Capsule Endoscopy for Obscure Gastrointestinal Bleeding

Abstract

Purpose: Obscure gastrointestinal bleed (OGIB) is difficult problem requiring extensive investigations. Capsule endoscopy, a new and potentially effective method to evaluate small bowel, may be useful for patients with OGIB. Methods: 16 patients with OGIB were evaluated using capsule endoscopy (Given Imaging Ltd., Yoqneam, Israel) during 19-mo period (from November 2003 to May 2005) after standard bowel preparation. Each patient was clinically evaluated. The images were downloaded to a computer after 8-h and examined by single investigator using a software (Rapid Reader). The patients with a definite diagnosis on capsule endoscopy received specific treatment and were followed-up. Results: Of 16 patients (median age 57-y, range 25 to 76; 9 males), symptomatic for a median duration of 15 months (range: 0.5 to 240), bleed was occult, overt or combined in 4, 9 and 3, respectively requiring blood transfusions (median 11 units, range 0 to 30). One patient presented with recurrent bleed after right-hemicolectomy and one other had negative exploratory laparotomy, both done elsewhere. Capsule endoscopy could detect the lesions potentially causing OGIB in 13 of 16 (81%) patients and these included isolated bleeding lesion in distal small bowel in one (ulcerated Meckel's diverticulum with bleeding at surgery), ulcerated stricture in small bowel in three patients (verified at surgery in two and one responded to anti-tubercular drugs), worms infestation (successfully treated with ivermectin), anastomotic ulcer in one, multiple angiodysplasia in two (verified by colonoscopy in both), isolated bleeding spot in duodenum in one, multiple small intestinal varices in two, small intestinal tumor in two (both verified by surgery) and no specific lesion in three patient. Though one patient had delayed capsule expulsion, none developed intestinal obstruction due to retained capsule. Conclusions: Capsule endoscopy is effective and safe for diagnosing lesions causing OBGIB.