Obscure Gastrointestinal Bleeding Research Articles

A rare cause of obscure gastrointestinal bleeding: Chronic enteropathy associated with SLCO2A1 mutation in a case from India

A rare cause of obscure gastrointestinal bleeding: Chronic enteropathy associated with <i>SLCO2A1</i> mutation in a case from India

Could Capsule Endoscopy Be Useful in Detection of Suspected Small Bowel Bleeding and IBD-10 Years of Single Center Experience.

A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel-Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn's disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel's diverticulum and Crohn's disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.

Video capsule endoscopy in overt and occult obscure gastrointestinal bleeding: Insights from a single-center, observational study in Japan.

This study aimed to evaluate the use of video capsule endoscopy (VCE) in patients with obscure gastrointestinal bleeding (OGIB), compare cases of overt and occult OGIB, assess the rates of balloon-assisted enteroscopy (BAE) interventions and rebleeding, and identify predictive markers of positive VCE findings. Medical records of 430 patients who underwent VCE for OGIB between 2004 and 2022 were analyzed. Occult OGIB was defined as IDA or positive fecal occult blood, whereas overt OGIB was defined as clinically imperceptible bleeding. We retrospectively analyzed demographics, VCE findings based on Saurin classification (P0, P1, and P2), outcome of BAE interventions, and rebleeding rates. A total of 253 patients with overt OGIB and 177 with occult OGIB were included. P1 findings were predominant in both groups, with a similar distribution. The percentage of patients receiving conservative therapy was higher in P1 than in P2 for both overt and occult OGIB. BAE was more frequently performed in P2 than in P1 VCE (83.0% vs. 35.3% in overt OGIB, 84.4% vs. 24.4% in occult OGIB). The percentage of positive findings and intervention in total BAE performed patients were comparable in P1 and P2 of overt OGIB, whereas these percentages in P2 were more than P1 of occult OGIB. VCE effectively identified OGIB lesions requiring intervention, particularly occult OGIB lesions, potentially reducing unnecessary BAE. Rebleeding rates varied according to the VCE findings, emphasizing the importance of follow-up in high-risk patients.

Capsule endoscopy for obscure gastrointestinal bleed in the tropics: A single-center experience on 350 patients.

Obscure gastrointestinal bleed (OGIB), now called small bowel bleed (SBB), comprises 5% to10% of all gastrointestinal (GI) bleed episodes and capsule endoscopy (CE) is a tool for its evaluation. Studies on CE in a large sample of SBB patients from the tropics are limited. We did a retrospective analysis of a prospectively maintained database of patients with SBB undergoing CE using PillCam or MiroCam CE. Of 350 patients (age 52.4 ± 17.4years; 248 [70.9%] male) undergoing CE, 243 (69.4%) and 107 (30.6%) had overt and occult SBB, respectively. CE detected lesions in 244 (69.7%) patients (single lesion in 172 [49.1%]; multiple in 72 [20.6%]). The single lesions included vascular malformations (52, 14.9%), ulcer/erosion (47, 13.4%), tumor (24, 6.9%), hookworm (19, 5.4%), stricture (15, 4.3%), hemobilia (1, 0.3%) and blood without identifiable lesion (9, 2.6%). Of 72 with multiple lesions, ulcer with stricture was the commonest finding (n = 43, 12.3%). No abnormality was detected in 106 (30.3%) patients. The frequency of lesion detection was comparable among patients with overt and occult SBB (173/243, 71.2% vs. 71/107, 66.3%, respectively; p = 0.4). Younger patients (0 to 39years) more often had multiple lesions on CE than the older (≥ 40years) ones (26/76, 34.2% vs. 46/228, 20.2%, respectively; p = 0.001). CE has a high diagnostic yield in SBB in the tropics, regardless of the type of bleed or of CE brand and the duration of recording. Multiple lesions associated with SBB are commoner among younger (< 40years) patients.

