Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis

Background and Aim: Uncertainty remains about the best test to evaluate patients with obscure gastrointestinal bleeding (OGIB). Previous meta‐analyses demonstrated similar diagnostic yields with capsule endoscopy (CE) and double balloon enteroscopy (DBE) but relied primarily on data from abstracts and were not limited to bleeding patients. Many studies have since been published. Therefore, we performed a new meta‐analysis comparing CE and DBE focused specifically on OGIB. Methods: A comprehensive literature search was performed of comparative studies using both CE and DBE in patients with OGIB. Data were extracted and analyzed to determine the weighted pooled diagnostic yields of each method and the odds ratio for the successful localization of a bleeding source. Results: Ten eligible studies were identified. The pooled diagnostic yield for CE was 62% (95% confidence interval [CI] 47.3–76.1) and for DBE was 56% (95% CI 48.9–62.1), with an odds ratio for CE compared with DBE of 1.39 (95% CI 0.88–2.20; P = 0.16). Subgroup analysis demonstrated the yield for DBE performed after a previously positive CE was 75.0% (95% CI 60.1–90.0), with the odds ratio for successful diagnosis with DBE after a positive CE compared with DBE in all patients of 1.79 (95% CI 1.09–2.96; P = 0.02). In contrast, the yield for DBE after a previously negative CE was only 27.5% (95% CI 16.7–37.8). Conclusions: Capsule endoscopy and double balloon enteroscopy provide similar diagnostic yields in patients with OGIB. However, the diagnostic yield of DBE is significantly higher when performed in patients with a positive CE.     

What is the impact of capsule endoscopy in the long term period?

AIM: To assess the clinical impact of capsule endoscopy(CE) in the long-term follow-up period in patients with obscure gastrointestinal bleeding(OGIB). METHODS: One hundred and forty-one patients who applied CE for OGIB between 2009 and 2012 were retrospectively analyzed, and this cohort was then questioned prospectively. Demographic data of the patients were determined via the presence of comorbid diseases, use of non-steroidal anti-inflammatory drugs anticoagulant-antiaggregant agents, previous diagnostic tests for bleeding episodes, CE findings, laboratory tests and outcomes.RESULTS: CE was performed on 141 patients becauseof OGIB. The capsule was retained in the upper gastrointestinal(GI) system in two of the patients, thus video monitoring was not achieved. There were 139 patients [62% male, median age: 72 years(range: 13-93 years) and a median follow-up duration: 32 mo(range: 6-82 mo)]. The overall diagnostic yield of CE was 84.9%. Rebleeding was determined in 40.3%(56/139) of the patients. The rebleeding rates of patients with positive and negative capsule results at the end of the follow-up were 46.6%(55/118) and 4.8%(1/21), respectively. In the multivariate analysis, usage of NSAIDs, anticoagulant-antiaggregant therapies(OR = 5.8; 95%CI: 1.86-18.27) and vascular ectasia(OR = 6.02; 95%CI: 2.568-14.146) in CE were detected as independent predictors of rebleeding. In the univariate analysis, advanced age, comorbidity, and overt bleeding were detected as predictors of rebleeding.CONCLUSION: CE is a reliable method in the diagnosis of obscure GI bleeding. Negative CE correlated with a significantly lower rebleeding risk in the long-term follow-up period.     

