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We report a clinical case from a patient with alcoholic cirrhosis who had chronic anemia and carried out several endoscopic studies without evidence of active bleeding, a complementary study with endoscopic capsule was requested to search for a source of bleeding. In the analysis of laboratory data, the presence of hypereosinophilia stands out in parallel. The images obtained in the video capsule study show geoparasites helminth-type. After parasite treatment, anemia improves and the absolute eosinophil count is normalized.
Reportamos el caso de un paciente cirrótico por alcohol con anemia crónica quien se realizó varios estudios endoscópicos sin evidencia de sangrado activo, por tal motivo se solicitó estudio complementario con cápsula endoscópica para búsqueda de fuente de sangrado. En el análisis de los datos de laboratorio paralelamente destaca la presencia de hipereosinofilia. Las imágenes obtenidas en el estudio de la video cápsula muestran varios geoparásitos de tipo helmintos. Posterior al tratamiento antiparasitario mejora la anemia y se normaliza el recuento absoluto de eosinófilos.
Subject(s)
Humans , Male , Middle Aged , Gastrointestinal Hemorrhage/etiology , Intestinal Diseases, Parasitic/diagnosis , Fibrosis/complications , Eosinophils , Gastrointestinal Hemorrhage/diagnosis , Anemia/complications , Intestines/parasitologyABSTRACT
Background: Video capsule endoscopy (VCE) is a valuable diagnostic tool for the evaluation of the small intestine. Evidence shows that it is effective in the diagnosis of occult bleeding and superficial lesions that are not radiographicallyobserved. We evaluated the efficacy and safety of the capsule endoscopy in the diagnosis and management of the common gastrointestinal disorders.Methods: A retrospective chart review of a total of 326 candidates who have met the inclusion criteria and who underwent VCE from the period from January 2006 till December 2018.Results: The main indication for Video Capsule Endoscopy was small bowel overt gastrointestinal bleeding with 106 cases (32.6%) followed by iron deficiency anemia with 104 cases (32%). Capsule retention rate was observed in 11 cases (3.4%) 4 of which were crohn抯 disease patients (22.2%). Overall diagnostic yield was 36%, 64% for overt gastrointestinal bleeding and 41% for occult gastrointestinal bleeding. The most common reported positive finding was Angiodysplasia in 19.9% of cases, followed by ulcers in 13.8% of cases, followed by polyps in 8.3% of cases and erosions in 8% of cases.Conclusions: Video capsule endoscopy proved to be an essential diagnostic tool in gastrointestinal bleeding. Advantages of VCE include; less labor, higher resolution examination of mucosa, relative safety, and noninvasiveness. On the other hand, it does not offer intervention capabilities when compared with enteroscopy and its interpretation was sometimes difficult and time consuming. Risk of capsule retention remains significant especially in patients suffering from crohn抯 disease.
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Objective To investigate the feasibility and application value of total enteroscopy with double balloon enteroscopy(DBE)for diagnosis and treatment of patients with obscure gastrointestinal bleeding(OGIB). Methods The clinical and endoscopic data of patients underwent DBE for OGIB in the Department of Gastroenterology,Remin Hospital of Wuhan University from January 2010 to December 2015 were retrospectively analyzed. Results Total enteroscopy was indicated in 36.3%(136/375)of patients. The success rate was 86.0%(117/136)and complication rate was 1.5%(2/136). Negative findings,non-small bowel lesions and small bowel lesions were detected in 44.4%(52/117), 6.8%(8/117), and 48.7%(57/117)of patients with total enteroscopy. Re-bleeding occurred in 8.9%(4/45)of patients with negative total enteroscopy,while 1 small bowel mesenchymoma and 1 gastric fundus Dieulafoy′s lesion were revealed subsequently. Re-bleeding occurred in 33.3%(5/15)of patients with incomplete enteroscopy,and 1 small bowel polyp and 1 small bowel angiectasis were revealed subsequently. Conclusion DBE can complete total enteroscopy within one day and provide important clinical information of OGIB. Non-small bowel lesions,small bowel lesion missed by DBE and potential bleeding lesions in small bowel beyond the reach of DBE should be considered in patients with negative enteroscopy.
