Capsule endoscopy (CE) is a promising diagnostic tool for patients with obscure gastrointestinal bleeding.
In this study, doctors from Italy evaluated the sensitivity and specificity of CE. They also investigated the outcome after CE in patients with obscure gastrointestinal bleeding.
|Angiodysplasia and Crohn’s disease were the most common diagnoses.|
The team evaluated 100 consecutive patients who had recent negative findings on upper and lower endoscopy. Of these, 26 had ongoing overt bleeding (group A), 31 had previous overt bleeding (group B), and 43 had guaiac-positive stools and iron-deficiency anemia (group C).
The team found that the yield of positive findings on CE was 92% in group A, 13% in group B, and 44% in group C.
They found that angiodysplasia (29%) and Crohn’s disease (6%) were the most common diagnoses.
The doctors determined that sensitivity, specificity, and positive and negative predictive values of CE were 89%, 95%, 97%, and 83%, respectively.
The team established that the CE results led to bleeding resolution in 87% of patients undergoing the procedure while actively bleeding.
However, capsule retention occurred in 5 patients due to unsuspected stenosis. This required surgery, which resolved the clinical problem, in 4 patients.
Dr Marco Pennazio and colleagues concluded, "CE is an effective diagnostic tool for patients with obscure GI bleeding".
"The best candidates for the procedure are those with ongoing obscure-overt bleeding or with obscure-occult bleeding".
"If done early in the course of the workup, CE could shorten considerably the time to diagnosis, lead to definitive treatment in a relevant proportion of patients, and spare a number of alternative investigations with low diagnostic yield".