A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding

OBJECTIVES: Due to its superior ability to examine the entire small bowel mucosa, capsule endoscopy (CE) has broadened the diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGIB). Published studies have revealed a numerically superior performance of CE in determining a source of OGIB compared with other modalities, but due to small sample sizes, the overall magnitude of benefit is unknown. Additionally, the types of lesions more likely to be found by CE versus alternate modalities are also unknown. The aim of this study was to evaluate the yield of small bowel findings with CE in patients with OGIB compared to other modalities using meta-analysis. METHODS: We performed a recursive literature search of prospective studies comparing the yield of CE to other modalities in patients with OGIB. Data on yield and types of lesions identified among various modalities were extracted, pooled, and analyzed. Incremental yield (IY) (yield of CE-yield of comparative modality) and 95% confidence intervals (95% CI) of CE over comparative modalities were calculated. RESULTS: A total of 14 studies (n = 396) compared the yield of CE with push enteroscopy for OGIB. The yield for CE and push enteroscopy was 63% and 28%, respectively (IY = 35%, p < 0.00001, 95% CI = 26-43%) and for clinically significant findings (n = 376) was 56% and 26%, respectively (IY = 30%, p < 0.00001, 95% CI = 21-38%). Three studies (n = 88) compared the yield of CE to small bowel barium radiography. The yield for CE and small bowel barium radiography for any finding was 67% and 8%, respectively (IY = 59%, p < 0.00001, 95% CI = 48-70%) and for clinically significant findings was 42% and 6%, respectively (IY = 36%, p < 0.00001, 95% CI = 25-48%). Number needed to test (NNT) to yield one additional clinically significant finding with CE over either modality was 3 (95% CI = 2-4). One study each compared the yield of significant findings on CE to intraoperative enteroscopy (n = 42, IY = 0%, p= 1.0, 95% CI =-16% to 16%), computed tomography enteroclysis (n = 8, IY = 38%, p= 0.08, 95% CI =-4% to 79%), mesenteric angiogram (n = 17, IY =-6%, p= 0.73, 95% CI =-39% to 28%), and small bowel magnetic resonance imaging (n = 14, IY = 36%, p= 0.007, 95% CI = 10-62%). Ten of the 14 trials comparing CE with push enteroscopy classified the types of lesions found on examination. CE had a 36% yield for vascular lesions versus 20% for push enteroscopy, with an IY of 16% (p < 0.00001, 95% CI = 9-23%). Inflammatory lesions were also found more often in CE (11%) than in push enteroscopy (2%), with an IY of 9% (p= 0.0001, 95% CI = 5-13%). There was no significant difference in the yield of tumors or "other" findings between CE and push enteroscopy. CONCLUSIONS: CE is superior to push enteroscopy and small bowel barium radiography for diagnosing clinically significant small bowel pathology in patients with OGIB. In study populations, the IY of CE over push enteroscopy and small bowel barium radiography for clinically significant findings is >or=30% with an NNT of 3, primarily due to visualization of additional vascular and inflammatory lesions by CE.     

Impact of fecal occult blood on obscure gastrointestinal bleeding:Observational study

AIM: To elucidate the association between small bowel diseases(SBDs) and positive fecal occult blood test(FOBT) in patients with obscure gastrointestinal bleeding(OGIB).METHODS: Between February 2008 and August 2013, 202 patients with OGIB who performed both capsule endoscopy(CE) and FOBT were enrolled(mean age; 63.6 ± 14.0 years, 118 males, 96 previous overt bleeding, 106 with occult bleeding). All patients underwent immunochemical FOBTs twice prior to CE. Three experienced endoscopists independently reviewed CE videos. All reviews and consensus meeting were conducted without any information on FOBT results. The prevalence of SBDs was compared between patients with positive and negative FOBT.RESULTS: CE revealed SBDs in 72 patients(36%). FOBT was positive in 100 patients(50%) and negative in 102(50%). The prevalence of SBDs was significantly higher in patients with positive FOBT than those with negative FOBT(46% vs 25%, P = 0.002). In particular, among patients with occult OGIB, the prevalence of SBDs was higher in positive FOBT group than negative FOBT group(45% vs 18%, P = 0.002). On the other hand, among patients with previous overt OGIB, there was no significant difference in the prevalence of SBDs between positive and negative FOBT group(47% vs 33%, P = 0.18). In disease specific analysis among patients with occult OGIB, the prevalence of ulcer and tumor were higher in positive FOBT group than negative FOBT group. In multivariate analysis, only positive FOBT was a predictive factors of SBDs in patients with OGIB(OR = 2.5, 95%CI: 1.4-4.6, P = 0.003). Furthermore, the trend was evidentam on g patients with occult OGIB who underwent FOBT on the same day or a day before CE. The prevalence of SBDs in positive vs negative FOBT group were 54% vs 13% in patients with occult OGIB who underwent FOBT on the same day or the day before CE(P = 0.001), while there was no significant difference between positive and negative FOBT group in those who underwent FOBT two or more days before CE(43% vs 25%, P = 0.20).CONCLUSION: The present study suggests that positive FOBT may be useful for predicting SBDs in patients with occult OGIB. Positive FOBT indicates higher likelihood of ulcers or tumors in patients with occult OGIB. Undergoing CE within a day after FOBT achieved a higher diagnostic yield for patients with occult OGIB.     