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Objective:To study the relative risk factor of bleeding again of patients with obscure gastrointestinal bleeding (OGIB) of negative result in capsule endoscopy(CE). Methods: 92 patients with OGIB whose extermination results of CE were negative were enrolled in the retrospective analysis, and they were divided into observation group(46 cases, with bleeding again) and control group(46 cases, without bleeding again). The data of casehistory of these patients were compared, respectively, and then these data were analyzed by using Logistic regression analysis.Results: The ratio of 50 years old or older than 50 years old and the number of abnormal blood coagulation of observation group were significantly higher than that of control group(x2=5.386,x2=14.331,P<0.05), respectively. And the number of taking Aspirin of observation group was significantly higher than that of control group, while the number of received special treatment of observation group was lower than that of control group(x2=7.180, x2=23.545,P<0.01). As the results of Logistic regression analysis, 50 years old or older than 50 years old, abnormal blood coagulation, taking Aspirin and non-receiving special treatment were the independent risk factors, respectively, for patients with negative results of CE.Conclusion: In the examination of CE, although the results of patients with OGIB were negative, they may blood again, and all of these factors including 50 years old or older than 50 years old, abnormal blood coagulation, taking Aspirin and non-receiving special treatment are the risk factors which can affect blooding again. These factors should be paid more attention.
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Resumen Actualmente, se pueden identificar lesiones del intestino delgado que antes eran inaccesibles. La principal herramienta diagnóstica es la videocápsula endoscópica por el alto valor predictivo negativo. Con los avances en los métodos endoscópicos, la clasificación del sangrado gastrointestinal ha cambiado. Es así como la definición del sangrado oscuro, que antes incluía al originado en el intestino delgado, se ha relegado cuando su origen no se puede identificar tras la realización de una esofagogastroduodenoscopia, colonoscopia y estudios del tracto digestivo medio, tales como videocápsula endoscópica, enteroscopia de empuje, enteroscopia profunda, enteroscopia intraoperatoria, enterorresonancia, enterotomografía, angiografía y gammagrafía.
Abstract Intestinal lesions that were previously inaccessible can now be identified. The most important new diagnostic tool is the endoscopic videocapsule because of its high negative predictive value. With advances in endoscopic methods, the classification of gastrointestinal bleeding has changed so that definition of occult and obscure bleeding that previously included bleeding originating in the small intestine has been relegated to cases for which the origin cannot be identified after performing esophagogastroduodenoscopy, colonoscopy and studies of the middle digestive tract such as endoscopic videocapsule, push enteroscopy, deep enteroscopy , intraoperative enteroscopy, MRI enterography, CT enterography, angiography and scintigraphy.
Subject(s)
Capsule Endoscopes , Intestine, Small/abnormalities , AngiographyABSTRACT
Hookworm infections are widely prevalent in tropical and subtropical areas, especially in low income regions. In the body, hookworms parasitize the proximal small intestine, leading to chronic intestinal hemorrhage and iron deficiency anemia. Occasionally, hookworms can cause overt gastrointestinal bleeding, but this is often ignored in heavily burdened individuals from endemic infectious areas. A total of 424 patients with overt obscure gastrointestinal bleeding were diagnosed by numerous blood tests or stool examinations as well as esophagogastroduodenoscopy, colonoscopy, capsule endoscopy or double-balloon enteroscopy. All of the patients lived in hookworm endemic areas and were not screened for hookworm infection using sensitive tests before the final diagnosis. The patients recovered after albendazole treatment, blood transfusion, and iron replacement, and none of the patients experienced recurrent bleeding in the follow-up. All the 31 patients were diagnosed with hookworm infections without other concomitant bleeding lesions, a rate of 7.3% (31/424). Seventeen out of 227 patients were diagnosed with hookworm infections in the capsule endoscopy (CE), and 14 out of 197 patients were diagnosed with hookworm infections in the double balloon enteroscopy (DBE). Hookworm infections can cause overt gastrointestinal bleeding and should be screened in patients with overt obscure gastrointestinal bleeding (OGIB) in endemic infectious areas with sensitive methods. Specifically, the examination of stool specimens is clinically warranted for most patients, and the proper examination for stool eggs relies on staff's communication.
