Scientists from Spain prospectively examined the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding.
They analyzed 42 patients (22 men and 20 women) with obscure gastrointestinal bleeding. Overt bleeding was present on 26 cases and occult blood loss with chronic anemia in 16.
| Bleeding site identified:|
Capsule endoscopy – 74%Enteroscopy – 19%
|Alimentary Pharmacology & Therapeutics|
All subjects had normal colonoscopy and esophagogastroduodenoscopy.
Each patient was instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days, with both techniques being blindly performed by separate examiners.
The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding.
The study showed that a bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; 8 of 42).
The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumor (6%).
No additional intestinal diagnoses were made by enteroscopy. In 7 patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach.
The authors conclude that, compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.