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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2013; 04(04): 107-113
DOI: 10.4103/0976-5042.132403
Original Article
Society of Gastrointestinal Endoscopy of India

Diagnostic role of capsule endoscopy in patients of obscure gastrointestinal bleeding after negative CT enterography

Jaswinder Singh Sodhi
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Ajaz Ahmed
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Abid Shoukat
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Bashir Ahmed Khan
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Gul Javid
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Mushtaq Ahmed Khan
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Manjeet Singh
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Feroz Shaheen
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Shaheen Nazir
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Zaffar Iqbal Kawoosa
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

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Abstract

Background and Objectives: Computed tomographic enterography (CT-EG) has emerged a useful tool for the evaluation of small bowel in patients of obscure gastrointestinal bleeding (OGIB). However, CT-EG may be negative in about 50-60% of patients. We aimed to see the efficacy of capsule endoscopy (CE) in patients of OGIB, who had initial negative CT-EG. Materials and Methods: All consecutive patients of OGIB after initial hemodynamic stabilization were subjected to CT-EG. Those having negative CT-EG were further evaluated with CE. Results: Fifty-five patients of OGIB with mean standard deviation age, 52.7 (19.0), range 18-75 years, women 31/55 (56.4%) were subjected to CT-EG. Nine (17.6%) patients had positive findings on CT-EG, which included mass lesions in six, thickened wall of distal ileal loops, narrowing, and wall enhancement in two and jejunal wall thickening with wall hyperenhancement in one patient. Forty-two patients had negative CT-EG of which 25 underwent CE for further evaluation. CE detected positive findings in 11 of 25 (48%) patients which included vascular malformations in three, ulcers in seven, and fresh blood without identifiable source in one. The diagnostic yield of CE in overt OGIB was more compared to occult OGIB ((7/14, 50%) vs (4/11, 36.4%) P = 0.2) and was higher if performed within 2 weeks of active gastrointestinal (GI) bleed (P = 0.08). Conclusions: In conclusion, CE is an additional tool in the evaluation of obscure GI bleed, especially mucosal lesions which can be missed by CT-EG.

Key words

Capsule endoscopy - colonoscopy - computed tomographic enterography - obscure gastrointestinal bleed - upper gastrointestinal endoscopy
 