Subject(s)
Humans , Albendazole , Ancylostoma , Ancylostomatoidea , Anemia, Iron-Deficiency , Blood Transfusion , Capsule Endoscopy , Colonoscopy , Diagnosis , Double-Balloon Enteroscopy , Eggs , Endoscopy, Digestive System , Follow-Up Studies , Hematologic Tests , Hemorrhage , Hookworm Infections , Intestine, Small , Iron , Necator americanus , OvumABSTRACT
Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.
Subject(s)
SarcomaABSTRACT
Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy. OGIB is considered an important indication for capsule endoscopy (CE). CE is particularly useful for the detection of vascular and small ulcerative lesions, conditions frequently associated with OGIB, particularly in Western countries. On the other hand, balloon enteroscopy (BE) can facilitate the diagnosis of lesions presenting with minimal changes of the mucosal surface, such as submucosal tumors, and can be used not only for diagnosis, but also for treatment, including endoscopic hemostasis. In other words, the complementary use of both CE and BE enables OGIB to be more efficiently diagnosed and treated. However, rebleeding can occur even in patients with negative results of CE, and such patients require repeat CE or BE. It is essential to effectively use both CE and BE based on a thorough understanding of the strong points and weak points of these procedures. Further advances and developments in virtual endoscopy incorporating computed tomography and magnetic resonance imaging are expected in the future.
Subject(s)
Humans , Capsule Endoscopy , Diagnosis , Endoscopy , Endoscopy, Gastrointestinal , Hand , Hemorrhage , Hemostasis, Endoscopic , Magnetic Resonance Imaging , UlcerABSTRACT
Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.
Subject(s)
Humans , Capsule Endoscopy , Diagnosis , Double-Balloon Enteroscopy , Hemorrhage , Mucous MembraneABSTRACT
El sangrado digestivo oscuro constituye entre 10 y 20% de todas las causas de sangrado digestivo. La etiología está claramente relacionada con el grupo etario en que se presente. Las linfangiectasias del yeyuno son una causa rara de sangrado digestivo, pero puede llegar a ser de alta mortalidad en caso de que no se detecte tempranamente. Reportamos un caso de un paciente joven sin historia previa de enfermedad, con sangrado digestivo manifestado por melenas, con anemización severa, con estudios endoscópicos iniciales normales, en quien hacemos abordaje con estudios para intestino delgado (video cápsula endoscópica y enteroscopia anterógrada de doble balón), con los que hacemos el diagnóstico y es llevado a cirugía, con adecuada evolución clínica y curación de la enfermedad. (Acta Med Colomb 2015; 40: 158-161).
Obscure gastrointestinal bleeding is between 10 to 20% of all causes of gastrointestinal bleeding. The etiology is clearly related to the age group in which it is presented. Lymphangiectasia in jejunum is a rare cause of gastrointestinal bleeding, but can have high mortality if not detected early. A case of a young patient with no history of previous disease presenting gastrointestinal bleeding manifested by melaena, with severe anemia and normal initial endoscopic studies, is presented. The diagnosis was made by endoscopic video capsule and antegrade double-balloon enteroscopy and surgery was performed with adequate clinical evolution and cure of the disease. (Acta Med Colomb 2015; 40: 158-161).
