Wireless Capsule Endoscopy and Double-Balloon Enteroscopy in Japanese Patients with Obscure Gastrointestinal Bleeding

Abstract

Wireless Capsule Endoscopy and Double-Balloon Enteroscopy in Japanese Patients with Obscure Gastrointestinal Bleeding Masatsugu Shiba, Kazuhide Higuchi, Natsuhiko Kameda, Kaori Kadouchi, Hirohisa Machida, Kazuki Yamamori, Hirotoshi Okazaki, Masaki Hamaguchi, Tomoko Wada, Yoshio Jinnno, Eiji Sasaki, Kenji Watanabe, Kazunari Tominaga, Toshio Watanabe, Yasuhiro Fujiwara, Shirou Nakamura, Nobuhide Oshitani, Tetsuo Aeakawa Background: Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies and increasingly being used in the investigation of obscure gastrointestinal bleeding. Double-balloon enteroscopy is emerging as another interesting alternative or complementary method. We aimed to evaluate the clinical utility of capsule endoscopy and compare the usefulness of double-balloon enteroscopy with capsule endoscopy. Patiens and Methods: From March 2004 through October 2004, we examined by CE 26 patients with complained of obscure GI bleeding and between June 2004 and October 2004, we used double-balloon enteroscopy on 14 patients and retrospectively evaluated the usefulness of double-balloon enteroscopy compared with capsule endoscopy. All patients had undergone non-diagnostic EGD, colonoscopy, and barium contrast radiography of the small bowel. Results: M2A capsule endoscopy disclosed abnormal small bowel findings in 23 (88%) out of 26 patients. Sixteen of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 58% (15 of 26 patients). Definite bleeding sites diagnosed by capsule endoscopy in 15 patients included angiodysplasia (4), small-bowel erosion (8), small-bowel ulcer (1) small-bowel tumors (2). Double-balloon enteroscopy detected the definite sources of bleeding in 11 (79%) of the 14 patients. Patients with definite bleeding sources included small-bowel erosion (4), small-bowel ulcer (4) small-bowel tumors (2), angiodysplasias (1), small-bowel polyp (1), small-bowel hemorrhagic polyp (1) and not detectable (1). Double-balloon enteroscopy localized an additional bleeding source in comparison with capsule endoscopy in 4 patients. On the other hand, capsule endoscopy localized an additional bleeding source in comparison with double-balloon enteroscopy in 2 patients. Capsule endoscopy was well tolerated by all patients. One patient had a complication of capsule retention due to stricture of ileum. Conclusions: Many of the bleeding sources recognized by both imaging methods were small-bowel erosions or small-bowel ulcers in this study; although angiodysplasia was most popular bleeding source of obscure gastrointestinal bleeding in several Western studies. Double-balloon enteroscopy resulted in more positive findings than capsule endoscopy, although there is no significant difference in both imaging methods.