Outcome of Patients With Obscure Gastrointestinal Bleeding After Capsule Endoscopy: Report of 100 Consecutive Patients

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Medscape Surgery 6(1), 2004. © 2004 Medscape

Gastroenterology

From

Gastroenterology

March 2004 (Volume 126, Number 3)

Outcome of Patients With Obscure Gastrointestinal Bleeding After Capsule

Endoscopy: Report of 100 Consecutive Patients

Pennazio M, Santucci R, Rondonotti E, et al

Gastroenterology. 2004;126(3):643-653

The authors used a new method, capsule endoscopy (CE), to investigate 100

consecutive patients with obscure gastrointestinal (GI) bleeding either

overt current, overt past, or with guaiac-positive stools plus anemia. The

patients swallowed a small capsule that transmits visual images of the

digestive tract to an external recorder. All patients in the study had

negative upper and lower GI tract studies. For patients with overt bleeding,

CE yielded positive findings in 24/26 patients (93%); for patients with

previous overt bleeding, the yield was 4/31 patients (13%); in patients with

anemia and guaiac-positive stool, the yield was 19/42 (44%). For the entire

group, CE was positive in 47 patients, negative in 38, and suspicious in 15

patients. CE was negative in 2 patients subsequently found to have duodenal

angiodysplasias.

Comment: Follow-up studies revealed a positive predictive value of 97%, a

negative predictive value of 83%, and an overall accuracy of 91%. The most

frequent lesions detected were angiodysplasias. Five patients needed surgery

because bowel stenosis caused capsule retention; surgery cured the

underlying bleeding in 4 of these patients. Capsule endoscopy is a new

modality for diagnosing obscure GI bleeding, always a source of concern to

the surgeon.