Capsule Endoscopy for Suspected Small Bowel Bleeding in Patients with Portal Hypertension

Cheon, Gang Il; Kim, Jin Oh; Hong, Sung Wook; Jeon, Seong Ran; Lee, Tae Hee; Kim, Hyun Gun; Cho, Won Young; Kim, Wan Jung; Kim, Min Jeong; Jeong, Sung Won; Jang, Jae Young; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong

Abstract

BACKGROUND/AIMS
In Korea, limited data are available on small bowel bleeding in patients with portal hypertension. This study reports on the use of capsule endoscopy in cases of suspected small bowel bleeding in patients with portal hypertension.
METHODS
Capsule endoscopy was used at our hospital to evaluate small bowel disease in 501 cases from July 2003 to June 2010. Of those cases, nine patients with portal hypertension due to liver cirrhosis with suspected small bowel bleeding were selected for the study. A retrospective analysis was performed using data from medical records.
RESULTS
Six of the nine (66.7%) patients were males with an average age of 53.4 years. The average hemoglobin level was 8.1 g/dL. Abnormalities noted during capsule endoscopy included portal hypertensive enteropathy in all nine cases (100%), jejunal varices in four (44.4%), jejunal and ileal angiodysplasia in five (55.5%), multiple small bowel erosions in one (11.1%), granularity of the jejunal mucosa in one (11.1%), and small bowel erythema in three (33.3%). Active bleeding from jejunal varices was detected in two patients (22.2%). Despite having no obvious active bleeding during the capsule endoscopy, four patients (44.4%) were diagnosed with portal hypertensive enteropathy with obscure small bowel bleeding.
CONCLUSIONS
Capsule endoscopy is a useful diagnostic tool for the evaluation of small bowel bleeding in patients with portal hypertensive enteropathy. Additional prospective and multicenter studies on the use of capsule endoscopy are needed to evaluate the incidence and clinical importance of portal hypertensive enteropathy.