TOP100 AS A RAPID TOOL FOR DIAGNOSIS IN OVERT SMALL BOWEL BLEEDING

Aims Small bowel bleeding is an insidious cause of repeated hospitalizations, blood transfusions and endoscopic explorations. Capsule endoscopy (CE) is the first-choice technique to explore the small bowel, although long reading times may particularly affect cases with active overt bleeding. From 2017 Pillcam Reader software incorporates a new tool called “TOP100” that rapidly identifies images of potentially abnormal lesions. The present study aims at evaluating TOP100 detection ability in patients with overt small bowel bleeding.

Methods CE videos were retrospectively selected according to the indication of recent overt small bowel bleeding (<14 days). One experienced endoscopist performed conventional reading (CR) and a second experienced endoscopist, blind to CR, assessed TOP100 images, rating the lesions according to Saurin classification: high risk bleeding lesions (P2) and potential bleeding lesions (P1).

Results Ninety-one patients were included. The CR diagnostic yield for P2 lesions was 71.4 % (65/91 patients). TOP100 detected 78.5 % of patients with P2 lesions (51/65). TOP100 detected 100 % of active bleeding (9/9) and 87.5 % of angiodysplasias (28/32) cases. TOP100 false negatives were angiodysplasias (n = 4), ulcers (n = 4), varices (n = 2) and polyps (n = 1). In 5 cases, suspected angiodysplasias (n = 4) and ulcers (n = 1) were identified by TOP100 and not confirmed by CR (false positives). TOP 100 identified 65 % of P1 lesions cases (17/25).

Conclusions TOP100 represents a rapid tool to correctly identify the majority of lesions in overt small bowel bleeding cases, with a 100 % detection rate in case of active bleeding, allowing a prompt indication for treatment. CR still remains the gold standard for a complete and meticulous assessment of the small bowel.

Citation Giordano A ¹, Escude L¹, Escapa M¹ et al. eP104 TOP100 AS A RAPID TOOL FOR DIAGNOSIS IN OVERT SMALL BOWEL BLEEDING. Endoscopy 2021; 53: S130.

Publication History

Article published online:
19 March 2021