A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding

OBJECTIVES: Capsule endoscopy (CE) has revolutionized the evaluation of obscure gastrointestinal bleeding (OGIB) but published literature is limited to small series with heterogeneous indications. The aim of this study was to determine the findings and the diagnostic yield of CE in a large series of patients with overt and occult OGIB. METHODS: Data on 260 patients who underwent CE for overt (N = 126) or occult (N = 134) OGIB were obtained by retrospective chart review and review of an internal database of CE patients and findings. RESULTS: Visualization of the entire small bowel was achieved in 74%. The majority of exams (66%) were rated as having a good or excellent prep. Clinically significant positive findings occurred in 53%. The yield of CE in the obscure-overt group was greater than in the obscure-occult group (60%vs 46%, P= 0.03). Small bowel angioectasias were the most common finding, comprising over 60% of clinically significant lesions. The mean follow-up was 9.6 months, and there were significant reductions in hospitalizations, additional tests/procedures, and units of blood transfused after CE. Both before and after CE, patients in the overt group had more significant GI bleeding than patients in the occult group. Complications occurred in five (1.9%) cases: nonnatural excretion (four) and CE impaction at cricopharyngeus (one). CONCLUSIONS: The yield of clinically important findings on CE in patients with OGIB is 53% and is greater in patients with obscure-overt than obscure-occult GI bleeding. Angioectasias account for the majority of significant lesions in both groups. Compared with pre-CE, patients had clinical improvement post-CE in medical interventions for OGIB. Complications of CE occur in less than 2% of cases.     

Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy

BACKGROUND: Obscure GI bleeding (OGIB) accounts for about 5% of all patients with GI bleeding. There are limited data on double-balloon enteroscopy (DBE) after a positive finding on capsule endoscopy (CE) in this setting. OBJECTIVE: To determine the clinical outcomes after DBE therapy. DESIGN: Prospective single-center cohort study. SETTING: Tertiary referral university hospital. MAIN OUTCOME MEASUREMENTS: Recurrent bleeding and blood transfusion requirements. PATIENTS AND METHODS: This prospective study of 60 consecutive patients with OGIB was conducted between July 2004 and March 2006. Patients underwent CE before DBE to target the lesion for either further diagnostic evaluation or therapeutic intervention. The mean (standard deviation [SD]) duration of follow-up was 10.0 +/- 5.2 months. RESULTS: The mean (SD) age was 62 +/- 18 years, with 31 men. A total of 74 DBE procedures were performed. An abnormality was seen by DBE in 45 patients (75%). In 12 patients (20%), a diagnosis was clarified or a new diagnosis was made. Therapy at DBE was performed in 34 patients (57%): 30 diathermies and 4 polypectomies. Endoscopic tattooing for targeted surgical removal was made in 3 additional patients. Multiple logistic regression analysis identified previous blood transfusion (odds ratio 10.5, 95% confidence interval 3.1-35; P < .001) to be the only independent predictor that required endoscopic therapy at DBE. Forty-eight patients (80%) had no further bleeding, and 46 patients (77%) had a normal Hb. Blood transfusion requirements fell from 34 patients to 10, P < .001. One patient had a perforation after therapeutic diathermy. LIMITATIONS: Nonrandomized study. CONCLUSIONS: In patients with OGIB and a positive finding on CE, DBE provided a safe and ambulatory method to achieve an excellent clinical outcome with significant reductions in recurrent bleeding and blood-transfusion requirements.     

A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding

Background: Recently, diagnosis of obscure gastrointestinal bleeding (OGIB) has improved greatly due to introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). However, the efficacy of CE over DBE in patients with previous OGIB remains unclear. This study aimed to compare, in terms of diagnostic yield, the efficacy of DBE with that of CE in patients with previous OGIB.

Patients and methods: We enrolled 223 consecutive patients with previous OGIB who were treated between May 2007 and March 2012. We retrospectively evaluated the respective diagnostic yields of CE and DBE in patients with previous OGIB using propensity score-matching analysis. We compared the diagnostic yield of CE with that of DBE.

Results: The diagnostic yields were 41.9% in DBE group and 11.6% in CE group, respectively (p?<?.01). On logistic regression analysis, DBE was significantly superior to CE after matching (Odds ratio [OR], 4.25; 95% confidence interval [CI], 1.43–12.6; p?<?.01), even after adjustment for propensity score (OR, 5.65; 95% CI, 1.56?20.5; p?<?.01).

Conclusions: Our results indicate that DBE might be more useful and perhaps safer than CE in achieving a positive diagnosis in patients with previous OGIB.     

