Intest Res.  2016 Jan;14(1):69-74. 10.5217/ir.2016.14.1.69.

The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

• Pandey V
• Ingle M
• Pandav N
• Parikh P
• Patel J
• Phadke A
• Sawant P

• KMID: 2174512
• DOI: http://doi.org/10.5217/ir.2016.14.1.69

Abstract

BACKGROUND/AIMS
To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding.
METHODS
The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted.
RESULTS
Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62+/-14 years, for females 58+/-16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding.
CONCLUSIONS
CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital.

Keyword

Etiology; Gastrointestinal bleeding; Capsule endoscopy; Angiodysplasia; Small bowel ulcer

MeSH Terms

Angiodysplasia
Capsule Endoscopy*
Crohn Disease
Diagnosis*
Female
Follow-Up Studies
Hemangioma
Hemorrhage*
Humans
Ileum
Lymphangiectasis, Intestinal
Male
Polyps
Ulcer

Figure

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  Fig. 1 Shows total number of patients enrolled, their outcomes and complication rates study design. GI, gastrointestinal.

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  Fig. 2 OMOM™ capsule endoscopy.

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  Fig. 3 Diagnostic yield of capsule endoscopy.

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  Fig. 4 Frequency of various etiologies observed in positive endoscopy findings. AVM, angiodysplasia; NSAID, NSAID enteropathy; SI, small intestinal; Lymphang, intestinal lymphangiectasias.

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  Fig. 5 (A) Jejunal varix, (B) CD, (C) Jejunal polyp, (D) Angiodysplasia, (E) Intestinal lymphangiectasias, (F) Small bowel ulcer (active bleeding).

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