Capsule Endoscopy Findings and Clinical Outcome in Patients with Obscure Gastrointestinal Bleeding M.E.Riccioni, S.Shah, A.Bizzotto, G.P.Lecca, C.Spada,)S.Rausei, G.Costamagna Digestive Endoscopy Unit, )General Surgery Unit Catholic UniversityRome, Italy Guido Costamagna, Maria Elena Riccioni, Syed Shah, Alessandra Bizzotto, Piera Giuseppina Lecca, Cristiano Spada, Stefano Rausei Background: Capsule Endoscopy (CE) is the preferred first line investigation in patients with obscure GI bleeding. However, the interpretation of CE findings is subject to variation resulting in differences in the reported diagnostic yield. Aim: To assess the diagnostic yield of CE and clinical outcome. Methods: One hundred and thirty seven consecutive patients (77 male, 60 female; mean age 60 yrs, range 8-90) underwent CE for obscure GI bleeding (30 ongoing overt bleeding, 60 previous overt bleeding, and 47 occult bleeding) from january 2003 to november 2005. All patients had previous negative upper and lower GI endoscopy. Results: The mean number of investigations prior to VCE was 4.3 (range 1-18). The small bowel was completely visualised in 103/137 (75%) patients. CE findings were positive in 56 patients (41%), suspicious in 52 (38%), and negative in 29 (21%). In order of decreasing frequency, the most common lesions seen were: angiodysplasias (37.7%), ulcers or erosions (21.1%), erythematous folds (9.7%), blood within the small bowel lumen (9.1%), polyps (8.6%), suspected small bowel tumours (7.4%), and other (6.4%). Capsule retention occured in 1 patient suffering from peritoneal carcinomatosis. Follow-up data was obtained in 74 patients (mean follow-up: 18.5 months; range 0-35). Of the patients with positive findings, CE diagnosis was confirmed in 27/34 (79.4%) patients, 13 were treated surgically, 12 medically, 7 endoscopically, and 5 received no treatment; bleeding resolved in 65.5%. Of the patients with suspicious findings, CE diagnosis was confirmed in 15/26 (57.7%) patients, 3 were treated surgically, 6 medically, 2 endoscopically, and 16 received no treatment; bleeding resolved in 76.9% (70% spontaneously). Of the patients with negative CE, CE diagnosis was confirmed in 6/14 (42.9%) patients; 10 received no treatment, 2 were treated medically, and 2 surgically; bleeding resolved in 91% (64% spontaneously). Conclusions: Long-term follow-up data confirm the high diagnostic yield of videocapsule endoscopy. CE seems to be useful in guiding management of patients with OGIB.