Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding.

Abstract

Capsule endoscopy (CE) has high positive (95%) and negative predictive values (83- 100%) for the bleeding source in patients with obscure gastrointestinal bleeding (OGIB) but the diagnostic yield is influenced by the timing of the examination and the nature of the bleeding. We investigated the role of early CE in the diagnosis of patients with overt OGIB. Patients were divided into 4 groups according to the interval between bleeding and CE. The diagnosis rate and clinical outcomes including type of intervention and recurrent bleeding were compared. The association between the timing of CE and small bowel lesions detected by CE was also analysed. Ninety patients with overt OGIB underwent CE. CE revealed the bleeding source in 46 patients (51%). The diagnosis rate was 73%, 48%, 50% and 35% in 1st, 2nd, 3rd and 4th quartiles (p=0.08). The duration between bleeding and CE was shorter for patients with angioectasia than for those with other abnormalities. The proportion of surgeries and endoscopic interventions was significantly higher in 1st and 2nd quartiles than 3rd and 4th quartiles (p=0.048). Earlier timing of CE achieved a higher diagnostic yield for patients with overt OGIB and consequently resulted in a higher intervention rate.