DOES CAPSULE ENDOSCOPY MAKE A DIFFERENCE IN THE MANAGEMENT OF PATIENTS WITH OCCULT GI BLEEDING?

Abstract

Purpose: Capsule endoscopy (C.E.) has been introduced as a new imaging technology to evaluate the small bowel. This has achieved widespread use in the assessment of occult GI bleeding. Emerging data suggest that the yield of C.E. to find small bowel lesions is superior to other current technologies. However, there are limited data regarding the usefulness of this technology in the daily management of patients with obscure GI bleeding. Aims: 1) To determine how C.E. results impact management of obscure GI bleed. 2) To evaluate patient tolerance and care impact as perceived by the patient. Methods: Designed as a retrospective pilot study. All consecutive patients that underwent C.E. from August 1999 until July 2002 were considered for inclusion. Two questionnaires were developed to assess impact and acceptance of C.E., one for patients and one for referring physicians. Patients were contacted by phone to obtain consent to participate in the study, to complete the patient questionnaire, and to obtain permission to contact their physicians to administer the physician questionnaire. Results: 38 of 41 patients eligible for study were contacted and agreed to participate. 97% of patients would be willing to repeat the procedure if required. 42% reported changes in their medical therapy based on C.E. results and 78% felt that C.E. made a difference in their care. 90% of these patients reported that capsule results limited or stopped further testing. 10.5% had definitive therapy (surgical, endoscopic or radiologic treatments) of the identified bleeding cause. From the physician perspective, 78% felt that C.E. results were of use in patient care. One physician referred a patient for surgical intervention and 4 others had plans to do so in the event of recurrent bleeding. 28% changed their management based on C.E. results and 86% limited the extent of further testing performed. Conclusions: Capsule endoscopy appears to be a well tolerated and beneficial study modality in the assessment of occult GI bleeding. Patient satisfaction appears to be high and physician treatment plans fairly responsive to the findings reported by capsule endoscopy. While these results are limited by the retrospective nature of this study capsule endoscopy seems to contribute positively to the management of patients with occult GI bleeding.