New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

Abstract

Objectives. Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P = 0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

Uncovering the uncertainty: Risk factors and clinical relevance of P1 lesions on small bowel capsule endoscopy of anemic patients

“…P2 lesions are known to have a high bleeding potential, with some studies reporting a rebleeding rate of up to 36.8%[ 16 ]. Different studies have also reported several factors that are associated with P2 lesions on SBCE of patients with IDA, namely NSAID and antiplatelet use, higher transfusion requirements, moderate to severe chronic kidney disease, older age, hypertension, hypercholesterolemia, and anticoagulants[ 6 , 7 , 17 , 18 ].…”

Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel

“… 53 Independent risk factors associated with an increased diagnostic yield of SBCE in OGIB include the presence of overt OGIB, 56 shorter interval between presentation and the procedure, 57 recurrent OGIB with >6 months of duration or more than one bleeding episode, 21 advanced age 50 and antithrombotic use. 58 The diagnostic yield may be further improved by the use of chromoendoscopy techniques, such as the Flexible Spectral Imaging Colour Enhancement (FICE, Fujinon Corporation ® , Saitama, Japan), incorporated in Given Imaging ® (Yoqneam, Israel) software, that enhance surface patterns to better observe mucosal lesions, 59 , 60 , 61 and the use of such techniques should be considered in patients where a strong suspicion for small bowel abnormalities remain despite a negative SBCE.…”

Does discontinuation of antithrombotics affect the diagnostic yield of small bowel capsule endoscopy in patients demonstrating obscure gastrointestinal bleeding?

“…Use of antithrombotics including antiplatelet agents and anticoagulants is associated with upper and lower GI bleeding. ( 8 – 10 ) Recent studies revealed that users of antithrombotics constitute a large proportion of OGIB patients who require examination of the small intestine using an SBCE, ( 5 , 11 ) and OGIB patients using antiplatelet agents and anticoagulants are more likely to show positive findings on SBCE examination than those not administered such agents. ( 11 , 12 )…”