Hypoxia and low-glucose environments co-induced HGDILnc1 promote glycolysis and angiogenesis

Small bowel vascular malformation disease (SBVM) commonly causes obscure gastrointestinal bleeding (OGIB). However, the pathogenetic mechanism and the role of lncRNAs in SBVM remain largely unknown. Here, we found that hypoxia and low-glucose environments co-augment angiogenesis and existed in SBVM. Mechanistically, hypoxia and low-glucose environments supported angiogenesis via activation of hypoxia and glucose deprivation-induced lncRNA (HGDILnc1) transcription by increasing binding of the NeuroD1 transcription factor to the HGDILnc1 promoter. Raised HGDILnc1 acted as a suppressor of α-Enolase 1 (ENO1) small ubiquitin-like modifier modification (SUMOylation)-triggered ubiquitination, and an activator of transcription of Aldolase C (ALDOC) via upregulation of Histone H2B lysine 16 acetylation (H2BK16ac) level in the promoter of ALDOC, and consequently promoting glycolysis and angiogenesis. Moreover, HGDILnc1 was clinically positively correlated with Neurogenic differentiation 1 (NeuroD1), ENO1, and ALDOC in SBVM tissues, and could function as a biomarker for SBVM diagnosis and therapy. These findings suggest that hypoxia and low-glucose environments were present in SBVM tissues, and co-augmented angiogenesis. Hypoxia and low-glucose environments co-induced HGDILnc1, which is higher expressed in SBVM tissue compared with normal tissue, could promoted glycolysis and angiogenesis.

A137 BALLOON-ASSISTED ENDOSCOPY FOR SMALL BOWEL BLEEDING – A REVIEW

Abstract Background Gastrointestinal (GI) bleeding is a potentially life-threatening medical emergency requiring immediate medical attention. Obscure GI bleeding (OGIB) Is defined as GI bleeding with no obvious culprit lesion found on initial upper or lower endoscopy. Further investigations are needed as 75% of those cases originate in the small bowel. The advent of small bowel endoscopy, consisting of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE) has allowed clinicians to endoscopically visualize the entire GI tract and perform therapeutic interventions. These devices include balloon assisted endoscopy (BAE) and Spiral Endoscopy (SPE). Aims The objectives of this review are to analyze the definitions, etiologies, and risk factors of OGIB. Furthermore, we reviewed the diagnostic and therapeutic yields of DAE and its safety profile. Due to the adverse effects and recall of SPE, we only report here on BAE. Methods A literature review was conducted using PubMed and OvidSP (Medline) to identify articles on the use of VCE and DAE for OGIB. Keywords included a combination of gastrointestinal bleeding with occult, obscure, active and inactive, small bowel bleed, diagnostic yield, therapeutic yield, and rebleeding rate. The information was obtained via systematic review and meta-analysis, retrospective studies, and case reports. Results A total of 32 papers were reviewed. The most common causes of OGIB reported were vascular lesions (23-47%), inflammatory lesions (12-16%), and tumors (5-16%). The risk factors associated with OGIB include age, cardiac disease, liver cirrhosis, chronic kidney disease, and hereditary vascular diseases. The overall diagnostic and therapeutic yields of BAE in OGIB were 76.3% and 49.5%, respectively. Factors that increased the yield included performing an initial VCE (increase by 7%) and performing the procedure within the first 10 days after the initial bleeding episode (87.5%) as compared to after 10 days (11.1%). Recurrent bleeding can occur in up to 46% of patients. Risk factors for rebleeding include cirrhosis, overt bleeding symptoms, and presence of multiple vascular lesions. Associated adverse effects in DAE were minor in 9.1% of patients and severe in less than 2%. These include bleeding (0.8%), perforation (0.3%), and pancreatitis (0.3%). Conclusions OGIB is a challenging clinical entity. BAE now allows clinicians to diagnose and treat culprit lesions in the small bowel with reasonable success and a strong safety profile, however timing and prior VCE can further optimize this. Clinical decisions and follow up should be made based around existing risk stratification tools and scores. Further prospective research is needed to determine optimal timing of DAE from presentation of OGIB that would increase diagnostic and therapeutic yields. Figure 1. A and B) Endoscopic images of small bowel vascular lesion. C) Bleeding vascular lesion treated with hemostatic clips. Funding Agencies None