Subject(s)
Humans , Male , Middle Aged , Lymphangiectasis , Capsule Endoscopes , Double-Balloon Enteroscopy , Hemorrhage , Intestine, SmallABSTRACT
Objective To evaluate the double-balloon enteroscopy(DBE) for obscure gastrointestinal bleeding(OGIB) and evaluate the health economics under the guidance of DBE for surgical treatment of obscure gastrointestinal bleeding.Methods A total of 114 patients,whose hemorrhage etiology could not be determined by conventional gastroscopy,enteroscopy and gastroenterography,underwent DBE.With pathological results as diagnostic criteria,the value of double-balloon enteroscopy for obscure gastrointestinal bleeding diagnosis was studied.Results The sensitivity,specificity and accuracy of DBE for OGIB were 85.86％,63.63％,81.57％,respectively.The positive likelihood ratio was 2.36 and the negative likelihood ratio was 0.22.The total days of hospitalization,hospital costs,cost of hospital drugs were lower in the DBE group than in the control group(27.2 ± 11.8 days VS 16.4 ±5.3 days,35 690.2 ±3 466.5 Yuan VS 19 409.3 ± 9 253.2 Yuan,17 805.8 ± 2 145.5 Yuan VS 9 133.0 ± 4 664.9 Yuan) (all P ＜ 0.05).Conclusion DBE plays an important role in diagnosis of OGIB.It has significance in clinic,health economics,and social benefits.
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Objective To investigate the optimal time for capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) .Methods Data of 76 patients with OGIB underwent capsule endoscopy from January 2013 to December 2014 were retro‐spectively analyzed .They were classified into two groups :emergency capsule endoscopy and non‐emergency capsule endoscopy .The demographic and clinical features and outcomes of capsule endoscopy ,complications and the times of hospital stays and hospitaliza‐tion expenses were compared .Results The overall diagnostic yield of capsule endoscopy was 48 lesions(63 .15% ) .The overall di‐agnostic yield of emergency capsule endoscopy group was 73 .68% (28/38) ,which was significantly higher than that in non‐emer‐gency capsule endoscopy group(52 .63% ,20/38) ,with statistical difference (P< 0 .05) .Conclusion Emergency capsule endoscopy have a higher rate of detection ,patients with OGIB should receive capsule endoscopy as soon as possible .
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Background:Because of its non-invasiveness,direct inspection,and high detection rate,capsule endoscopy(CE) has been accepted as the first-line examination for diagnosis of obscure gastrointestinal bleeding(OGIB). However,no matter the result of CE is positive or negative,it is unable to accurately predict the occurrence of rebleeding. Aims:To preliminarily investigate the related risk factors of rebleeding in OGIB patients with positive or negative CE for reducing the rebleeding rate. Methods:One hundred and sixteen OGIB patients undergone CE and with follow-up data from October 2009 to October 2013 at the First Affiliated Hospital of Soochow University were recruited,the rebleeding rate of patients with positive and negative CE,and the risk factors of rebleeding were analyzed. Results:CE diagnostic rate was 56. 9% , and the overall rebleeding rate was 37. 9% . The rebleeding rate in CE positive patients was significantly higher than that in CE negative patients(48. 5% vs. 24. 0% ,P < 0. 01). Male,age ≥50 years,hypertension,accumulated bleeding ≥500 mL within 3 months before CE were the independent risk factors of increase in rebleeding rate in CE positive patients. Age≥50 years,abnormal blood coagulation,without specific treatment were the independent risk factors of increase in rebleeding rate in CE negative patients. Conclusions:Followed-up should be performed in OGIB patients with risk factors of rebleeding for at least 24 months after CE. Repeated examination can be avoided in OGIB patients without risk factors.
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Objective To explore the etiological diagnosis of obscure gastrointestinal bleeding in patients undergoing double-balloon enteroscopy and summarize the nursing strategies.Methods Eighty-six patients with obscure gastrointestinal bleeding underwent double-balloon enteroscopy. Before operation,preparations of surgical stuff and bowel were conducted,during the operation,surgical cooperation was carefully performed and after the surgery and the patients were closely observed for prevention of complications.Results All the patients lived through the enteroscopy without any complications of perforation and bleeding. The positive detection rate was 83.7%.Conclusion Double-balloon enteroscopy is of great accuracy etiologically for the diagnosis of obscure gastrointestinal bleeding. The nursing measures including right evaluation of patients' condition,careful pre-operational, proficient surgical cooperation and close observation are of great significance for the success of double-balloon enteroscopy.
