scholarly journals Current Clinical Indications for Small Bowel Capsule Endoscopy

2015 ◽  
Vol 28 (5) ◽  
pp. 632 ◽  
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

<p><strong>Introduction:</strong> 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.<br /><strong>Material and Methods:</strong> Bibliographic review of relevant and recent papers indexed in PubMed.<br /><strong>Results and Discussion:</strong> 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<br />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<br />disease is evolving.<br /><strong>Conclusions:</strong> 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.</p>

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

2018 ◽  
Vol 09 (04) ◽  
pp. 168-175 ◽  
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.

scholarly journals Massive Obscure Overt Gastrointestinal Bleed: An Unusual Cause diagnosed by Capsule Endoscopy

2012 ◽  
Vol 46 (1) ◽  
pp. 37-39 ◽  
Author(s):  
Surjeet Singh ◽  
Chalapathi Rao ◽  
Surinder S Rana ◽  
Amit Bhauwala ◽  
Kartar Singh ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Gastrointestinal Bleeding ◽  
Capsule Endoscopy ◽  
Unusual Case ◽  
Tropical Countries ◽  
Gastrointestinal Bleed ◽  
Common Causes

ABSTRACT Common causes for obscure overt gastrointestinal bleeding originating from the small bowel include small bowel angioectasias, Crohn's disease, ulcers and tumors. In tropical countries, intestinal ulcerations secondary to tuberculosis and parasitic infestations have also been described as causes of gastrointestinal bleeding. We present a very unusual case of massive obscure overt gastrointestinal bleeding due to massive hookworm infestation of the small bowel that was diagnosed by capsule endoscopy and successfully treated with oral albendazole. How to cite this article Rao C, Sharma A, Rana SS, Bhauwala A, Singh S, Singh K, Bhasin DK. Massive Obscure Overt Gastrointestinal Bleed: An Unusual Cause diagnosed by Capsule Endoscopy. J Postgrad Med Edu Res 2012;46(1):37-39.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
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.

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

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
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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