Clinical impact of capsule endoscopy on further strategy and long-term clinical outcome in patients with obscure bleeding

Background: Capsule endoscopy (CE) is highly effective in detecting small-bowel lesions in patients with obscure GI bleeding (OGIB). Little is known about the impact of CE on further management and outcomes in patients with OGIB. Objective: To evaluate the impact of CE on the management and outcomes of patients with OGIB. Design: Retrospective cohort study. Setting: Tertiary-referral center. Patients: A total of 92 patients referred for obscure-overt bleeding (N = 36) or obscure-occult bleeding (N = 56). Interventions: CE was performed after a negative endoscopic examination of the upper-GI and lower-GI tract. Follow-up was performed by collecting information from the referring physicians. Main Outcome Measurements: Need for transfusion, overt bleeding, anemia. Results: Ninety-two patients (52 men, 40 women), with a mean age of 66.5 years (range 22-90 years) and a mean follow-up time of 635.5 days (range 81-1348 days) were studied. Relevant lesions were found in 55 of 92 patients (59.8%). After a CE, invasive small-bowel investigations were more often done in patients with a positive CE result (P = .01). Invasive endoscopic or surgical therapy was far more often performed in patients with a positive CE finding (P < .001). The outcome after a CE was favorable in 61 of 92 patients (66.3%) and was defined by the absence of overt bleeding and a normal Hb value on the latest available laboratory result. In the younger age category, a 100% resolution of OGIB was observed after long-term follow-up. On the contrary, angiodysplasia was a predictor for a less favorable clinical outcome (P = .04). Limitations: Retrospective analysis. Conclusions: A CE has an important impact on a further diagnostic workup, therapeutic strategy, and long-term clinical evolution in patients with OGIB, with a favorable outcome in 66.3% of patients after CE-guided therapy.