  • References

  • 1 Katz LB. The role of surgery in occult gastrointestinal bleeding. Semin Gastrointest Dis 1999;10:78-81.
  • 2 Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993;88:807-18.
  • 3 Kwo PY, Tremaine WJ. Nonsteroidal anti-inflammatory drug-induced enteropathy: Case discussion and review of the literature. Mayo Clin Proc 1995;70:55-61.
  • 4 Lang J, Price AB, Levi AJ, Burke M, Gumpel JM, Bjarnason I. Diaphragm disease: Pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol 1988;41:516-26.
  • 5 Lewis BS, Kornbluth A, Waye JD. Small bowel tumours: Yield of enteroscopy. Gut 1991;32:763-5.
  • 6 Bartram CI, Amess JA. The diagnosis of Meckel’s diverticulum by small bowel enema in the investigation of obscure intestinal bleeding. Br J Surg 1980;67:417-8.
  • 7 Taverner D, Talbot IC, Carr-Locke DL, Wicks AC. Massive bleeding from the ileum: A late complication of pelvic radiotherapy. Am J Gastroenterol 1982;77:29-31.
  • 8 Blecker D, Bansal M, Zimmerman RL, Fogt F, Lewis J, Stein R, et al. Dieulafoy’s lesion of the small bowel causing massive gastrointestinal bleeding: Two case reports and literature review. Am J Gastroenterol 2001;96:902-5.
  • 9 Risti B, Marincek B, Jost R, Decurtins M, Ammann R. Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: Three cases and literature-review. Am J Gastroenterol 1995;90:1878-80.
  • 10 Yuki N, Kubo M, Noro Y, Kasahara A, Hayashi N, Fusamoto H, et al. Jejunal varices as a cause of massive gastrointestinal bleeding. Am J Gastroenterol 1992;87:514-7.
  • 11 Zaman A, Katon RM. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of standard endoscope. Gastrointest Endosc 1998;47:372-6.
  • 12 Apostolopoulos P, Liatsos C, Gralnek IM, Kalantzis C, Giannakoulopoulou E, Alexandrakis G, et al. Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc 2007;66:1174-81.
  • 13 Rockey DC. Occult and obscure gastrointestinal bleeding: Causes and clinical management. Nat Rev Gastroenterol Hepatol 2010;7:265-79.
  • 14 Huprich JE, Fletcher JG, Alexander JA, Fidler JL, Burton SS, McCullough CH. Obscure gastrointestinal bleeding: Evaluation with 64-section multiphase CT enterography: Initial experience. Radiology 2008;246:562-71.
  • 15 Huprich JE. Multi-phase CT enterography in obscure GI bleeding. Abdom Imaging 2009;34:303-9.
  • 16 Hara AK, Walker FB, Silva AC, Leighton JA. Preliminary estimate of triphasic CT enterography performance in hemodynamically stable patients with suspected gastrointestinal bleeding. AJR Am J Roentgenol 2009;193:1252-60.
  • 17 Sodhi JS, Zargar SA, Rashid W, Shaheen F, Singh M, Javid G, et al. 64-section multiphase CT enterography as a diagnostic tool in the evaluation of obscure gastrointestinal bleeding. Indian J Gastroenterol 2012;31:61-8.
  • 18 Paulsen SR, Huprich JE, Hara AK. CT enterography: Noninvasive evaluation of Crohn’s disease and obscure gastrointestinal bleed. Radiol Clin North Am 2007;45:303-15.
  • 19 Tochetto S, Yaghmai V. CT enterography: Concept, technique and interpretation. Radiol Clin North Am 2009;47:117-32.
  • 20 Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointestinal bleeding: Detection and localization with arterial phase multi-detector row helical CT. Radiology 2006;239:160-7.
  • 21 Saperas E, Dot J, Videla S, Alvarez-Castells A, Perez-Lafuente M, Armengol JR, et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 2007;102:731-7.
  • 22 Saurin JC, Delvaux M, Gaudin JL, Fassler I, Villarejo J, Vahedi K, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: Blinded comparison with video push-enteroscopy. Endoscopy 2003;35:576-84.
  • 23 Khalife S, Soyer P, Alatawi A, Vahedi K, Hamzi L, Dray X, et al. Obscure gastrointestinal bleeding: Preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy. Eur Radiol 2011;21:79-86.
  • 24 Heo HM, Park CH, Lim JS, Lee JH, Kim BK, Cheon JH, et al. The role of capsule en doscopy aft er negative CT enterography in patients with obscure gastrointestinal bleeding. Eur Radiol 2012;22:1159-66.
  • 25 Rastogi A, Sshoen RE, Slivka A. Diagnostic yield and clinical outcomes of capsule endoscopy. Gastrointest Endosc 2004;60:959-64.
  • 26 Ring SL, Chan LS, Hsiung CW, Yuan WH, Hsin CC, En WT, et al. Capsule endoscopy in elderly patients with obscure gastrointestinal bleeding. Int J Gerontol 2010;4:23-7.
  • 27 Sidhu R, Sanders DS, Kapil K, Leeds JS, McAlindon ME. Factors predicting the diagnostic yield and intervention in obscure gastrointestinal bleeding investigated using capsule endoscopy. J Gastrointestin Liver Dis 2009;18:273-8.
  • 28 Lewis BS, Eisen GM, Friedman S. A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 2005;37:960-5.
  • 29 Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World J Gastroenterol 2008;14:5245-53.
  • 30 Carey EJ, Leighton JA, Heigh RI, Shiff AD, Sharma VK, Post JK, et al. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol 2007;102:89-95.
  • 31 Pennazio M, Eisen G, Goldfarb N; ICCE. ICCE consensus for obscure gastrointestinal bleeding. Endoscopy 2005;37:1046-50.
  • 32 Li F, Gurudu SR, De Petris G, Sharma VK, Shiff AD, Heigh RI, et al. Retention of the capsule endoscope: A single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc 2008;68:174-80.
  • 33 Boriskin HS, Devito BS, Hines JJ, Scarmato VJ, Friedman B. CT enterography vs capsule endoscopy. Abdom Imaging 2009;34:149-55.
  • 34 Huprich JE, Fletcher JG, Fidler JL, Alexander JA, Guimarães LS, Siddiki HA. Prospective Blinded Comparison of Wireless Capsule Endoscopy and Multiphase CT Enterography in Obscure Gastrointestinal Bleeding. Radiology 2011; 260: 744-51
  • 35 Agrawal JR, Travis AC, Mortele KJ, Silverman SG, Maurer R, Reddy SI, Saltzman R. Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. J Gastroenterol and Hepatol 2012; 27:751-59
  • 36 Soyer P, Boudiaf M, Fishman EK, Hoeffel C, Dray X, Manfredi R, et al. Imaging of malignant neoplasms of the mesenteric small bowel: New trends and perspectives. Crit Rev Oncol Hematol 2011;80:10-30