Capsule Endoscopy versus Standard Tests in Influencing Management of Obscure Digestive Bleeding: Results from a German Multicenter Trial

Neu, Bruno; Ell, Christian; May, Andrea; Schmid, Elke; Riemann, J F; Hagenmüller, F; Keuchel, Martin; Soehendra, Nib; Seitz, Uwe; Meining, Alexander; Rösch, Thomas

doi:10.1111/j.1572-0241.2005.41649.x

Cited by 98 publications

(44 citation statements)

References 23 publications

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“…The diagnostic yield of CE in OGIB in the present study (36%) was lower than those reported in western literatures (42%-71%) [6,7,[10][11][12][13][14][15][16] and those reported in metaanalyses (61%-63%) [3,4] . There are many possible reasons.…”

Section: Discussioncontrasting

confidence: 83%

“…The very low rebleeding rate in patients with positive CE results (together with appropriate management according to the CE findings) is found to be lower than those reported from the West [6,7,[10][11][12][13][14][15][16] . The low rebleeding in our study could be due to the spontaneously improved nature of the disease (i.e., NSAID-induced ulcers) and the ability to provide specific treatments, i.e., surgery for small bowel tumors, which were also prevalent in this study.…”

Section: Discussionmentioning

confidence: 74%

“…Most small bowel ulcers were able to heal spontaneously within days to weeks. Secondly, the low diagnostic yield might be due to the low prevalence of angiodysplasia in Thai patients (27%) which is the major cause of OGIB in other studies (33%-79%) [6,7,[10][11][12][13][14][15][16] . The finding that small bowel ulcer, instead of angiodysplasia was the most common cause of OGIB in this study needs attention.…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

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Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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AIM:To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB). METHODS:The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients' medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients' outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients. RESULTS:Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy's (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001). CONCLUSION:In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 74%

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

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Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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“…This implies that a normal examination may not always expedite a diagnosis; however, it allows the physician to quit a certain line of investigations and advocate an expectant approach. One of the first studies trying to assess the cumulative re-bleeding rate of OGIB was published in 2005 by Neu et al (18). In this prospective, multicenter study, re-bleeding occurred more frequently in patients with positive than negative VCE (44.7% vs. 22.2%) after 13-month follow-up period.…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 97%

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

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Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

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“…In particular, depletion of the two silver oxide batteries used in current devices may prevent complete imaging of the small intestine if the pill remains in the stomach for too long. The problem becomes most apparent by the inability to view the cecum (the marker of a complete examination) in 10%-15% of CE examinations of the small bowel (Neu et al,2005;Triester et al,2006).This will eventually be overcome by using power transfer methods from outside the body. In the short term, this problem can partly be solved by using more efficient power management algorithms that enable an 11 h recording time.…”

Section: Next Generation Capsule Endoscopymentioning

confidence: 99%

Capsule Endoscopy: A Comprehensive Review

Jain¹,

Jain²

2011

New Techniques in Gastrointestinal Endoscopy

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Capsule Endoscopy versus Standard Tests in Influencing Management of Obscure Digestive Bleeding: Results from a German Multicenter Trial

Abstract: CE helps with management decisions and can replace other more complex and risky standard tests. Nevertheless, clinical parameters are equally important for predicting further bleeding and should also be used to decide on further management.

Cited by 98 publications

References 23 publications

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

Capsule Endoscopy: A Comprehensive Review

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