The position of capsule endoscopy relative to push enteroscopy in the diagnostic algorithm of obscure gastrointestinal bleeding is unclear.
Previous studies involved the use of both techniques in all patients.
Dr Raymond Jian and colleagues from France conducted a 12-month trial in which patients were randomized to undergo either of the explorations.
|Capsule endoscopy identified a bleeding source in 50% of patients|
The alternative method was only used if the first-line method revealed no definite bleeding source, or if required for clinical reasons during follow-up.
The team randomized 40 to receive capsule endoscopy and 38 to push enteroscopy.
The researchers found that capsule endoscopy used as the first-line exploration, identified a bleeding source in 50% of patients.
The team observed that push enteroscopy used as a first-line exploration identified a bleeding source in 24% of patients.
Capsule endoscopy missed lesions in 8% of patients, and all these lesions were located in sites accessible to standard endoscopy.
The research team noted that push enteroscopy missed lesions in 26% of patients.
Capsule endoscopy followed by push enteroscopy only if necessary was similar to using push enteroscopy as a first-line exploration in terms of diagnostic yield.
The team noted that clinical outcome, and therapeutic impact were also similar using either strategy.
However, using capsule endoscopy as a first-line exploration reduced the percentage of patients needing the alternative exploration.
Dr Jian's team concluded, “Capsule endoscopy has a higher diagnostic yield than push enteroscopy in obscure gastrointestinal bleeding.”
“A strategy based on capsule endoscopy as first-line exploration avoids unnecessary explorations.”