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Objective To investigate the optimal time for double balloon enteroscopy (DBE) in patients with obscure gastrointestinal bleeding (OGIB).Methods Data of 78 patients with OGIB who underwent DBE from January 2009 to November 2013 were retrospectively analyzed.They were classified into two groups:emergency DBE and non-emergency DBE.The demographic and clinical features and outcomes of DBE,the time of examination and complications were compared.Results The overall diagnostic yield of DBE was 48 lesions (61.54 ％).The overall diagnostic yield of emergency DBE group was 77.14％,which was significantly higher than that in non-emergency DBE group (48.83％) (P =0.019).The time of examination in emergency group was shorter than that of non-emergency group with significant difference (P =0.031).Conclusion Emergency DBE takes less time and yields a higher rate of detection.Patients withOGIB should receive DBE as soon as possible.
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El sangrado digestivo oscuro constituye un reto diagnóstico y terapéutico para el gastroenterólogo debido a la complejidad de su manejo y asociación con elevada morbi-mortalidad. El advenimiento de nuevas herramientas diagnósticas tales como la cápsula endoscópica, enteroscopia asistida por balones y enterografía (TAC, RM), cambiaron de forma definitiva la comprensión y abordaje de esta situación clínica, generando con ello nuevas estrategias diagnósticas y terapéuticas que en la actualidad resultan costo efectivas. Se realizó una revisión bibliográfica en la base de datos Medline (Pubmed) (1995-2013) de los artículos originales publicados en el idioma inglés, tomando en consideración las palabras claves, "sangrado digestivo oscuro", "hemorragia digestiva", "sangrado digestivo oculto", "cápsula endoscópica", "enteroscopia". El objetivo de este artículo consiste en hacer una revisión del abordaje diagnóstico del sangrado digestivo oscuro
Obscure gastrointestinal bleeding is a diagnostic and therapeutic challenge for the gastroenterologist due to the complexity of it´s management and it´s association with high morbidity and mortality. The advent of new diagnostic tools such as capsule endoscopy, balloon assisted enteroscopy and enterography (CT,MR) permanently changed the understanding and approach to this clinical situation, thereby generating new diagnostic and therapeutic strategies that are currently cost effective. We conducted a literature review in Medline (PubMed) (1995 to 2013) of the original articles published in the English language, taking into consideration the key words, "obscure gastrointestinal bleeding," "gastrointestinal bleeding", "occult gastrointestinal bleeding", "capsule endoscopy", "balloon assisted by enteroscopy". The aim of this paper is to give an overview of the diagnostic approach of obscure gastrointestinal bleeding
Subject(s)
Female , Diagnostic Techniques, Digestive System , Capsule Endoscopy/methods , Double-Balloon Enteroscopy/methods , Gastrointestinal Hemorrhage/diagnosis , Hemorrhage/pathology , GastroenterologyABSTRACT
Objetivos: La cápsula endoscópica (CE) ha revolucionado la evaluación diagnóstica de pacientes con sangradogastrointestinal de origen oscuro (SGO). El objetivo de nuestro estudio fue evaluar el rendimientodiagnóstico de CE en pacientes con SGO en nuestro centro. Métodos: Se realizó un estudio descriptivoy retrospectivo, revisando historias clínicas en 60 pacientes consecutivos llevados a CE con indicación deSGO, entre septiembre de 2009 y septiembre de 2011, en el Hospital Pablo Tobón Uribe. Los hallazgos enCE se interpretaron según el grado de relevancia clínica para el diagnóstico definitivo: normales (P0), poco(P1) y altamente relevante (P2). Resultados: El rendimiento diagnóstico de CE en pacientes con SGO fue de57%. No se encontró diferencia significativa en la presencia de lesiones relevantes (P2), entre pacientes conSGO evidente y oculto (63% vs. 52%, p: 0,49); 26% de lesiones significativas (P2) en CE, se encontrabanal alcance de endoscopia alta (17%) o colonoscopia total (9%). En cuanto al tipo de lesión P2 encontrada,47% fueron vasculares, 44% inflamatorias y 9% neoplásicas. Los pacientes con lesiones P2 eran de mayoredad, comparados con aquellos con lesiones P1 y P0 (p: 0,05). Conclusión: El rendimiento diagnóstico deCE en SGO, en nuestra serie, es muy similar al reportado en publicaciones internacionales. El tipo de lesiónsignificativa (P2) más frecuentemente encontrada fue la vascular
