in capsule endoscopy: a valuable tool for gastrointestinal bleeding diagnosis

“…Despite presenting itself as the first line diagnostic procedure for SBB evaluation (12) , SBCE review is often hindered by the substantial amount of time needed for entire small bowel visualization (22) , which may be of particular importance in the presence of active small bowel haemorrhage (19) . The SBI tool, included in the RAPID reader ® software (Given Imaging, Yokneam, Israel), allows for a significant reduction of the reviewing duration from up to some hours to a few minutes (8,22) , marking red areas identified by an algorithm as either active bleeding or potentially bleeding lesions.…”

“…Also, because the clinical significance of P1 lesions has been increasingly questioned (17,19) and there is paucity of directed therapeutical approach to small bowel erosions, we defined only P2 lesions and active bleeding when considering SBI performance. We followed a methodology similar to previous studies (7,18) where a true positive result was defined if the SBI marked at least one P2 lesion and all active bleeding, a false positive if the SBI marked any frame in a SBCE without either a P2 lesion or active bleeding, a false negative if the SBI missed any active bleeding or all P2 lesions, and a true negative if the SBI marked no frame in a negative SBCE.…”

“…One of the chief limitations in SBCE is the significant reading time needed for the thorough review of the entire small bowelpreviously published studies report a median reading time ranging from 17 to 120 minutes to observe the 50.000 images captured by the device (8,22) . This limitation is of particular interest for indications such as overt SBB, when the timely diagnosis and treatment is of paramount relevance (19) . RAPID reader ® (Given Imaging, Yokneam, Israel) includes seve ral software functionalities designed to assist the gastroenterologist for a faster and more efficient video revision, such as Suspected blood indicator in capsule endoscopy: a valuable tool for gastrointestinal bleeding diagnosis .…”

Current Clinical Indications for Small Bowel Capsule Endoscopy

“…In another recent study of 144 patients with overt OGIB, SBCE resulted in higher detection rate of active bleeding and/or angioectasias (44.4% vs 27.8%, p = 0.046) when performed within 72h of hospital admission. 13 In a randomized controlled trial, Leung et al 14 found that the diagnostic yield of SBCE was higher than angiography (53.3% vs 20%; p = 0.016) in patients with severe overt OGIB, and the cumulative risk of rebleeding was 16.7% and 33.3%, respectively (p = 0.10). The use of BAE as the first line examination in this setting has been advocated as a cost-effective approach, due to the high probability of positive findings and the possibility of immediate therapeutic intervention.…”