Digestive Diseases and Sciences

, Volume 56, Issue 6, pp 1763–1768

Bleeding Lesions Within Reach of Conventional Endoscopy in Capsule Endoscopy Examinations for Obscure Gastrointestinal Bleeding: Is Repeating Endoscopy Economically Feasible?

  • Jiannis Vlachogiannakos
  • Kostis Papaxoinis
  • Nikos Viazis
  • Anastasia Kegioglou
  • Ioannis Binas
  • Dimitrios Karamanolis
  • Spiros D. Ladas
Original Article

Abstract

Background

Most tertiary gastroenterology centers currently offer an open-access capsule endoscopy (CE) service, including patients with obscure gastrointestinal bleeding. However, CE may identify lesions missed by conventional endoscopy.

Aims

To determine the incidence of bleeding lesions missed by the preceding gastroscopy/colonoscopy that were revealed by CE and compare potential differences in the rate of identifying such lesions in patients that we investigated as opposed to those investigated elsewhere.

Methods

We prospectively reviewed data from patients subjected to CE for obscure bleeding. We analyzed all cases where a source of bleeding was located in the stomach, duodenum, or colon.

Results

A total of 317 consecutive patients were subjected to CE for obscure gastrointestinal bleeding within 28 months. Prior to CE examination, 174 patients had gastroscopy and colonoscopy in our institutions and 143 were referrals, all with negative endoscopic investigation. We identified 11 (3.5%) cases where the source of bleeding was found in the stomach (n = 4) or the cecum (n = 7). There was a significant difference of extra small intestinal lesions diagnosed by CE between referrals (9/143, 6.3%) and endoscopic investigation performed in our institutions (2/174, 1.15%), (p = 0.026). The estimated cost of re-endoscoping in our institution all CE referrals would be €50,050 (143 patients × €350), to avoid unnecessary CE examinations (9 patients × €600 = €5,400).

Conclusions

Reading the whole CE video is important, because small-bowel CE may identify lesions responsible for obscure bleeding missed by the preceding gastroscopy and colonoscopy. Repeating conventional endoscopy by experts before CE is not a cost-effective approach.

Keywords

Obscure gastrointestinal bleeding Capsule endoscopy Gastroscopy Colonoscopy 

References

  1. 1.
    Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133:1697–1717.PubMedCrossRefGoogle Scholar
  2. 2.
    Leighton JA, Golstein J, Hirota W, et al. Obscure gastrointestinal bleeding. Gastrointest Endosc. 2003;58:650–655.PubMedCrossRefGoogle Scholar
  3. 3.
    Lin S, Rockey D. Obscure gastrointestinal bleeding. Gastroenterol Clin N Am. 2005;34:679–698.CrossRefGoogle Scholar
  4. 4.
    Pennazio M, Santucci R, Rondonotti E, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: Report of 100 consecutive cases. Gastroenterology. 2004;126:643–653.PubMedCrossRefGoogle Scholar
  5. 5.
    Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002;123:999–1005.PubMedCrossRefGoogle Scholar
  6. 6.
    de Leusse A, Vahedi K, Edery J, et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? Gastroenterology. 2007;132:855–862.PubMedCrossRefGoogle Scholar
  7. 7.
    Voderholzer W, Beinhoelzl J, Rogalla P, et al. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy. 2003;35:1009–1014.PubMedCrossRefGoogle Scholar
  8. 8.
    Fukumoto A, Tanaka S, Shishido T, et al. Comparison of detectability of small-bowel lesions between capsule endoscopy and double-balloon endoscopy for patients with suspected small-bowel disease. Gastrointest Endosc. 2009;69:857–865.PubMedCrossRefGoogle Scholar
  9. 9.
    Kitiyakara T, Selby W. Non-small bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc. 2005;62:234–238.PubMedCrossRefGoogle Scholar
  10. 10.
    Elijah D, Daas A, Brady P. Capsule endoscopy for obscure GI bleeding yields a high incidence of significant treatable lesions within reach of standard upper endoscopy. J Clin Gastroenterol. 2008;42:962–963.PubMedCrossRefGoogle Scholar
  11. 11.
    Viazis N, Sgouros S, Papaxoinis K, et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: A prospective, randomized, controlled study. Gastrointest Endosc. 2004;60:534–538.PubMedCrossRefGoogle Scholar
  12. 12.
    Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy? A meta-analysis. Am J Gastroenterol. 2009;104:219–227.PubMedCrossRefGoogle Scholar
  13. 13.
    Viazis N, Papaxoinis K, Theodoropoulos I, et al. Impact of capsule endoscopy in obscure small-bowel bleeding: Defining strict diagnostic criteria for a favorable outcome. Gastrointest Endosc. 2005;62:717–722.PubMedCrossRefGoogle Scholar
  14. 14.
    Rey JF, Ladas S, Alhassani A. Kuznetsov K and the ESGE Guidelines Committee. European Society of Gastrointestinal Endoscopy (ESGE). Video capsule endoscopy: Update to guidelines. Endoscopy. 2006;38:1047–1053.PubMedCrossRefGoogle Scholar
  15. 15.
    Hartmann D, Schmidt H, Schilling D, et al. Follow-up of patients with obscure gastrointestinal bleeding after capsule endoscopy and intraoperative enteroscopy. Hepatogastroenterology. 2007;54:780–783.PubMedGoogle Scholar
  16. 16.
    Saperas E, Dot J, Videla J, Alvarez-Castells A, et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol. 2007;102:731–737.PubMedCrossRefGoogle Scholar
  17. 17.
    Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: Indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–48.PubMedCrossRefGoogle Scholar
  18. 18.
    Estevez E, Gonzalez-Conde B, Vazquez-Iglesias JL, et al. Diagnostic yield and clinical outcomes after capsule endoscopy in 100 consecutive patients with obscure gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2006;18:881–888.PubMedCrossRefGoogle Scholar
  19. 19.
    Carey EJ, Leighton JA, Heigh RI, et al. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol. 2007;102:89–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Buscaglia JM, Giday SA, Kantsevoy SV, et al. Performance characteristics of the suspected blood indicator feature in capsule endoscopy according to indication for study. Clin Gastroenterol Hepatol. 2008;6:298–301.PubMedCrossRefGoogle Scholar
  21. 21.
    D’Halluin PN, Delvaux M, Lapalus MG, et al. Does the “Suspected Blood Indicator” improve the detection of bleeding lesions by capsule endoscopy? Gastrointest Endosc. 2005;61:243–249.PubMedCrossRefGoogle Scholar
  22. 22.
    Gilbert D, O’Malley S, Selby W. Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding? J Gastroenterol Hepatol. 2008;23:1806–1809.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jiannis Vlachogiannakos
    • 1
  • Kostis Papaxoinis
    • 1
  • Nikos Viazis
    • 2
  • Anastasia Kegioglou
    • 2
  • Ioannis Binas
    • 1
  • Dimitrios Karamanolis
    • 2
  • Spiros D. Ladas
    • 1
  1. 1.Hepatogastroenterology Unit, First Department of Medicine, PropaedeuticMedical School, Athens University, Laiko General Hospital, AthensAthensGreece
  2. 2.Second Department of GastroenterologyEvangelismos General HospitalAthensGreece

Personalised recommendations