DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173560

Diagnostic yield of video capsule endoscopy in obscure occult gastrointestinal bleed

Nitin R. Gaikwad, Sudhir J. Gupta, Tushar H. Sankalecha, Harit G. Kothari

Abstract


Background: Gastrointestinal blood loss is the leading cause of iron deficiency anemia in developing world. Many patients had normal findings on initial upper and lower gastrointestinal endoscopy. When such patients present with stool occult blood positivity, it’s an indication to evaluate small bowel by video capsule endoscopy for detecting possible source of bleeding. Aim was to know the diagnostic yield of video capsule endoscopy in anaemic patients with occult gastrointestinal bleed.

Methods: In this retrospective study, we evaluated all the data of video capsule endoscopy which were done in patients with obscure occult gastrointestinal bleed.

Results: Total sample size was 21 patients. M:F ratio was 1.6:1 Average age of patients was 51.52±6.3 years. Youngest patient was of 16 years and Oldest patient was of 78 years. Video capsule endoscopy was normal in 8/21(38.09%), and had positive findings in 13/21(61.90%). Most common finding was aphthous ulcer in jejunum and ileum in 19.04%. Followed by Telangiectasia in 14.28%, NSAID enteropathy in 4.76%, Jejunal diverticulosis in 9.52%, celiac disease, xanthelasma, enteroliths in ileum, ileal nodularity in 4.76% each. Complication occurred in one patient (4.76%) in the form of retention of the capsule, which was retrieved by double balloon Enteroscopy.

Conclusions: Video capsule endoscopy has a good diagnostic yield of around 61.90% in patients with obscure occult gastrointestinal bleed. It is best performed during ongoing bleed or immediately thereafter. Careful patient selection and repeating the upper and lower GI Scopy before video capsule endoscopy can be a reliable option before video capsule endoscopy to prevent complication.


Keywords


Capsule endoscopy, Obscure occult gastrointestinal bleed

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References


Zuckerman GR, Prakash C, Asking MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterol. 2000;118:201-21.

Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol. 2005;100:2407-18.

Pasha SF, Leighton JA, Das A, Harrison ME, Decker GA, Fleischer D, et al. Double-balloon Enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol. 2008;6:671-6.

Pennazio M, Eisen G, Goldfarb N. ICCE consensus for obscure gastrointestinal bleeding. Endosc. 2005;37:1046-50.

Teshima CW, Kuipers EJ, Van Zanten SV, Mensink PB. Double balloon Enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol. 2011;26:796-801.

Gupta R, Lakhtakia S, Tandan M, Banerjee R, Ramchandani M, Anuradha S, et al. Capsule endoscopy in obscure gastrointestinal bleeding-an Indian experience. Indian J Gastroenterol. 2006;25:188-90.

Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010;71:280-6.

Goenka MK, Majumder S, Kumar S, Sethy PK, Goenka U. Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding. World J Gastroenterol. 2011;17:774-8.

J Tong, S Svarta, G Ou, R Kwok, J Law, R Enns. Diagnostic yield of capsule endoscopy in the setting of iron deficiency anemia without evidence of gastrointestinal bleeding. Can J Gastroenterol. 2012;26(10):687-90.

Zhang BL, Chen CX, Li YM. Capsule endoscopy examination identifies different leading causes of obscure gastrointestinal bleeding in patients of different ages. Turk J Gastroenterol. 2012;23:220-5.

Lim YJ, Yang C-H. Non-steroidal anti-inflammatory drug-induced enteropathy. Clin Endosc. 2012;45(2):138-44.

Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterol. 2004;126:643-53.

Murray JA, Rubio-Tapia A, Van Dyke CT, Brogan DL, Knipschield MA, Lahr B, et al. Mucosal atrophy in celiac disease: extent of involvement correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6:186-93.

Bhattarai M, Bansal P, Khan Y. Longest duration of retention of video capsule: A case report and literature review. World J Gastrointest Endosc. 2013;5:352-5.