Capsule endoscopy in acute obscure gastrointestinal bleeding

Background and aim: About 5% of all patients with acute gastrointestinal bleeding are classified as obscure gastrointestinal bleeders. Recent studies have shown that the diagnostic yield of capsule endoscopy (CE) is higher performed within the first 48 – 72 hours after the onset of gastrointestinal bleeding as an emergency CE. We retrospectively analyzed the CE results in our center from 2011 to 2013 March and we compared the diagnostic yield of emergency CE with all other small bowel cases.

Patients and methods: Small bowel CE is reimbursed by the National Health Insurance in Hungary since August 2011. Since that time we performed a total of 152 small bowel CE examinations. In 2 cases we had technical failures. Out of the total cohort 11 small bowel capsule endoscopies were performed during the first 72 hours after the bleeding started. We analyzed the findings of this 11 emergency CE-s and compared with the 139 scheduled examinations.

Results: The mean age in the emergency group was 61.3 ± 15.9 year and 57.4 ± 14.6 year in the non-emergency group. In the emergency group 6 patients had melena, 2 had haematochezia and 3 had both. A total of 56 E blood transfusion were given (5 E/patients in average) in the emergency CE group while 368 E (2.6 E/patients in average) in the non-emergency group. The diagnostic yield was 30.4% in the non-emergency group while 100% in the emergency CE group. We detected the cause of bleeding in 10 cases (90.9%) in the emergency group while only in 43.3% of cases in the non-emergency group. The findings in the emergency CE group were as follows: 4 AVM cases, 4 angiodysplasia cases, 3 NSAID ulcers cases, 2 cases with bleeding of unknown origin and 1 Meckel diverticula case. Based on the emergency CE surgery was performed in 2 cases. As a control, the bleeding source was detected by small bowel CE in 61 (43.9%) out of 139 scheduled CE results patients.

Conclusion: In our retrospective analysis we found that emergency small bowel CE has a high diagnostic yield. In acute GI bleeders after negative gastroscopy and colonoscopy emergency CE is recommended to find the bleeding source.