Diagnostic yield and therapeutic implications of capsule encloscopy in obscure gastrointestinal bleeding

Aim-The main aim of this study was to evaluate efficacy and therapeutic impact of capsule endoscopy (CE) in obscure gastrointestinal bleeding (OGIB). In addition, we evaluated the software of automatic detection of red zones (SBI, Given Imaging). Patients and methods-From June 2002 to June 2003, thirty-five patients with OGIB underwent capsule endoscopy after negative upper and lower digestive endoscopy. Capsule endoscopy was performed following a 12-hour fasting period and some received 2 L of PEG the night before for bowel preparation. Results-CE was performed for occult (N = 18) or overt (N = 17) OGIB. Potentially bleeding lesions were found in 16/35 patients (45.7%). Lesions were angiodysplasias (N = 8), ulcerations (N = 4), tumors (N = 2) and active bleeding without visible lesion (N = 2). Lesions were located in gastric antrum (N = 1), duodenum (N = 2) and jejuno-ileum (N = 13). Endoscopic (N = 10), surgical (N = 2) or medical (N = 1) treatments were performed in 13/35 (37%). SBI was retrospectively evaluated in 24 patients with sensitivity, specificity, positive and negative predictive value of respectively 45%, 73%, 50% and 69%. CE retention during 10 days occurred in a patient with a small bowel NSAID-induced stricture. Conclusion-CE is a safe and effective procedure in the management of OGIB and had a therapeutic impact in more than one third of patients.