Performance of PILLCAMSB3 Video-Capsule Endoscopy in the Diagnosis of the Non-Small Bowel Hemorrhagic Lesions Undetected by Upper and Lower Digestive Endoscopy

Abstract

Introduction: Videocapsule endoscopy (VCE) is a minimally invasive approach to visualize the mucosal surface of the gastrointestinal tract. It was initially used in the evaluation of small-bowel lesions, however many studies showed that it has a potential role in evaluating other digestive segments as the stomach and large bowel. Our study aim to assess the diagnostic performance of VCE after a non-conclusive upper and lower digestive endoscopy and to highlight the comfort and the diagnostic efficiency of this tool. Materials and Methods: In this monocentric and descriptive study, we include all patients who underwent a Pillcam SB3 VCE (59 patients), from July 2018 to Semptember 2022, after a normal gastroscopy and ileocoloscopy. All the patients received a preparation by PEG (2l the day before ingestion of the capsule) with clear broth the day before the examination, and a 10 days off oral iron if previously prescribed. Results: 59 patients were included and 15 VCE (25%) allowed the diagnosis of non-small haemorrhagic lesions, unnoticed by usual endoscopy. The main indication for VCE was an unxplained digestive bleeding (73%) with an average hemoglobin level of 5,4g/dL. The mean age was 59 years (23-90 years) with a femal predominance (sex-ratio:0,6). 40% of the patients had a chronic renal failure, 13% had a portal hypertension, 13% had a history of heart disease, 6% had a Rendu-Osler disease. 13% of patients were on antiplatelet agent, 6% on anticoagulants therapy and 6% on non-steroidal anti-inflammatory drugs. The mean time between the onset of symptoms and the VCE was 26,3months. The lesions noticed by VCE were: angiodysplasia (80%), with different localizations: gastric (46%), duodenal (21%), cecal (21%), bulbar (12%) and Forrest III gastric ulcerations (20%). The diagnostic yield of VCE in non-small bowel hemorrhagic lesions was 25%. Conclusion: The VCE represents the most patient-friendly alternative method of examination. It is a first-line approach in the evaluation of small-bowel lesions, but it can also detect upper and lower digestive lesions. However, we believe that the slightest doubt concerning the quality of the first upper and lower digestive endoscopies in patients with digestive bleeding and/or anemia should lead to the repetition of the conventional endoscopies before performing VCE.