A165 MALIGNANT TUMORS OF THE SMALL BOWEL DIAGNOSED BY DOUBLE BALLOON ENTEROSCOPY: A FIFTEEN-YEAR EXPERIENCE OF A MEDICAL CENTER IN MID-TAIWAN

Abstract Background The malignant tumors of the small bowel are relatively rare, and their pre-operative diagnosis is usually difficult Aims This study was aimed to investigate the clinical characteristics of patients with malignant small bowel tumors who underwent double balloon enteroscopy. Secondary end points were to evaluate the usefulness and safety of double balloon enteroscopy for the diagnosis of patients with suspected small bowel tumors derived from other previous procedures. Methods From January 2008 to June 2023, we retrospectively analyzed consecutive patients who underwent double balloon enteroscopy at a medical center in mid-Taiwan over a 15-year period (Figure 1). Results Double balloon enteroscopy were performed in 1001 patients. Small bowel tumors were diagnosed in 141 patients (141/1001; 14.1%), of which 76 patients (53.9%) (43 males, a mean age of 61.89 years) had malignant tumors : 37 had gastrointestinal stromal tumors (49.4%), 16 had adenocarcinoma (20.8%), 10 had metastatic cancer (13.1%), 7 had lymphoma (9.2%), 3 had angiosarcoma (3.9%), 2 had carcinoid (2.6%), and 1 had desmoid tumor (1.3%) (Figure 2). The indications for double-balloon enteroscopy in patients with malignant small bowel tumors were obscure gastrointestinal bleeding (68.4%). The concordance rate of diagnoses based on double balloon enteroscopy with diagnoses based on small bowel barium study, computed tomography, and capsule endoscopy among patients with small bowel tumors was 54.1%, 65.9% , and 76.9%, respectively. (Figure 3, 4) . Therapeutic plans were changed to surgery in 67.1 % of patients with malignant small bowel tumors. Additionally, treatment was added on chemotherapy in 25.6% of patients with malignant small bowel tumors after the results of double-balloon enteroscopy. Conclusions Approximately 14.1% of patients who underwent double balloon enteroscopy had small bowel tumors, 53.9% of small bowel tumors are malignant. The most common indication for double balloon enteroscopy in patients with malignant small bowel tumors was obscure gastrointestinal bleeding. Double balloon enteroscopy is a very useful modality in diagnosing malignant small bowel tumors and has an important impact on therapeutic plans and clinical results. Figure 1. The Prevalence Rate of Small Bowel Tumor Figure 2. Malignant tumor Figure 3. Location Distribution of Small Bowel Tumors Figure 4. The clinical manifestations of Malignancy Tumors Funding Agencies None Intestinal Disorders

Jejunal Dieulafoy's lesion as a cause of difficult-to-manage obscure gastrointestinal bleeding. Combined endoscopic treatment.

Dieulafoy's lesion (DL) is an uncommon vascular malformation-an aberrant, dilated submucosal arteriole (1-3 mm thick, 10 x nv). It runs near the mucosal surface and protrudes, and may potentially induce gastrointestinal bleeding (GIB). It usually originates in the stomach (upper lesser curvature), with endoscopy being the diagnostic, therapeutic modality of choice. Jejunal DL (JDL) is a rare cause of obscure GIB (OGIB) that is challenging for endoscopists and threatens patient lives. Other diagnostic techniques such as Tc99m-labeled red blood cell scintigraphy, well established in the classic armamentarium for OGIB diagnosis, cannot overcome endoscopic procedures. We report the case of a patient with OGIB secondary to an exceptionally located Dieulafoy's lesion who underwent combined endoscopic treatment.

Challenges in Diagnosing and Managing Dieulafoy’s Lesions: A Case Report Highlighting the Importance of Clinical Suspicion and Multidisciplinary Approach in Obscure Gastrointestinal Bleeding

Challenges in Diagnosing and Managing Dieulafoy’s Lesions: A Case Report Highlighting the Importance of Clinical Suspicion and Multidisciplinary Approach in Obscure Gastrointestinal Bleeding

Jejunal gastrointestinal stromal tumor: a diagnostic challenge.

Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors of the gastrointestinal tract and a rare cause of gastrointestinal bleeding. These tumors usually affect people over 50 years of age and they exhibit a wide range of clinical manifestations, including asymptomatic patients, nonspecific symptoms, obstruction or bleeding, which may delay diagnosis. Early diagnosis and treatment are crucial because GISTs can be aggressive and metastasize. This case highlights the importance of considering GISTs in the differential diagnosis of obscure gastrointestinal bleeding.

Clinical features, treatments and prognosis of appendiceal bleeding: a case series study

BackgroundAppendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years.MethodsA retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed.ResultsAppendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding.ConclusionsThe diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.

Construction of a prediction model for predicting rebleeding in patients with obscure gastrointestinal bleeding after capsule endoscopy

Objective: To explore the risk factors of rebleeding in patients with obscure gastrointestinal bleeding (OGIB) after capsule endoscopy (CE), and construct a model to predict rebleeding. Methods: The data of patients with OGIB who underwent CE in Zhongda Hospital Affiliated to Southeast University from July 2018 to September 2021 were retrospectively analyzed. Follow-up data were obtained via electronic medical records or telephone interviews. Univariate and multivariate Cox regression models were performed to figure out the risk factors of rebleeding in OGIB patients. Then the optimal prediction model was determined and presented as a nomogram. The model was evaluated by C statistic, calibration curve and decision curve analysis. Results: One hundred and thirty patients with OGIB were included, including 64 females and 66 males, aged (55.8±17.2) years (18-87 years), and 39 (30.0%) cases developed rebleeding during follow-up. Univariate and multivariate Cox regression model analysis showed the duration of more than 2 weeks OGIB (HR=3.70, 95%CI: 1.85-7.42, P<0.001), a history of previous gastrointestinal bleeding (HR=5.25, 95%CI: 2.00-13.81, P<0.001), positive CE findings (HR=3.72, 95%CI: 1.66-8.33, P=0.001), and the lowest hemoglobin level before CE<80 g/L (HR=2.00, 95%CI: 1.02-3.84, P=0.044) were risk factors for rebleeding, while specific treatment (HR=0.25, 95%CI: 0.11-0.54, P<0.001) was a protective factor. The corresponding scores of the above five predictive factors were: OGIB duration>2 weeks: 79 points; Previous history of gastrointestinal bleeding: 100 points; The result of CE was positive: 79 points; Specific treatment:-85 points; Minimum hemoglobin before CE<80 g/L: 41 points. The prediction model constructed from the above five variables had good discriminative capability (concordance index=0.798, 95%CI: 0.732-0.865). The calibration curves showed high consistency between nomogram-predicted probabilities and actual observations. The decision curves showed that when the threshold probability was above 0.04, the use of the nomogram to predict rebleeding provided a greater net benefit than the assumption of "all patients rebleeding or no patients rebleeding". Conclusion: The prediction model established in this study has a good ability to predic rebleeding in patients with OGIB after CE examination.

Obscure gastrointestinal bleeding in a patient with factor VII deficiency: a case controlled with tranexamic acid

Factor VII deficiency is a rare, inherited coagulopathy, which can lead to prolonged bleeding. Here, we present a case report of an adolescent with factor VII deficiency who experienced small bowel bleeding that was successfully treated with tranexamic acid. This case highlights the potential use of tranexamic acid as an effective therapeutic option for managing gastrointestinal bleeding in patients with hemostatic insufficiency of unknown etiology.

Small Bowel Capsule Endoscopy: Benefits of Rereading Rather than Repeating—A Single Blinded Randomized Study

