Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience

ABSTRACT

This study assessed the diagnostic yield of capsule endoscopy [CE] and its impact on patients with obscure gastrointestinal bleeding [OGIB]. Between May 2007 and May 2009, 63 patients with OGIB [overt bleeding 25, and occult blood loss with chronic ferropenic anemia 38] and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic tests, CE findings, therapeutic interventions, medical treatment and clinical outcomes following CE were evaluated. The overall diagnostic yield was 44.44% of patients and included findings of angiectasia in 11 [17.46%] patients, nonsteroidal anti-inflammatory drugs enteropathy in 6 [9.52%] patients, celiac disease in 3 [4.76%] patients, tumors in 2 [3.17%] patients, and a variety of other diagnoses ranging from varices to ulcers [due to congenital afibrinogenemia and amyloidosis]. The diagnostic yield was notably higher in overt bleeders [15/25, 60%] compared to occult bleeders [13/38, 34.21%; p = 0.044], and in patients with overt bleeding who had CE within the first 10 days [14/16, 87.5%] after the bleeding episode in comparison to overt bleeders who underwent CE >10 days after the bleeding episode [2/16, 11.1%; p < 0.0001]. During follow-up [11.8 +/- 7 months], CE findings led to specific therapy that resolved the underlying disease or improved the clinical condition in 45 of 63 patients, thus having a positive clinical impact of 71.43%. CE has a high diagnostic yield and a positive influence on clinical management in a significant proportion of patients with OGIB. These data further support the role of CE in routine clinical practice