Analysis of the factors that affect the diagnostic yield of capsule endoscopy in patients with obscure gastrointestinal bleeding]

BACKGROUND/AIMS: Capsule endoscopy (CE) has become a valuable modality for the detection of small bowel lesions. The usefulness of CE for obscure gastrointestinal (GI) bleeding has been established with an overall diagnostic yield of 60%. It is unknown whether CE is of equal value in all the patients or of greater benefit in selected groups in Korea. We evaluated the factors that affect the diagnostic yields of CE in patients with obscure GI bleeding. METHODS: CE was performed in 126 consecutive patients [74 men and 52 women mean age 52.5 years (25-75 yrs), 23 with active bleeding] with obscure GI bleeding between September 2002 and July 2004. Patients were divided into two groups: those with documented bleeding lesions and those with non specific CE findings. We analyzed the clinical characteristics and other parameters that influenced the diagnostic yields of CE. RESULTS: A definite or probable cause for obscure GI bleeding was found in 69% (80/116) of the patients. NSAID induced ulcer (16.4%) and angiodysplasia (12.1%) were the most common diagnoses. In patients with active bleeding, the diagnostic yield was significantly greater than that of the patients with occult bleeding (80% vs. 68.3%, p<0.05). However, there was no significant difference in parameters between patients with abnormal CE and those with normal CE in respect to gender, age, previous bleeding history, need for transfusion, cecum imaging, and bowel preparation. CONCLUSIONS: The diagnostic yield of CE in patients with obscure GI bleeding is 69%. It is significantly higher in patients with active bleeding.     

Darier's disease with esophageal involvement

Abstract

Objective. Nowadays, capsule endoscopy (CE) is the first-line procedure after negative upper and lower gastrointestinal (GI) endoscopy for obscure gastrointestinal bleeding (OGIB). Approximately, two-thirds of patients undergoing CE for OGIB will have a small-bowel abnormality. However, several patients who underwent CE for OGIB had the source of their blood loss in the stomach or in the colon. The aim of the present study is to determine the incidence of bleeding lesions missed by the previous gastroscopy/colonoscopy with CE and to evaluate the indication to repeat a new complete endoscopic workup in subjects related to a tertiary center for obscure bleeding before CE. Methods and methods. We prospectively reviewed data from 637/1008 patients underwent to CE for obscure bleeding in our tertiary center after performing negative gastroscopy and colonoscopy. Results. CE revealed a definite or likely cause of bleeding in stomach in 138/637 patients (yield 21.7%) and in the colon in 41 patients (yield 6.4%) with a previous negative gastroscopy and colonoscopy, respectively. The lesions found were outside the small bowel in only 54/637 (8.5%) patients. In 111/138 patients, CE found lesions both in stomach and small bowel (small-bowel erosions in 54, AVMs in 45, active small-bowel bleeding in 4, neoplastic lesions in 3 and distal ileum AVMs in 5 patients). In 24/41 (58.5%) patients, CE found lesions both in small bowel and colon (multiple small-bowel erosions in 15; AVMs in 8 and neoplastic lesion in 1 patients. All patients underwent endoscopic therapy or surgery for their nonsmall-bowel lesions. Conclusions. Lesions in upper or lower GI tract have been missed in about 28% of patients submitted to CE for obscure bleeding. CE may play an important role in identifying lesions missed at conventional endoscopy.     

Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

AIM:To investigate long-term outcome in obscure gastrointestinal bleeding(OGIB) after negative capsule endoscopy(CE) and identify risk factors for rebleeding.METHODS:A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital.Ninety-five patients(84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study.Follow-up data were obtained from the patients’ medical records.The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases.The primary outcome measure was the detection of rebleeding after CE,and factors associated with rebleeding were evaluated using multivariate analysis.RESULTS:Of the 95 enrolled patients(median age 61 years,range 17-85 years),62 patients(65.3%) were male.The median duration of follow-up was 23.7 mo(range 6.0-89.4 mo).Seventy-three patients(76.8%) underwent CE for obscure-overt bleeding.Complete examination of the small bowel was achieved in 77 cases(81.1%).Significant lesions were found in 38 patients(40.0%).The overall rebleeding rate was 28.4%.The rebleeding rate was higher in patients with positive CE(36.8%) than in those with negative CE(22.8%).However,there was no significant difference in cumulative rebleeding rates between the two groups(log rank test;P = 0.205).Anticoagulation after CE examination was an independent risk factor for rebleeding(hazard ratio,5.019;95%CI,1.560-16.145;P = 0.007),regardless of CE results.CONCLUSION:Patients with OGIB and negative CE have a potential risk of rebleeding.Therefore,close observation is required and alternative modalities should be considered in suspicious cases.     

