Obscure recurrent gastrointestinal bleeding: a revealed mystery?

Riccioni, Maria Elena; Urgesi, Riccardo; Cianci, Rossella; Marmo, C.; Galasso, Doménico; Costamagna, Guido

doi:10.3109/00365521.2014.898327

Cited by 16 publications

(15 citation statements)

References 32 publications

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“…Small bowel lesions were overlooked during conventional endoscopy, either because of intermittent bleeding nature of the lesions or because some lesions are really missed. In fact there are few studies showing bleeding lesions within the reach of conventional upper endoscopy/colonoscopy that have been obviously missed during the initial examination [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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

Akın

Yürekli

Bolat

et al. 2016

Diagnostic and Therapeutic Endoscopy

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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.

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Section: Introductionmentioning

confidence: 99%

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

Akın

Yürekli

Bolat

et al. 2016

Diagnostic and Therapeutic Endoscopy

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“…Maneuverability is the most important factor in determining whether CE can be effectively controlled in the gastrointestinal tract . In the present study, the SMCE device was advanced to the entire cardia and fundus, which were considered to be extremely challenging regions for active control in other studies …”

Section: Discussionmentioning

confidence: 51%

Standing‐type magnetically guided capsule endoscopy versus gastroscopy for gastric examination: multicenter blinded comparative trial

Lai

Wang

Cai

et al. 2019

Digestive Endoscopy

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Aim To compare feasibility and safety after gastrointestinal checkup by standing‐type magnetically controlled capsule endoscopy (SMCE) and conventional gastroscopy. Methods This was a prospective multicenter, blinded study that compared SMCE with gastroscopy in patients from April 2018 to July 2018. All patients first underwent SMCE and then subsequently had gastroscopy with i.v. anesthesia. We calculated the compliance rates of gastric lesion detection by SMCE using gastroscopy as the standard. Capsule retention rate, incidence of adverse events, and patient satisfaction were documented throughout the study. Results One hundred and sixty‐one patients who completed SMCE and gastroscopy were included in the analysis. Positive compliance rate among SMCE and gastroscopy was 92.0% (95% CI: 80.77%–97.78%). Negative compliance rate was 95.5% (89.80%, 98.52%). Moreover, overall compliance rate was 94.41% (89.65%, 97.41%). Sixty‐four pathological outcomes were identified. Of these 64 outcomes, 50 were detected by both procedures. The gastroscopy method neglected seven findings (such as five erosions, one polyp, and one ulcer). Furthermore, SMCE also overlooked seven lesions (i.e. one erosion, two polyps, one atrophy, and three submucosal tumors). Capsule retention or related adverse events were not reported. Conclusion Standing‐type magnetically controlled capsule endoscopy provides equivalent agreement with gastroscopy and may be useful for screening of gastric illnesses without any anesthesia.

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“…The rate of presence of bleeding sites outside of the small intestine appears to be large. In fact, previous reports demonstrated that the rates ranged 12.5–28 % [ 12 ]. However, because the detection rate of small bowel lesions by VCE in our study was equivalent to that of previous reports (65 % vs. 59.4–72.5 %), [ 13 – 15 ] our population does not appear to be skewed by inappropriate upper GI endoscopy or colonoscopy [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy

et al. 2015

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BackgroundBoth double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) have similar diagnostic yields for patients with overt obscure gastrointestinal bleeding (OGIB). However, the choice of initial modality is still controversial. The aim of this study was to show the clinical outcome of the strategy of initial VCE, followed by DBE.MethodsEighty-nine consecutive overt OGIB patients who had undergone VCE as the initial examination were analyzed. The interpreters of VCE evaluated the necessity of performing DBE, and the antegrade or retrograde route was chosen, depending on the transit time of the capsule.ResultsThirty-seven patients (42 %) underwent DBE depending on the findings of VCE. Of these, bleeding sites in the small bowel were identified in 29 patients with the initially selected route (21 antegrade and 8 retrograde). The remaining 8 later underwent DBE by the other route, but 7 had no bleeding lesion, which was confirmed by second-look VCE. One remaining patient had a jejunal varix found by VCE, but DBE from either side could not reach the lesion. The sensitivity and negative predictive value of VCE were 100 %, both for the presence of small bowel lesions and the requirement of hemostasis in the small bowel; this indicated that VCE never misses relevant findings in the small bowel, and that negative VCE findings correspond to the lack of necessity for further examination.ConclusionsVCE as the initial examination can efficiently identify overt OGIB patients who require DBE. The strategy of initial VCE for overt OGIB appears to be reasonable.

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Obscure recurrent gastrointestinal bleeding: a revealed mystery?

Abstract: Lesions in upper or lower GI tract have been missed in about 28% of patients submitted to CE for obscure bleeding. CE may play an important role in identifying lesions missed at conventional endoscopy.

Cited by 16 publications

References 32 publications

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

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

Standing‐type magnetically guided capsule endoscopy versus gastroscopy for gastric examination: multicenter blinded comparative trial

Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy

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