Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE.Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB.Results. There was no significant difference in diagnostic yield between occult and overt OGIB. The small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n=18, 18%), vascular lesions (n=11, 11%), and tumors (n=4, 3%), and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n=51, 16%), vascular lesions (n=31, 10%), and tumors (n=20, 6%).Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB.

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New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

Gastroenterology Research and Practice ◽

10.1155/2014/709217 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Pedro Boal Carvalho ◽

Bruno Rosa ◽

Maria João Moreira ◽

José Cotter

Keyword(s):

Small Bowel ◽

Drug Use ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Decisive Role ◽

Bleeding Risk ◽

Obscure Gastrointestinal Bleeding ◽

Anticoagulant Drug ◽

The Impact

Objectives.Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE.Methods.Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE.Results.One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11,P=0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE.Conclusions.Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

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Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

Gastroenterology Research and Practice ◽

10.1155/2016/8367519 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

Ye Chu ◽

Sheng Wu ◽

Yuting Qian ◽

Qi Wang ◽

Juanjuan Li ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Obscure Gastrointestinal Bleeding ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Computed Tomographic ◽

Double Balloon ◽

Complementary Value

Objectives. The complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB).Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations.Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9%) but was significantly higher than the yield of CTE (87% versus 25%,p<0.001). The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%,p<0.001) and DBE (39.1% versus 17.4%,p=0.013), while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE.Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB.

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PA.214 DIAGNOSTIC YIELD OF SMALL BOWEL CAPSULE ENDOSCOPY FOR INDICATIONS OTHER THAN OBSCURE GASTROINTESTINAL BLEEDING

Digestive and Liver Disease ◽

10.1016/s1590-8658(08)60409-0 ◽

2008 ◽

Vol 40 ◽

pp. S154

Author(s):

C.M. Girelli ◽

V. Malacrida ◽

F. Barzaghi

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Obscure Gastrointestinal Bleeding

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Clinical Impact of Small Bowel Capsule Endoscopy in Obscure Gastrointestinal Bleeding

Medicina ◽

10.3390/medicina56100548 ◽

2020 ◽

Vol 56 (10) ◽

pp. 548

Author(s):

Ana-Maria Singeap ◽

Camelia Cojocariu ◽

Irina Girleanu ◽

Laura Huiban ◽

Catalin Sfarti ◽

...

Keyword(s):

Small Bowel ◽

Clinical Outcome ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Obscure Gastrointestinal Bleeding ◽

Deficiency Anemia ◽

Occult Gastrointestinal Bleeding ◽

Therapeutic Decisions

Background and objectives: The most frequent indications for small bowel capsule endoscopy (SBCE) are obscure gastrointestinal bleeding (OGIB) and iron deficiency anemia (IDA). The aim of this study was to evaluate the diagnostic yield (DY) of SBCE in overt and occult OGIB, as well as its impact on the clinical outcome. Materials and Methods: This study retrospectively included all cases of OGIB investigated by SBCE in a tertiary care referral center, between 1st January 2016 and 31st December 2018. OGIB was defined by overt or occult gastrointestinal bleeding, with negative upper and lower endoscopy. Occult gastrointestinal bleeding was either proved by a fecal test or presumptively incriminated as a cause for IDA. DY was defined as the detection rate for what were thought to be clinically significant findings. DYs for overt and occult bleeding were assessed and compared. Gender, age, hemoglobin levels, NSAID consumption and the use of anticoagulants were recorded. Following SBCE results, individual therapeutic decisions were made, and follow-up data were recorded. Results: 224 SBCE examinations were performed for OGIB, of which 148 were for overt OGIB, and 76 for unexplained IDA. Positive findings were found in 139 patients, resulting in an overall DY for OGIB of 62%, higher in overt OGIB (75%) compared to IDA (37%). The most frequent findings were small bowel angioectasias (62.2% in overt OGIB and 78.5% in IDA). On multivariate logistic regression analysis, only hemoglobin level <10 g/dL and anticoagulants were the variables independently associated with positive findings. All patients received medical, endoscopic or surgical treatment and had good clinical outcome during follow-up. Conclusion: SBCE has a high diagnostic yield and a positive impact on management of patients with OGIB.

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Is It Possible to Predict the Presence of Intestinal Angioectasias?

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2014/461602 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Tiago Cúrdia Gonçalves ◽