胶囊内镜在老年人不明原因消化道出血中的应用价值

目的 通过分析老年不明原因消化道出血(PGIB)患者的临床资料和胶囊内镜检查结果,探讨胶囊内镜在老年OGIB患者中的应用价值. 方法 分析比较2002年5月至2007年2月,因OGIB在我院行胶囊内镜检查的老年患者及非老年患者的一般资料、出血类型及检查结果.老年组97例,男性40例、女性57例,平均年龄(70.8±6.8)岁;非老年组99例,男性61例、女性38例,平均年龄(44.4±10.3)岁. 结果 老年组显性出血89例,隐性出血8例;非老年组分别为91例和8例.两组胃排空时间、全小肠检查完成率及胶囊延迟率,差异均无统计学意义,老年组小肠转运时间较非老年组显著延长(P<0.05).老年组2例因胶囊内镜滞留于食管未纳入诊断统计,老年组获阳性诊断62例(65.3%),血管病变为最常见病因;非老年组获阳性诊断67例(67.7%).小肠克罗恩病为最常见病因.两组获得阳性诊断率差异无统计学意义,阳性诊断构成比差异有统计学意义(P<0.01).老年组未发现并发症. 结论 胶囊内镜检查对老年OGIB患者是一项安全有效的检查手段,血管病变为老年OGIB患者最常见的病因.     

Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

AIM:To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS:We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult,overt),CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS:Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE.In 222 patients (...     

胶囊内镜对老年不明原因消化道出血的诊断及再出血因素分析

目的 评估胶囊内镜对老年不明原因消化道出血的诊断价值，并通过长期随访结果分析其再出血率及其影响因素。方法入选2002年5月至2008年2月间因不明原因消化道出血在本院行胶囊内镜检查的老年患者127例，评估受检患者的耐受性和诊断率，并随访根据诊断结果实施的治疗效果、再出血率及其影响因素。结果127例受检者中阳性诊断率为66．1％，其中以血管病变为最主要诊断，其次为肿瘤和克罗恩病，分别为59．5％、16．7％和11．9％。剔除10例失访者后，经随访发现117例中再出血率为41％，其中阳性诊断组为48-8％（38／78），阴性诊断组为25．7％（10／39），两组具有统计学差异（P〈0．05）；而阳性诊断组中非血管病变者再出血率为24．2％（8／33），血管病变者为66．7％（30／45），同样具统计学差异（P〈0．01）。结论胶囊内镜对于老年不明原因消化道出血患者是一项安全有效的检查手段。胶囊内镜诊断中以非血管性病变及阴性者再出血率低，而血管病变者再出血率高。     

The small bowel as a source of gastrointestinal blood loss

The small bowel is a rare but important source of blood loss from the gastrointestinal (GI) tract. In approximately 5% of all patients with GI bleeding, no cause for the bleeding is evident even after an extensive workup. This bleeding is often termed "gastrointestinal bleeding of obscure origin" or "obscure gastrointestinal bleed" (OGIB). Recent advancements in enteroscopy have contributed to a better understanding of the small bowel as a source of bleeding. On average, 27% of patients with OGIB have been shown to have lesions in the small bowel, with common findings including arteriovenous malformations (AVMs) and small bowel tumors. The trend in primary diagnostic workup for obscure GI bleeding or suspected small bowel lesions is shifting toward enteroscopic examination. Availability of an accessory channel now offers the clinician management options such as endoscopic injection therapy, electrocautery, and polypectomy. The "gold standard" for examination of the entire small bowel is intraoperative enteroscopy. A newer technique involving laparascopic assistance may lower the morbidity associated with this examination. Combined hormonal therapy may be an alternative treatment for patients with AVMs or an unknown cause of bleeding after enteroscopic examination.     

Factors Associated with the Clinical Impact of Capsule Endoscopy in Patients with Overt Obscure Gastrointestinal Bleeding

Background and Study Aims  

Capsule endoscopy (CE) does not necessarily identify positive findings in patients with overt obscure gastrointestinal bleeding (OGIB). We aimed to identify factors predictive of positive CE findings and those of re-bleeding after negative CE in overt OGIB.     

