A Retrospective Study to Determine the Ability of Video Capsule Endoscopy to Detect Upper Gastrointestinal Pathology Compared to Standard Endoscopy in Patients with Obscure Bleed

Abstract

Purpose: Currently no dedicated studies comparing upper gastrointestinal findings on video capsule endoscopy (VCE) to standard upper endoscopy (EGD) exist. The purpose of this retrospective study is to examine whether VCE and EGD can detect similar upper gastrointestinal findings in patients with obscure bleeding. Methods: All patients 18 years or older who presented with obscure bleeding and underwent both EGD and VCE within 1 month of each other at Beth Israel Medical Center were retrospectively reviewed from January 2000 to December 2007. All VCEs were performed with the M2A (Given) Pillcam. Each VCE and EGD report was blindly reviewed and findings were noted for both modalities. Patient demographics, dates, indications, findings, gastric transit time, and post endoscopy Rockall scores were collected. Data was analyzed by Spearman correlation coefficients and descriptive statistics. Results: Sixty-five (31 M:34 F) subjects were enrolled. Mean age was 66.5 years (18–96). The indication was 38% for iron deficiency anemia and 62% for occult bleeding. The duodenum was reached in 100% of subjects. The mean gastric transit time was 35.2 seconds. See Table 1 for findings. One duodenal ulcer was detected on VCE and fresh blood was seen on the corresponding EGD. Unremarkable VCE exams had corresponding non-significant findings on EGD 82% of the time. Post endoscopy Rockall scores for the VCE and EGD were 0.55 and 0.47 respectively, with a Spearman correlation coefficient of 0.29 (P= 0.0191). Rockall scores agreed perfectly 55% of the time and by one unit 97% of the time.Table 1: Comparison of FindingsConclusion: Video capsule endoscopy and standard upper endoscopy appear to have similar detection rates for upper gastrointestinal pathology in patients presenting with obscure bleeding. The correlation appears to be strongest for erosive and non-erosive gastroduodenitis. VCE appears to detect more vascular lesions compared to EGD. The majority of unremarkable exams on VCE corresponded to non-significant findings on EGD.