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
