Video capsule endoscopy: Initial experience from a tertiary care center in Sri Lanka

Background: Since its global introduction in 2000, capsule endoscopy (CE) has revolutionized the evaluation of small bowel disease. Aims and Objective: The aim of this study was to share our experience with CE including the findings and its diagnostic yield. Materials and Methods: A retrospective study was carried out at Colombo South Teaching Hospital of Sri Lanka. Data of patients who underwent CE from its initiation in 2017 until June 2020 were obtained from the hospital computer database. These included the patient demographics, indications for the study, quality of bowel preparation, and its findings. Results: The study included 54 patients with a mean age of 55 years. Mean gastric time and small bowel transit time were 52 and 272 min, respectively. Forty-five CE studies were done for the evaluation of small bowel bleeding and an abnormal study was found in 26 (57.78%) patients. Small intestinal ulcers and erosions were the most frequently found abnormality (n=16, 35.56%) followed by tumors (n=5, 11.11%). Active bleeding was evident in 14 (31.11%) patients. Overall diagnostic yield was higher in those with a history of overt bleeding (n=15, 71.43%) compared to occult bleeding (n=11, 45.83%). Most patients who were evaluated for abdominal pain and diarrhea had normal CE except for two who had small intestinal ulcers and subepithelial lesions. Only one case was complicated with capsule retention. Conclusion: CE is a useful investigation for the evaluation of small bowel disease, particularly in suspected small bowel bleeding. In contrast to western population, ulcers and erosions were the more frequently found abnormalities seen in local setting.

New Trends and Advances in Non-Variceal Gastrointestinal Bleeding—Series II

The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.