Efficacy and implications of a 48-h cutoff for video capsule endoscopy application in overt obscure gastrointestinal bleeding

Abstract

Background and study aims: Early video capsule endoscopy (VCE) may provide a high diagnostic yield and improve clinical outcomes in patients with overt obscure gastrointestinal bleeding (OGIB); however, there is no practical recommendation for the ideal timing of VCE application in overt OGIB. Therefore, this study investigated the diagnostic yield and efficacy of VCE to assess overt OGIB with respect to the timing of application. Patients and methods: We retrospectively enrolled patients who had undergone VCE for overt OGIB between April 2004 and February 2014 at a tertiary referral academic center. We included hemodynamically stable patients who underwent VCE for overt OGIB after negative bidirectional endoscopy. We analyzed the diagnostic yield of VCE, therapeutic intervention rate, and length of hospital stay. Results: A total of 94 patients underwent VCE to assess overt OGIB. The diagnostic yields in the groups that underwent VCE < 48 h and > 48 h from the last overt OGIB were 66.7 % and 40.6 %, respectively (P = 0.019). Therapeutic intervention was performed in 26.7 % and 9.4 % of patients in the < 48-h and > 48-h groups, respectively (P = 0.028). The mean lengths of hospital stay in the < 48-h and > 48-h groups were 5 days (95 % confidence interval [CI], 4.8 – 7.7) and 7 days (95 %CI, 6.9 – 10.1), respectively (P = 0.039). Conclusions: Performing VCE within 2 days from the last overt OGIB results in a higher diagnostic yield, higher therapeutic intervention rate, and shorter hospital stay. Therefore, VCE application with a 48-h cutoff could improve the outcome of patients with overt OGIB.

Small bowel capsule endoscopy

“…[ 34 ] This is important, especially for the detection of bleeding, where time might be critical. [ 35 ] Technical staff is already being trained for the viewing of the capsule video. [ 36 – 38 ] Our data show that precise indication for CE by a gastroenterologist leads to better diagnostic yield, and as a consequence makes treatment decisions possible.…”

“…In comparison to radiographic imaging techniques, CE is highly sensitive in the detection of occult arterial and venous bleeding, especially if done during bleeding episodes. [ 35 ] Its sensitivity is higher than CT-angiography or magnetic resonance enteroclysis. [ 39 ] Nevertheless, blood flow rates for bleeding detection by CE have not yet been described.…”

Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate - is sooner than 14 d advisable? Catarina Gomes, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Joana Silva, Jaime Pereira Rodrigues, Mafalda Sousa, João Carlos Silva, João Carvalho

“…When comparing different groups according to the timing of CE, previous studies have shown that the earlier the capsule study is started, the greater the DY achieved[ 13 , 16 , 25 - 30 ]. Several studies evaluating the timing from overt-OGIB to CE, such as 48-72 h[ 16 , 25 , 27 ], 1 wk[ 28 ], 10 d[ 29 ], 15 d[ 30 ] have already been reported, demonstrating that the DY was always superior whenever CE was performed earlier. In our study, that association was not found, since independently from the timing of CE, the DY was similar between all periods examined ( P > 0.05).…”

“…Using CE early in the course of overt-OGIB seems to be attractive, because of the higher DY, and even if no lesion is found, at least, it has the potential to localize the source of the bleeding[ 12 - 15 ]. However, the data is limited and the optimal timing for CE in overt-OGIB remains unclear[ 1 , 16 ].…”

Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol

“…It is highly acceptable that the sooner CE is performed, the higher the diagnostic value. CE within 2 days of the last overt gastrointestinal bleeding after negative bidirectional endoscopic findings could improve the management of these patients providing a more rapid, appropriate and cost-effective therapeutic plan [ 25 ]. CE was better than CTA in a previous study [ 26 ].…”