Joana Magalhães ◽

Pedro Boal Carvalho ◽

Maria João Moreira ◽

Bruno Rosa ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Small Bowel ◽

Gastrointestinal Bleeding ◽

Predictive Factors ◽

Capsule Endoscopy ◽

Diagnostic Tool ◽

Diagnostic Yield ◽

Vascular Lesions ◽

Important Diagnostic Tool ◽

The Mean

Background and Aim. Angioectasias are the most common vascular anomalies found in the gastrointestinal tract. In small bowel (SB), they can cause obscure gastrointestinal bleeding (OGIB) and in this setting, small bowel capsule endoscopy (SBCE) is an important diagnostic tool. This study aimed to identify predictive factors for the presence of SB angioectasias, detected by SBCE. Methods. We retrospectively analyzed the results of 284 consecutive SBCE procedures between April 2006 and December 2012, whose indication was OGIB, of which 47 cases with SB angioectasias and 53 controls without vascular lesions were selected to enter the study. Demographic and clinical data were collected. Results. The mean age of subjects with angioectasias (70.9±14.7) was significantly higher than in controls (53.1±18.6; P<0.001). The presence of SB angioectasias was significantly higher when the indication for the exam was overt OGIB versus occult OGIB (13/19 versus 34/81, P=0.044). Hypertension and hypercholesterolemia were significantly associated with the presence of SB angioectasias (38/62 versus 9/38, P<0.001 and 28/47 versus 19/53, P=0.027, resp.). Other studied factors were not associated with small bowel angioectasias. Conclusions. In patients with OGIB, overt bleeding, older age, hypercholesterolemia, and hypertension are predictive of the presence of SB angioectasias detected by SBCE, which may be used to increase the diagnostic yield of the SBCE procedure and to reduce the proportion of nondiagnostic examinations.

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Current Clinical Indications for Small Bowel Capsule Endoscopy

Acta Médica Portuguesa ◽

10.20344/amp.6128 ◽

2015 ◽

Vol 28 (5) ◽

pp. 632 ◽

Cited By ~ 6

Author(s):

Bruno Rosa ◽

José Cotter

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Diagnostic Instrument ◽

Obscure Gastrointestinal Bleeding ◽

Disease Extent ◽

Small Bowel Tumors

Introduction: Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice. Material and Methods: Bibliographic review of relevant and recent papers indexed in PubMed. Results and Discussion: Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with “negative“ small bowel capsule endoscopy is debatable. Cross-sectional imaging may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn’s disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn’s disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac disease is evolving. Conclusions: Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn’s disease, or patients with known Crohn’s disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.

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Su1152 Does Discontinuation of Antithrombotic Agents Affect Diagnostic Yield of Small Bowel Capsule Endoscopy in Patients With Obscure Gastrointestinal Bleeding?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.668 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB293-AB294

Author(s):

Toshio Watanabe ◽

Sunao Shimada ◽

Yuji Nadatani ◽

Koji Otani ◽

Fumio Tanaka ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Obscure Gastrointestinal Bleeding ◽

Antithrombotic Agents

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Does discontinuation of antithrombotics affect the diagnostic yield of small bowel capsule endoscopy in patients demonstrating obscure gastrointestinal bleeding?

Journal of Clinical Biochemistry and Nutrition ◽

10.3164/jcbn.17-142 ◽

2018 ◽

Vol 63 (2) ◽

pp. 149-153 ◽

Cited By ~ 1

Author(s):

Shiro Nakamura ◽

Toshio Watanabe ◽

Sunao Shimada ◽

Yuji Nadatani ◽

Koji Otani ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Obscure Gastrointestinal Bleeding

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Capsule Endoscopy for Obscure Gastrointestinal Bleeding: A Single‑Center Experience

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_35_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 168-175 ◽

Cited By ~ 1

Author(s):

Virender Chauhan ◽

Vasudha Goel ◽

Mukesh Jain ◽

Gaurav Gupta ◽

Rupesh Pokharna ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Gastrointestinal Bleeding ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Specific Treatment ◽

Obscure Gastrointestinal Bleeding ◽

Female Ratio ◽

Worm Infestation

ABSTRACT Background: Capsule endoscopy (CE) has an established role in evaluating obscure gastrointestinal bleeding (OGIB). The aim was to know the diagnostic yield of CE and spectrum of OGIB. Materials and Methods: In this retrospective study, we evaluated all the patients with obscure gastrointestinal bleed using MiroCam capsule endoscope (IntroMedic, Seoul, Korea) between February 2014 and March 2018. Clinical data, ancillary investigations, and response to specific treatment were considered to confirm CE findings. Results: Out of 102 patients included in the study (mean age 54.5 ± 16.1 years, male: female ratio = 1.83:1) OGIB‑overt and OGIB‑occult was present in 46 and 56 patients, respectively. Diagnostic yield of CE was similar in both the groups (overt‑37/46, 80.4% versus occult‑37/56, 66.5%) (P ≥ 0.05), although there was trend to find more lesions in overt group. Overall positive diagnostic yield was 72.5%. Lesions detected were vascular malformations in 21 (20.5%), nonsteroidal anti‑inflammatory drug enteropathy in 13 (12.7%), small bowel ulcerations in 27 (26.4%), which were further divided into three subgroups (a) nonspecific ulcerations 11 (10.7%), (b) tubercular ulcer with/without stricture in 7 (6.8%) and (c) serpiginous ulcers and fissuring with cobble‑stone appearance suggestive of Crohn’s disease in 9 (8.8%), portal hypertensive enteropathy in 5 (4.9%), worm infestation (hookworms in 3, roundworms 1) in 4 (3.9%), and small bowel tumour in 1 (0.98%) patient. Overall, 56.7% patients were having definitive (P2) lesions (Saurin classification). Two patients had retention of capsule, but none developed intestinal obstruction. Capsule was removed with surgical intervention. Conclusion: CE has high diagnostic yield, relative safety and tolerability, and it is an important diagnostic tool for OGIB. Small bowel tuberculosis, Crohn’s disease and Worm infestation continue to be commonly recognized causes of OGIB in developing countries like India.

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