Capsule endoscopy urged for obscure GI bleeding.
Dr. Jorg G. Albert and associates at Martin-Luther-University Hospitals and Clinics in Halle, Germany, reported on 293 capsule endoscopy results in 285 patients seen at five study centers between 2001 and 2004.
Capsule endoscopy identified a bleeding source in 224 patients (76.5%) who had previously undergone bidirectional endoscopies that produced inconclusive results. The data showed that capsule endoscopy was diagnostic in 177 (79%) of these patients, and a repeat capsule endoscopy or additional testing was diagnostic in another 47 patients (21%). In 142 cases, therapeutic measures were initiated based on capsule endoscopy findings. In these cases, the treatments selected were medical therapy in 46%, an endoscopic procedure in 31%, and surgery in 23%.
Capsules were retained in four patients, three of whom required surgery to remove the device, which is swallowed by the patient and transmits images from within the digestive tract.
The most common diagnosis was an-giodysplasia, in 40% of patients. Other relatively common diagnoses included bleeding ulcers in 9%, NSAID enteropa-thy in 6%, suspected malignant tumors in 3%, and Crohn's disease, Meckel's diverticulum, and bleeding diverticulum in 2% of cases each.
No source of bleeding was found in 24% of patients, and these patients experienced half the rate of bleeding recurrences, compared with the group as a whole.
"We were able to follow-up 84% of patients for at least 12 months and a mean of 20 months," Dr. Albert said in an interview. "One of the main results was that a negative capsule endoscopy resulted in a low rate of recurrence of bleeding events and hospital admission." In contrast, angiodysplasia was associated with a 6.6-times elevated rate of relapse.
In all, 27% of patients reported a re-bleeding episode, with 18% requiring readmission to the hospital and 15% requiring blood transfusions.
Strong predictors of recurrence included a diagnosis of angiodysplasia, use of anticoagulants, patient age older than 60 years, and prior bleeding events.
The investigators emphasized the usefulness of capsule endoscopy in their poster: "A specific change in management is implemented in about two-thirds of cases in whom capsule endoscopy establishes a diagnosis, and in half of all patients investigated, and it seems to influence outcome," they stated.
"Capsule endoscopy might therefore be regarded as the first-line diagnostic method in intestinal bleeding following negative bidirectional endoscopy."
Dr. Albert reported having no conflicts of interest.
BY BETSY BATES
Los Angeles Bureau
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|Title Annotation:||Gastroenterology; gastrointestinal|
|Publication:||Internal Medicine News|
|Article Type:||Clinical report|
|Date:||Aug 1, 2006|
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