Objectives: Capsule endoscopy (CE) has revolutionized diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGB). The aim of our study was to evaluate diagnostic performance of CE in patients with OGB at our center. Methods: This retrospective study reviewed the medical records of 60 consecutive patients who had undergone capsule endoscopy because of OGB at the Hospital Pablo Tobon Uribe between September 2009 and September 2011. CE findings were interpreted according to degree of clinical relevance for definitive diagnosis: normal (P0), not very relevant (P1) and highly relevant (P2). Results: The diagnostic performance of CE for patients with OGB was 57%. No significant difference was found among patients with obvious and hidden relevant lesions (P2) OGB (63% vs. 52%, p: 0.49). 26% of relevant lesions (P2) found by EC could have been found with upper endoscopy (17%) or total colonoscopy (9%). Of the P2 lesions found, 47% were vascular, 44% were neoplastic and 9% were inflammatory. Patients with P2 lesions were older tan those with P1 and P0 lesions (p: 0.05). Conclusion: The diagnostic performance of CE for OGB in our seriesis similar to that reported in international publications. The most frequently found P2 lesions were vascular lesions
Subject(s)
Humans , Male , Adolescent , Adult , Female , Aged , Capsule Endoscopy , Diagnosis , Academic PerformanceABSTRACT
Video capsule endoscopy and double balloon enteroscopy have their main application in the so-called obscure gastrointestinal bleeding, clinical condition in which bleeding is most likely originated in the small intestine. Both methods achieve good diagnostic performance with a favorable safety profile. The capsule is simpler to perform and examines the entire small bowel in a high proportion of cases, but without possibility of therapies. The double-balloon enteroscopy allows multiple types of endoscopic therapy of bleeding lesions, but is more complex to perform, requires sedation/anesthesia and most often does not achieve a complete review of the entire small bowel. Currently, both methods are considered complementary in the approach to the diagnosis and treatment of patients with obscure gastrointestinal bleeding. In most patients the ideal approach would be capsule endoscopy for diagnosis, followed by double balloon enteroscopy with therapeutic intent.
La videocápsula endoscópica y enteroscopia de doble balón tienen su aplicación principal en la denominada hemorragia digestiva de origen oscuro, situación clínica en la que el sangrado se origina muy probablemente en el intestino delgado. Ambos métodos logran buen rendimiento diagnóstico y con un perfil de seguridad muy favorable. La cápsula es más simple de realizar y examina todo el intestino delgado en una alta proporción de los casos, pero carece de posibilidad de efectuar terapias. La enteroscopia de doble balón permite realizar múltiples tipos de terapéutica endoscópica de las lesiones sangrantes, pero es más compleja de realizar, requiere de sedación/ anestesia y la mayor parte de las veces no logra un examen completo de todo el intestino delgado. En la actualidad se consideran métodos complementarios en el enfrentamiento diagnóstico y en el tratamiento de pacientes con hemorragia digestiva de origen oscuro. En la mayoría de los pacientes la aproximación ideal sería realizar primero una cápsula endoscópica para diagnóstico, seguida de enteroscopia de doble balón con intención terapéutica.
Subject(s)
Humans , Capsule Endoscopy , Double-Balloon Enteroscopy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapyABSTRACT
ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.
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ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.