Abstract Objectives Small bowel capsule endoscopy (SBCE) technology detects small bowel lesions. Many factors affect its sensitivity. SBCE is also costly, and patients might not be able to repeat the test when results are equivocal. Instead of repeating the test, reading the results by two endoscopists might provide a better or a cheaper option in the right settings. We studied the sensitivity of SBCE when read by two different physicians and checked if, rather than repeating the examination, rereading the results improved its sensitivity. Furthermore, we studied the effect of small bowel transit time (SBTT) on the diagnostic yield. Materials and Methods A retrospective cohort study on capsule endoscopies was conducted between 2018 and 2019 in a tertiary care center in Lebanon. A total of 42 patients with anemia or obscure gastrointestinal bleed were included for SBCE after a negative evaluation with upper and lower gastrointestinal (GI) endoscopy. Two specialists read the results. The second physician was blinded from the first reader's results. We compared the sensitivity of the two readings. SBTT correlation with the diagnostic yield was calculated. Results Out of 42 patients, 18 tested positive in the first reading and 31 in the second reading. The diagnostic yield increased from 43 to 74% (p = 0.0043). Among the 33 patients who had a documented SBTT, longer SBTT correlated with a higher diagnostic yield (odds ratio [OR] &gt; 1), but no statistical significance was demonstrated. Conclusion Within the limitations of this study, we found that rereading capsule endoscopy can be more cost-effective than repeating the test.

1146 Laparoscopic Retrieval of a Retained Video Endoscopy Capsule: Case Report and Review of Literature

Abstract Video-Capsule-Endoscopy (VCE) is a non-invasive method and a useful tool in determining the aetiology of obscure gastrointestinal bleeding and in the diagnosis of Crohn’s disease. Despite its proven utility, VCE carries risks, primarily capsule retention (CR). This refers to the failure of the capsule passing by day 14. CR may suggest underlying pathology, but in the process can lead to several sequelae including obstruction. We report the case of a 28-year-old patient with suspected Crohn’s disease requiring laparoscopic bowel-resection and retrieval of the capsule. The patient presented in 2019 with bloating, crampy abdominal pain and altered bowel habits. Initial endoscopic and blood investigations were unremarkable, however subsequent tests revealed raised calprotectin and anaemia. OGD and colonoscopy remained negative. In April 2021, he underwent VCE, demonstrating an inflamed distal ileum with structuring. However, the capsule failed to pass. After a period of watchful waiting and multidisciplinary discussion resulting in a trial of infliximab and steroid therapy, the capsule remained in-situ as confirmed by sequential X-rays and CTs. In March 2022, he underwent uncomplicated 3-port laparoscopic small bowel resection and retrieval of the retained capsule and was discharged 2 days later. Our case demonstrates an optimal approach in the management of CR. An initial conservative trial with medical therapy was attempted. MDT discussion ensured both gastroenterologists and surgeons were involved in the decision-making. Finally, our literature review demonstrated a lack of concise guidelines. Thus, based on the latest evidence we developed an algorithmic flow chart for the management of retained VCE.

Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants

Introduction Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources. Materials and Methods Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC. Results 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 (p < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 (p < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 (p < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days (p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl (p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6–65). Conclusions LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.

A Randomized, Controlled Trial, comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single Balloon Enteroscopy in patients with Small-Bowel Disorders - THE MOTOR TRIAL (NCT 05548140).

Device-assisted enteroscopy (DAE) has revolutionized the management of Small Bowel Disorders (SBD). No study to date has compared both Novel Motorized Spiral Enteroscopy (NMSE) and Single Balloon Enteroscopy (SBE) as a randomized controlled trial. Hence, this study was planned to include patients having SBD with the primary aim to compare the Total Enteroscopy Rate (TER). This study was conducted at the Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India from 20th September 2022 to 15th December 2022. All consecutive patients, aged more than 18 years with suspected SBD, and planned for Total Enteroscopy (TE) were screened for inclusion. The primary outcome was to compare the TER and secondary outcomes were to compare the technical success, time taken to reach the Depth of Maximal Insertion (DMI), withdrawal time, total procedure time, diagnostic yield, therapeutic success, and adverse events. Seventy-two patients out of the 110 patients screened, were randomized in either of NMSE (n=35) or SBE (n=37) group. The most common indication for the procedures was obscure GI bleed (48%), others being unexplained abdominal pain with indeterminate radiologic findings (32%) and chronic diarrhea (20%). In NMSE group the TER was 71.4%; while in the SBE group, it was 10.8%, (p<0.0001). The total procedure time (min) was much lesser with NMSE (58.17±21.5 min) versus SBE (114.2±33.5 min), (p<0.0001). The diagnostic yield of NMSE (80%) was comparatively higher than SBE (62.1%), (p = 0.096). Minor adverse events (Grade I) were observed in both the groups: NMSE (3/35, 8.5%) and SBE (2/37, 5.4%). This RCT shows that with NMSE higher TER can be achieved in shorter duration with minimal adverse events, compared to SBE.

