Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin?

Background. Capsule endoscopy is becoming the investigation of choice for GI bleeding of obscure etiology. This study examined whether clinical or other features predict an increased likelihood of finding a lesion in patients with this type of bleeding. Methods: Clinical and other data were collected prospectively for 92 patients undergoing capsule endoscopy for GI bleeding of obscure origin. Patients were divided into two groups: those with overt bleeding (42 patients) and those with anemia alone (50 patients). The relationship between these data and the findings at capsule endoscopy was examined. Results: A definite or probable cause of bleeding was found in 60 patients (angiodysplasias 47, tumor 7, ulcer 3, gastric antral vascular ectasia 2). There was no difference between the two groups with respect to age, gender, mode of presentation, duration of bleeding, or need for transfusion. Lesions were found as often in patients who had only one preceding endoscopy and colonoscopy as in those who had multiple procedures. Colonic cleansing and cecal imaging by the capsule did not influence the result. Hospitalized patients were more likely to have an actively bleeding lesion detected. Conclusions: Capsule endoscopy is equally useful in patients with overt and occult GI bleeding of obscure origin. Capsule endoscopy should be performed early in the evaluation of these patients.