Urgent Capsule Endoscopy Is Useful in Severe Obscure‐overt Gastrointestinal Bleeding

Abstract

Aim: With capsule endoscopy (CE) it is possible to examine the entire small bowel. The present study assessed the diagnostic yield of CE in severe obscure-overt gastrointestinal bleeding (OOGIB). Methods: During a 3-year period, 15 capsule examinations (4.5% of all CE in a single institution) were carried out in 15 patients (11 men; mean age 69.9 Ϯ 20.1 years) with severe ongoing bleeding, defined as persistent melena and/or hematochezia, with hemodynamic instability and the need for significant red blood cell transfusion. CE was carried out after non-diagnostic standard upper and lower endoscopy. The mean time from admission until CE was 4.1 Ϯ 4.4 days (0-15 days). Results: CE revealed active bleeding in seven patients and signs of recent bleeding in four. Etiology of bleeding was correctly diagnosed in 11 patients (73.3%) (portal hypertension enteropathy, three patients; subepithelial ulcerated lesion, two patients; angiodysplasia, two patients; jejunal ulcer with visible vessel, one patient; multiple small bowel ulcers, one patient; jejunal tumor, one patient; jejunal mucosa irregularity with adherent clot, one patient). One patient (6.7%) had active bleeding but no visible lesion. As a consequence of the capsule findings, specific therapeutic measures were undertaken in 11 patients (73.3%) with five managed conservatively, four endoscopically and two surgically. Two patients experienced bleeding recurrence. One of them, with a probable small bowel tumor, refused any other interventions. Conclusions: CE is useful in patients with severe OOGIB by providing positive findings in the majority of patients, with subsequent impact on therapeutic procedures.

Endoscopic Evaluation and Management of Gastrointestinal Bleeding in Patients with Ventricular Assist Devices

“…The timing of capsule endoscopy is paramount for success in finding a source of bleeding [13]. Previous investigators demonstrated a 73.3% yield for VCE in their evaluation of obscure-overt gastrointestinal bleeding, with an average time from admission to VCE of 4.1 days.…”

An Unusual Endoscopic Image of a Submucosal Angiodysplasia

“…It is responsible for 2–10% of the cases of digestive bleeding [2]. It is considered severe (1% of all cases) if any of the following is present: overt presentation, recurrent episodes of acute bleeding, transfusion dependence, and need for hospitalization [3].…”

“…CE allows the examination of the entire small bowel with similar diagnostic yield, and double-balloon enteroscopy permits real-time exploration with the advantage of therapeutic approach [2]. …”

“…In our institution and in this particular clinical case we used early CE because it has no major complications, it is easy to perform with no discomfort to the patient [2], and we had the possibility to read it right after the examination. This strategy has the advantage of determining the next step.…”

Analysis of the causes and clinical characteristics of jejunoileal hemorrhage in China: a multicenter 10 year retrospective survey

“…Obscure gastrointestinal bleeding (OGIB) is blood loss from an unknown source that persists or recurs after negative investigations including esophagogastroduodenoscopy (EGD), colonoscopy and radiologic evaluation [1]. OGIB is the initial classification in about 5% of all patients with bleeding from the digestive tract [2]. OGIB originates most commonly from the small intestine; the jejunoileum is reportedly subsequently identified as the origin of bleeding in 75% of patients initially classified as having OGIB [1,3-5].…”