Roles of Capsule Endoscopy and Single-Balloon Enteroscopy in Diagnosing Unexplained Gastrointestinal Bleeding

Abstract

Background/Aims:The diagnostic algorithms used for selecting patients with obscure gastrointestinal bleeding (OGIB) for capsule endoscopy (CE) or balloon-assisted enteroscopy (BE) vary among facilities. We aimed to demonstrate the appropriate selection criteria of CE and single balloon-assisted enteroscopy (SBE) for patients with OGIB according to their conditions, by retrospectively comparing the diagnostic performances of CE and BE for detecting the source of the OGIB. Methods:We investigated 194 patients who underwent CE and/or BE. The rate of positive findings, details of the findings, accidental symptoms, and hemostasis methods were examined and analyzed.Results:CE and SBE were performed in 103 and 91 patients, respectively, and 26 patients underwent both examinations. The rate of positive findings was significantly higher with SBE (73.6%) than with CE (47.5%, p<0.01). The rate of positive findings was higher in overt bleeding cases than in occult bleeding cases for both BE and SBE. Among the overt bleeding cases, the rate was significantly higher in ongoing bleeding cases than in previous bleeding cases. Conclusions:Both CE and SBE are useful to diagnose OGIB. For overt bleeding cases and ongoing bleeding cases, SBE may be more appropriate than CE because endoscopic diagnosis and treatment can be completed simultaneously.

Diagnostic Value and Safety of Emergency Single-Balloon Enteroscopy for Obscure Gastrointestinal Bleeding

“…Patients who had overt or occult bleeding within 24 hours after hospital admission underwent emergency SBE. Otherwise, nonemergency SBE was applied [24,25]. All patients and/or their authorized family members provided a signed written informed consent for the SBE examination and treatment (if needed).…”

Anisakiasis in the Small Intestine with Excessive Bleeding That Was Difficult to Diagnose Endoscopically

“…Bleeding in the small intestine is mainly caused by erosions, ulcers, vascular malformations, diverticula, and inflammatory bowel disease (7). Annually, about 20,000 cases of anisakiasis are reported around the world; of these cases, 90% involve the stomach, and only 4-5% involve the small intestine (2,6,8).…”

“…The primary site of bleeding was deep in the small intestine, making it difficult to diagnose the patient endoscopically. Ooka et al reported that SBE is superior to CE for identifying the primary site of bleeding, with 73.6% and 47.5% of cases identified, respectively (7). In the present case, it was not possible to identify the location despite multiple endoscopic examinations; this may be because the primary site of bleeding was in the small intestine between the deepest points of reach for both the anterograde and retrograde routes, and the visibility was significantly reduced due to the large amount of blood in the stool.…”

Obscure Gastrointestinal Bleeding: Capsule or Balloon?

“…In this issue of Clinical Endoscopy , Ooka et al [ 3 ] reported that the rate of positive findings for OGIB was significantly higher with SBE (73.6%) than with CE (47.5%), and SBE may be more appropriate for overt OGIB. However, caution is required in the interpretation of the results of this report.…”

“…Diagnostic yield of CE and BAE for patients with overt bleeding is higher than that for patients with occult bleeding, and the diagnostic yield for patients with ongoing overt bleeding is higher than that for patients with previous overt bleeding. In Ooka’s study [ 3 ], the percentage of patients with overt bleeding was higher in the SBE group than in the CE group (80.8% vs. 58.4%), and ongoing overt bleeding was also more frequent (100.0% vs. 90.9%) in the SBE group. The results might have changed if the authors performed multivariate analyses according to the amount and timing of bleeding.…”