Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

Abstract

Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.

Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia

“…Due to the clinical relevance, in the 50 % diagnostic yield, we included 4.4 % of findings outside the small bowel. Our lesion miss rate outside the small bowel is much lower than those reported in previous studies, which found that patients referred for small-bowel endoscopic imaging had a significant number of lesions within the reach of upper and lower endoscopy 27 28 29 . Fry et al 30 found 24.3 % of sources of gastrointestinal bleeding outside the small bowel with double balloon enteroscopy (DBE).…”

Non-small bowel lesion detection at small bowel capsule endoscopy: A comprehensive literature review

“…Akin et al[30] recently reviewed prospectively collected databases of patients referred to a tertiary teaching hospital in Turkey for potential small bowel bleeding, after inconclusive upper and lower conventional endoscopy. These patients were referred for SBCE and 114 met the inclusion criteria of the study[30].…”

“…Akin et al[30] recently reviewed prospectively collected databases of patients referred to a tertiary teaching hospital in Turkey for potential small bowel bleeding, after inconclusive upper and lower conventional endoscopy. These patients were referred for SBCE and 114 met the inclusion criteria of the study[30]. In 50% of cases a definite or likely cause of the bleeding was identified and amongst them, 8 patients (approximately 7%) were reported to have non-small bowel lesions within the reach of conventional endoscopy[30].…”

“…These patients were referred for SBCE and 114 met the inclusion criteria of the study[30]. In 50% of cases a definite or likely cause of the bleeding was identified and amongst them, 8 patients (approximately 7%) were reported to have non-small bowel lesions within the reach of conventional endoscopy[30]. The majority of these findings were identified in the caecum (5/8).…”

Initial experience of video capsule endoscopy at a tertiary center in Saudi Arabia

“…In fact, missing nonbleeding vascular lesions during upper and lower endoscopies is not uncommon; air insufflation and the required sedation are potential reasons for missing such lesions. [ 17 18 ] One valuable aspect of VCE is its physiological nature, as it does not require air insufflation or sedation, which increases the sensitivity for detecting vascular lesions.…”