Influence of Patient Selection on the Outcome of Capsule Endoscopy in Patients with Chronic Gastrointestinal Bleeding

Abstract

BACKGROUND The published success rates of capsule endoscopy (CE) in the detection of definite bleeding sources in patients with chronic gastrointestinal bleeding (CGB) range from 48 to 76%. Up to now, the influence of selection of the patients on the number of positive findings in the CE, is not clear. METHODS Between April 2001 and Juni 2003 127 patients with CGB and suspected bleeding source in the small bowel were referred to our unit. In 74 patients (58%) CE was performed; 70 of these 74 patients could be enrolled in the analysis. These 70 patients (32 men, 38 women) with a mean age of 57.8 (range 14 to 90) years were devided into two groups: the so-called study group (32 patients; prospective study, published in Endoscopy 2002) and the post-study group (38 patients, retrospective analysis). The patients data and results of CE of these two groups were compared with one another. RESULTS In the study group the selection of patients was done with more restraint than in the post-study group: 49% (32/65) vs. 65% (38/58) patients received a CE. The overall success rate of CE in the detection of definite bleeding sources was 54% (38/70 pats.); in the study group in 66% (21/32 pats.) and in the post-study group only in 45% (17/38 pats.) a relevant bleeding source could be seen. There were no significant differences regarding the patients data such as age, sex, taking of anticoagulant medication, duration of CGB and type of bleeding (overte, occult). Significant differences were found as follows: in the study group the lowest hemoglobin level (mean 5.9g/dl) was significant lower than in the post-study group (mean 7,7 g/dl) and the number of blood units that had been transfused was significant higher in the study group (median of 10 units vs. 2 units in the post-study group). No patient with a lowest hemoglobin level during the bleeding period of more than 10g/dl had a positive CE. CONCLUSION The selection of patients is very important for the success rate of CE. In case of patients with CGB the lowest hemoglobin level and the number of blood transfusions seem to be the main factors.