ICCE Consensus for Obscure Gastrointestinal Bleeding

Disease Challenges

The annual incidence of gastrointestinal bleeding in the United States has been conservatively estimated at approximately 100 episodes per 100,000 persons, accounting for approximately 300,000 hospitalizations per year [1]. Obscure gastrointestinal bleeding represents about 5 % of those patients with gastrointestinal bleeding of any type. It is defined as bleeding of unknown origin that persists or recurs (i. e., recurrent or persistent iron-deficiency anemia, fecal occult blood test positivity, or visible bleeding) after a negative initial or primary endoscopy (upper and/or lower gastrointestinal endoscopy) [2]. The source of bleeding is frequently located in the small bowel and can result from a number of conditions, including vascular lesions, tumors, and inflammatory lesions.

Radiographic techniques for evaluation of the small bowel are relatively insensitive for flat, small, infiltrative, or inflammatory bleeding lesions. Other imaging techniques such as angiography and radioisotope bleeding scan are insensitive in the absence of brisk bleeding. Intraoperative enteroscopy is the most complete but also the most invasive means of examining the small bowel. Push enteroscopy is at present considered an effective diagnostic procedure, but it is time-consuming and only allows exploration of the jejunum [3]. Double-balloon enteroscopy is a new specialized method for enteroscopy. Outcomes have been promising for achieving complete enteroscopy and providing therapy without the need for laparotomy [4], but the use of this method is still not widespread. Capsule endoscopy (CE) is a valuable tool in the diagnostic toolkit. Key advantages of CE include: ability to review and share images; patient preference; safety profile; ability to conduct the procedure in a variety of settings; clarity of image, comparable to other forms of endoscopy; and ability to image the entire small bowel. This paper reviews the data reported in the scientific literature concerning the influence of CE in the management of patients with gastrointestinal bleeding and its potential impact on health outcomes.

References

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