Lower gastrointestinal bleeding:Role of 64-row computed tomographic angiography in diagnosis and therapeutic planning

AIM: To determine the value of computed tomographic angiography(CTA) for diagnosis and therapeutic planning in lower gastrointestinal(GI) bleeding.METHODS: Sixty-three consecutive patients with acute lower GI bleeding underwent CTA before endovascular or surgical treatment. CTA was used to determine whether the lower GI bleeding was suitable for endovascular treatment, surgical resection, or conservative treatment in each patient. Treatment planning with CTA was compared with actual treatment decisions or endovascular or surgical treatment that had been carried out in each patient based on CTA findings.RESULTS: 64-row CTA detected active extravasation of contrast material in 57 patients and six patients had no demonstrable active bleeding, resulting in an accuracy of 90.5% in the detection of acute GI bleeding(57 of 63). In three of the six patients with no demonstrable active bleeding, active lower GI bleeding recurred within one week after CTA, and angiography revealed acute bleeding. The overall location-based accuracy, sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) for the detection of GI bleeding by 64-row CTA were 98.8%(249 of 252), 95.0%(57 of 60), 100%(192 of 192), 100%(57 of 57), and 98.5%(192 of 195), respectively. Treatment planning was correctly established on the basis of 64-row CTA with an accuracy, sensitivity, specificity, PPV and NPV of 98.4%(248 of 252), 93.3%(56 of 60), 100%(192 of 192), 100%(56 of 56), and 97.5%(192 of 196), respectively, in a location-based evaluation. CONCLUSION: 64-row CTA is safe and effective in making decisions regarding treatment, without performing digital subtraction angiography or surgery, in the majority of patients with lower GI bleeding.     

Meta-analysis shows similar re-bleeding rates among Western and Eastern populations after index video capsule endoscopy

Background & aimsVideo capsule endoscopy (VCE) is the first-line diagnostic procedure for investigating obscure gastrointestinal bleeding (OGIB). Different re-bleeding rates following index VCE have been reported among Western and Eastern studies.MethodsWe conducted a comprehensive literature search to identify studies examining re-bleeding rates after VCE for OGIB. Meta-analysis assessed the pooled proportion of re-bleeding events after VCE for OGIB according to study’s origin (Western vs. Eastern) and according to the length of follow-up (≥24 months vs. <24 months). We also calculated the re-bleeding odds ratios (OR; 95% CI) after positive vs. negative index VCE, overt vs. occult initial presentation of bleeding and after interventional treatment for positive index cases, according to the study’s origin.ResultsWe included 46 (30 Western and 16 Eastern) studies with 5796 patients. Significant heterogeneity was detected among meta-analyzed studies. Overall, the pooled re-bleeding rate was similar between Western (29%; 95% CI: 23–34) and Eastern (21%; 95% CI: 15–27) populations, irrespective of the length of follow-up. The odds of re-bleeding was significantly higher after positive as compared to negative index VCE in Eastern studies (OR: 1.77; 95% CI: 1.07–2.94). Application of specific treatment after positive index VCE was associated with lower re-bleeding odds in both Western (OR: 0.37; 95% CI: 0.16–0.87) and Eastern (OR: 0.39; 95% CI: 0.21–0.72) populations.ConclusionsPatients undergoing VCE for OGIB have similar re-bleeding rates in the East and the West, regardless of the length of follow-up. However, increased re-bleeding odds after positive index VCE is observed in Eastern studies.     

Abdominal pain accompanied by weight loss may increase the diagnostic yield of capsule endoscopy: a Korean multicenter study

