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Endoscopy 2007; 39(12): 1031-1036
DOI: 10.1055/s-2007-967022
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Capsule endoscopy: impact on clinical decision making in patients with suspected small bowel bleeding

C.  Gubler1 , M.  Fox1 , P.  Hengstler2 , D.  Abraham2 , F.  Eigenmann3 , P.  Bauerfeind1
  • 1Division of Gastroenterology, Department of Internal Medicine, University Hospital Zurich, Switzerland
  • 2Division of Gastroenterology, Department of Internal Medicine, Hospital St. Gallen, Switzerland
  • 3Division of Gastroenterology, Department of Internal Medicine, Hospital Baden, Switzerland
Further Information

Publication History

submitted 17 April 2007

accepted after revision 4 October 2007

Publication Date:
10 December 2007 (online)

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Commentaire de travail de C. Gubler et al., pp. 1031Endoscopy 2007; 39(12): 83-83
DOI: 10.1055/s-0032-1308884

Background and study aim: Capsule endoscopy is widely used for diagnosis of small-bowel disease; however, the impact of capsule endoscopy on clinical management remains uncertain. We conducted a prospective study of the impact capsule endoscopy on clinical management decisions in 128 patients with suspected small-bowel pathology.

Methods: Prior to performing each procedure the gastroenterologist predicted the findings of capsule endoscopy and further management based on the clinical history and previous investigations. This prediction was compared with the actual results of capsule endoscopy and the following investigative and therapeutic management.

Results: The actual findings of capsule endoscopy and the further management were consistent with clinical prediction in 93/128 patients (73 %) and, irrespective of capsule endoscopy findings, no further procedures were required in 80 % of these patients. In 13 patients (10 %), gastric or colonic pathology was discovered that had not been detected on prior gastroscopy or colonoscopy. Thus, capsule endoscopy findings in the small bowel changed clinical management in 22 patients (17 %). In 4 patients, positive findings on capsule endoscopy that had not been predicted by the examiner prompted referral for abdominal surgery. Conversely, planned surgery was canceled in four other patients.

Conclusion: In this series of patients referred for capsule endoscopy, small-bowel findings and appropriate clinical management were predicted on clinical grounds alone in approximately three-quarters of patients. Repetition of standard upper and lower endoscopy may be useful in many patients prior to small-bowel imaging. Referral for capsule endoscopy should take into account whether the findings will impact on clinical management; however, capsule endoscopy is mandatory in patients in whom surgery for small-bowel bleeding is intended.

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P. Bauerfeind, MD 

Division of Gastroenterology
Department of Internal Medicine
University Hospital of Zurich

Raemistrasse 100
8091 Zurich
Switzerland

Fax: +41-1-2554503

Email: peter.bauerfeind@usz.ch