Abstract
Small bowel capsule endoscopy (SBCE) visualizes the small bowel (SB) mucosa. Gastrointestinal (GI) bleeding from SB accounts for the majority of SBCE indications. We aimed to assess, in a “real-world” prospective study, the diagnostic yield of SBCE in a cohort of consecutive patients with obscure gastrointestinal bleeding (OGIB). Secondary end point was to assess the frequency of adverse events and the role of SBCE in determining the diagnostic work-up and clinical outcome. From 2016 to 2018, all patients referred for SBCE examination were enrolled. Indication for SBCE was re-assessed by 2 dedicated gastroenterologists. Inclusion criteria: (1) age ≥ 18 and ≤ 85 years; (2) diagnosis of OGIB; 3) non-diagnostic standard bidirectional endoscopy; (4) informed consent. Exclusion criteria: (1) deglutition impairment; (2) SBCE contraindications; (3) pregnancy. The cohort included 50 patients [males 18 (36%), age 68 (27–83)]. SBCE indication: patients with ongoing overt OGIB (Group A) (n = 11; 22%), previous overt OGIB (Group B) (n = 14; 28%), occult bleeding (with Iron Deficiency Anaemia) (Group C) (n = 25; 50%). SBCE detected clinically relevant lesions in 46 (92%) cases. Clinically relevant lesions were more frequent in Group C (24/25; 96%), followed by Group A (10/11; 91%) and Group B (12/14; 85.5%). After SBCE, treatment was medical (60%); endoscopic (14%), surgical (36%) or conservative (18%). Clinical follow-up showed complete resolution in 63.2%, partial/absent resolution in 18.4% of cases. In a prospective study, the high diagnostic yield of SBCE supports its role as first-line investigation in patients with OGIB. However, this achievement requires an accurate and timely assessment by dedicated gastroenterologists.
Highlights
Small Bowel Capsule Endoscopy (SBCE) allows the visualization of the small bowel (SB) mucosa
After clinical re-assessment by 2 dedicated gastroenterologists referring to our Unit, 53 (63.1%) patients were reputed deserving SBCE examination (Fig. 1)
In a prospective study including a cohort of consecutive patients undergoing SBCE for Obscure gastrointestinal bleeding (OGIB), a high diagnostic yield was observed
Summary
Small Bowel Capsule Endoscopy (SBCE) allows the visualization of the small bowel (SB) mucosa. Indications for SBCE include the search for a wide spectrum of SB lesions. Gastrointestinal (GI) bleeding (overt or occult) from a SB source accounts for the majority of SBCE indications [2]. Since the introduction of SBCE in 2001 and of deep enteroscopy in 2004, most (~ 75%) of the previously defined “obscure bleeding” have been shown to originate from the SB. In these patients, SBCE should follow a complete, high quality standard upper and lower endoscopic examination [2, 3]
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