OBJECTIVE: Capsule endoscopy (CE) is approved for the evaluation of obscure gastrointestinal (GI) bleeding and its use has increased in the assessment of patients with various small-bowel disorders. The yield of CE for indications of disorders other than GI bleeding is not yet well described. The aim of the present study was to determine in which subgroup of patients with unexplained abdominal pain, CE would be a helpful evaluation tool. MATERIAL AND METHODS: The results of CE in 110 patients (70 M, 40 F, mean age 50.8+/-14.1 years) with unexplained abdominal pain from 12 tertiary referral centers between September 2002 and September 2004 were retrospectively analyzed. RESULTS: The visualization of the small bowel to the cecum was successfully carried out in 69.1% of the patients. Nineteen out of the 110 cases revealed positive findings that explained the symptoms of the patient (diagnostic yield=17.3%). Diagnosis included small-bowel stricture (5), Crohn's disease (3), small-bowel tumor (2), radiation-induced enteritis (1), NSAID-induced enteropathy (1), ischemic ileitis (1), diffuse lymphangiectasia (1), and significant erosion or ulceration (5). By univariate logistic regression analysis, the positive findings of CE were significantly associated with weight loss (odds ratio (OR), 11.9; 95% CI [2.0, 70.6]), elevated erythrocyte sedimentation rate (ESR) (>20 mm/h) (OR, 11.5; 95% CI (1.9, 69.5)), elevated C-reactive protein (CRP) (>or=0.4 mg/dL) (OR, 5.0; 95% CI (1.6, 15.9)), and hypoalbuminemia (albumin<3 g/dL) (OR, 23.1; 95% CI (2.4, 223.1)). Using a multivariate analysis, weight loss was found to be a significant risk factor for positive findings of CE (OR, 18.6; 95% CI (1.6, 222.4), p=0.02). CONCLUSIONS: The results of this study suggest that CE can be helpful in patients suffering from abdominal pain that cannot be explained by established examinations, if the pain is accompanied by weight loss.     

胶囊内镜在不明原因消化道出血诊断中的应用

背景：胶囊内镜是明确不明原因消化道出血（OGIB）的检查手段之一,其诊断率可能受到检查时机和出血自然病程的影响。目的：探讨胶囊内镜在OGIB诊断中的应用价值和最佳检查时机。方法：收集2010年10月～2012年6月厦门大学附属中山医院46例接受胶囊内镜检查的OGIB患者。回顾性分析胶囊内镜检查诊断OGIB的阳性率、疑诊率、敏感性、特异性、阳性预测值和阴性预测值,比较不同检查时机对OGIB检出率的影响。结果：胶囊内镜检查诊断OGIB的阳性率为71．7％,疑诊率为13．0％,阴性率为15．2％,诊断敏感性、特异性以及阳性预测值、阴性预测值分别为96．3％、75．0％、92．9％、85．7％。活动性出血组的检出率显著高于出血停止组（96．3％对68．4％,P=0．030）,显性出血者的检出率与隐性出血者相比差异无统计学意义（100％对75．0％,P=0．148）。出血停止≤2周者的检出率显著高于出血停止〉2周者（90．9％对37．5％,P=0．041）。结论：胶囊内镜是诊断OGIB的一种安全、有效的检查手段,出血后尽早行胶囊内镜检查可能提高阳性诊断率并为进一步干预创造条件。     

Outcome in obscure gastrointestinal bleeding after capsule endoscopy

AIM: To investigate the clinical impact of capsule endoscopy (CE) after an obscure gastrointestinal bleeding (OGIB) episode, focusing on diagnostic work-up, follow-up and predictive factors of rebleeding.METHODS: Patients who were referred to Hospital del Mar (Barcelona, Spain) between 2007 and 2009 for OGIB who underwent a CE were retrospectively analyzed. Demographic data, current treatment with non-steroid anti-inflammtory drugs or anticoagulant drugs, hemoglobin levels, transfusion requirements, previous diagnostic tests for the bleeding episode, as well as CE findings (significant or non-significant), work-up and patient outcomes were analyzed from electronic charts. Variables were compared by χ² analysis and Student t test. Risk factors of rebleeding were assessed by Log-rank test, Kaplan-Meier curves and Cox regression model.RESULTS: There were 105 patients [45.7% women, median age of 72 years old (interquartile range 56-79)] and a median follow-up of 326 d (interquartile range 123-641) included in this study. The overall diagnostic yield of CE was 58.1% (55.2% and 63.2%, for patients with occult OGIB and overt OGIB, respectively). In 73 patients (69.5%), OGIB was resolved. Multivariate analysis showed that hemoglobin levels lower than 8 g/dL at diagnosis [hazard ratios (HR) = 2.7, 95%CI: 1.9-6.3], patients aged 70 years and above (HR = 2.1, 95%CI: 1.2-6.1) and significant findings in CE (HR = 2.4, 95%CI: 1.1-5.8) were independent predictors of rebleeding.CONCLUSION: One third of the patients presented with rebleeding after CE; risk factors were hemoglobin levels < 8 g/dL, age ≥ 70 years or the presence of significant lesions.