Small-bowel B-cell lymphoma presenting as autoimmune hemolytic anemia and severe obscure gastrointestinal bleeding.

Small-bowel B-cell lymphoma presenting as autoimmune hemolytic anemia and severe obscure gastrointestinal bleeding.

Where does capsule endoscopy fit in the diagnostic algorithm of small bowel intussusception?

IntroductionThe investigation of small bowel (SB) intussusception is variable, reflecting the lack of existing standards. The aim of this study was to understand the role of small bowel capsule endoscopy (SBCE) to investigate this pathology. MethodologyThis was a retrospective multi-centre study. Patients with intussusception on SBCE and those where SBCE was carried out due to findings of intussusception on radiological investigations were included. Relevant information was collected. ResultsNinety-five patients (median age 39+/-SD19.1 years, IQR 30) were included. Radiological investigations were carried out in 71 patients (74.7%) prior to SBCE with intussusception being present in 60 patients on radiological investigations (84.5%). Thirty patients (42.2%) had intussusception on radiological investigations followed by a normal SBCE. Ten patients (14.1%) had findings of intussusception on radiological investigations, a normal SBCE and repeat radiological investigations that were also normal. Abnormal findings were noted on SBCE that could explain intussusception on imaging in (16 patients) 22.5% of patients.Five patients (5.3%) underwent radiological investigations and SBCE to investigate coeliac disease and intussusception. None had associated malignancy. Four patients (4.2%) underwent SBCE to investigate familial polyposis syndromes and went on to SB enteroscopy and surgery accordingly.Most patients (n = 14; 14.8%) with intussusception on initial SBCE (without prior radiological imaging) had suspected SB bleeding (n = 10, 10.5%). Four patients (4.2%) had additional findings of a mass on CT scan and went on to have surgery. ConclusionSBCE should be used to complement radiology when investigating intussusception. It is a safe non-invasive test that will minimise unnecessary surgery. Additional radiological investigations following a negative SBCE in cases of intussusception noted on initial radiological investigations are unlikely to yield positive findings. Radiological investigations following intussusception noted on SBCE in case of patients presenting with obscure gastrointestinal bleeding, may yield additional findings.

Early intervention with double balloon enteroscopy for higher yield for inpatient overt obscure gastrointestinal bleeding: A propensity matched analysis.

Overt obscure gastrointestinal bleeding (OOGIB) is defined as continued bleeding with unknown source despite esophagogastroduodenoscopy (EGD) and colonoscopy evaluation. Small bowel evaluation through video capsule endoscopy (VCE) or double balloon enteroscopy (DBE) is often warranted. We studied the timing of DBE in hospitalized OOGIB patients regarding diagnostic yield, therapeutic yield, and GI rebleeding. We performed a retrospective review of DBEs performed at a tertiary medical center between November 2012 and December 2020. The inclusion criterion was first admission for OOGIB undergoing DBE. Those without previous EGD or colonoscopy were excluded. Patients were stratified into two groups: DBE performed within 72 h of OOGIB (emergent) and beyond 72 h of OOGIB (nonemergent). Propensity score matching was used to adjust for the difference in patients in the two groups. Logistic regression analysis was used to assess factors associated with diagnostic and therapeutic yield. Kaplan-Meir survival curve showed GI bleed-free survival following initial bleed and was compared using the log rank test. A total of 154 patients met the inclusion criterion, of which 62 had emergent DBE and 92 had nonemergent DBE. The propensity-score-matched sample consisted of 112 patients, with 56 patients each in the emergent and nonemergent groups. Univariate and multivariable logistic regression analysis showed a significant association between VCE and emergent DBE and diagnostic and therapeutic yield (P < 0.05). Emergent DBE patients had increased GI bleed-free survival compared to those in the nonemergent group (P = 0.009). Our data demonstrate that emergent DBE during inpatient OOGIB can impact the overall diagnostic yield, therapeutic yield, and GI rebleeding post DBE.