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Asociación Mexicana de Gastroenterología

2005, Number 2

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Rev Gastroenterol Mex 2005; 70 (2)

Diagnostic utility and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding. Preliminary results.

García-Compean D, Armenta JA, González JA, Maldonado H

Language: Spanish
References: 33
Page: 120-128
PDF size: 90.43 Kb.


ABSTRACT

Introduction: Obscure gastrointestinal bleeding (OGIB) represents from 5 to 10% of all episodes of gastrointestinal bleeding. The diagnosis is difficult to make because in most cases it originates in the small bowel. Radiological methods have low sensitivity and push enteroscopy does not allow for examination of the whole length of the small bowel. Capsule endoscopy is a recently introduced method which allows for the complete examination of the small bowel. Only a few studies have assessed its clinical impact. Objective: To evaluate the diagnostic yield and the clinical impact of capsule endoscopy in patients with OGIB. Method: 28 patients were studied: 9 with iron deficiency anemia (32%), 14 with melena (50%) and 5 with melena and hematochezia (32%). They were 16 men and 12 women. Median values were: age 53 years (range 18-87), hemoglobin 7 g/dL (4-11), endoscopic and radiologic studies 4 (2-8), hospital admissions 3 (1-5) and transfused blood units 5 (0-52). Results: Capsule endoscopy detected bleeding and non-bleeding lesions in 23 patients (82%). The diagnoses were: angiodysplasia in 10 patients (36%); ulcers in 7 (25%) and neoplasm in 6 (21%). In 12 patients (43%) findings motivated the performance of other diagnostic or therapeutic procedures: 8 patients were operated on (6 with neoplasm and 2 with stenotic ulcers); 3 received endoscopic treatment for angiodysplasia and ulcers; and one patient was submitted to ileoscopy with biopsy for Crohn´s disease. There were no complications and good tolerance was observed. Conclusions: Capsule endoscopy had a diagnostic yield of 82% and a clinical impact of 43% in this highly selected group of patients with OGIB in whom no other endoscopic or radiologic procedures could lead to the diagnosis.


REFERENCES

  1. Peterson W. Obscure gastrointestinal bleeding. Med Clin North Am 1988; 72: 1169-76.

  2. Netterville R, Hardy J, Martin R. Small bowel hemorrhage. Ann Surg 1968; 167: 949-57.

  3. Thompson J, Salem R, Hemingway A. Specialist investigation of obscure gastrointestinal bleeding. Gut 1987; 28: 47-51.

  4. Spechler S, Schimmel E. Gastrointestinal tract bleeding of unknown origin. Arch Intern Med 1982; 142: 236-40.

  5. Fried A, Poulos A, Hotfield D. The effectiveness of the incidental small bowel series. Radiology 1981; 140: 45-6.

  6. Rex D, Lappas J, Magliate D. Enteroclysis in the evaluation of suspected small intestinal bleeding. Gastroenterology 1989; 97: 58-60.

  7. Voeller GR, Bunch G, Britt L. Use of technetium labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage. Surgery 1991; 110: 799-804.

  8. Rollins ES, Picus A, Hicks M, et al. Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin. Am J Roentgenol 1991; 156: 385-8.

  9. Barkin JS, Lewis BS, Reiner D, et al. Diagnostic and therapeutic jejunoscopy with a new, long enteroscope. Gastrointest Endosc 1994; 40: 15.

  10. Chong J, Tagle M, Barkin JS, et al. Small bowel push-type enteroscopy for patients with occult gastrointestinal bleeding of suspected small bowel pathology. Am J Gastroenterol 1994; 89: 2143-6.

  11. American Gastroenterological Association medical position statement. Evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 197-200.

  12. Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature 2000; 405: 417.

  13. Lewis B, Goldfarb N. Review article: the advent of capsule endoscopy- a not-so-futuristic approach to obscure gastrointestinal bleeding. Aliment Pharmacol Ther 2003; 17: 1085-96.

  14. Barouk J, Sacher-Huvelin S, Le Rhun M, et al. La capsule endoscopique: une technique d’avenir? Gastroenterol Clin Biol 2002; 26: 879-82.

  15. 15.Scapa E, Jacob H, Lewkowicz S, et al. Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology. Am J Gastroenterol 2002; 97: 2776-9.

  16. 16.Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002; 123: 999-1005.

  17. Voderholzer WA, Ortner M, Rogalla P, et al. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy 2003; 35: 1009-14.

  18. Lewis B, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc 2002; 56: 39-53.

  19. Ell C, Remke S, May A, et al. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 2002; 34: 685-9.

  20. Adler DG, Knipschield M, Gostout C. A prospective comparison of capsule endoscopy and push enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 2004; 59: 492-8.

  21. Appleyard M, Fireman Z, Glukhovsky A, et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small bowel lesions. Gastroenterology 2000; 119: 1431-8.

  22. Pennazio M, Santucci R, Rondonotti E, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004; 126: 643-53.

  23. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993; 88: 807-18.

  24. Mata A, Bordas M, Feu F, et al. Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy. Aliment Pharmacol Ther 2004; 20: 189-94.

  25. Junquera F, Feu F, Papo M, et al. A multicenter, randomized clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology 2001; 121: 1073-9.

  26. Barkin J, Friedman S. Wireless capsule endoscopy requiring surgical intervention: the world’s experience. Am J Gastroenterol 2002; 97: S298.

  27. Bhinder F, Schneider DR, Farris K, et al. NSAIDs associated small intestinal ulcers and strictures: diagnosis by video-capsule enteroscopy (Abstr). Gastroenterology 2002; 122: A345.

  28. Rösch T. DDW reports 2003 Orlando: Capsule endoscopy. Endoscopy 2003; 35: 816-22.

  29. Cave DR, Wolff R, Mitty R, et al. Indications, contraindications and an algorithm for the use of M2A video capsule in obscure G-I bleeding (Abstr). Gastrointest Endosc 2002; 55: AB 136.

  30. Riccioni ME, Hasaj O, Spada C, et al. M2A patency capsule to detect intestinal strictures: Preliminary results. Program and abstracts of the Second Conference on Capsule Endoscopy, Berlin. March 23-25, 2003: 169.

  31. Faigel DO. Cutting the cord for capsule endoscopy. Gastroenterology 2002; 123: 1385-8.

  32. Goldfarb H, Phillips A, Conn M, Lewis B, Nash D. Economic and health outcomes of capsule endoscopy. Dis Manage 2002; 5: 123-35.

  33. Giasi-Gonzalez E, Garcia-Compean D, Maldonado H. Relación costo-beneficio de la capsuloendoscopia en el diagnóstico de la hemorragia gastrointestinal de origen oscuro: Reporte de 24 casos. Rev Gastroenterol Mex 2004; 69(Abstr): S308.




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