The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea. European Radiology
(Impact Factor: 4.01).
01/2012; 22(6):1159-66. DOI: 10.1007/s00330-011-2374-1
The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography.
We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%.
Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy.
Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography.
• CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). • Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. • Negative CT enterography does not exclude important causes of small bowel bleeding. • Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy.
Available from: PubMed Central
- "Additionally, VCE has shown promise in the evaluation of suspected Crohn’s disease and small bowel tumors (5). A number of studies have compared VCE with conventional enteroclysis; VCE has been compared with traditional diagnostic modalities, including small bowel series, enteroclysis, computed tomography (CT) and push enteroscopy (PE) (6–9). Small bowel VCE is the procedure of choice for evaluating obscure GI bleeding and is superior to radiographic procedures in detecting Crohn’s disease of the small bowel. "
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ABSTRACT: The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn's disease. A total of 55 cases of small bowel Crohn's disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn's disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn's disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.
Available from: Philippe Soyer
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ABSTRACT: A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. KEY POINTS: • Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions. • Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation. • A fair and unbiased comparison of the two investigations is still needed.
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ABSTRACT: Video capsule endoscopy (VCE) has become the first choice in the evaluation of suspected small bowel bleeding [1–4]. The positive impact of VCE on clinical outcomes in patients with obscure gastrointestinal bleeding (OGIB) has been demonstrated in several studies [5–7]. VCE showed a better diagnostic yield in detecting mucosal lesions in patients with OGIB when compared with radiologic investigations such as small bowel follow-through (SBFT), small bowel enteroclysis (SBE), or cross-sectional imaging such as CT scans or MRI [2, 4, 8–10]. Device-assisted enteroscopy (DAE), which comprises single-balloon, double-balloon, and spiral enteroscopy, also enables inspection of the whole small bowel mucosa and permits the performance of therapeutic interventions . DAE is time-consuming, however; so VCE and DAE should be considered complementary procedures. The effect of VCE on diagnosis and outcome in patients with established Crohn’s disease (CD) and clinically suspected CD has been also demonstrated in several studies [11–15]. Recent studies have also shown that VCE is useful for screening and surveillance of patients with polyposis syndromes [16, 17]. Furthermore, the usefulness of VCE for patients with celiac disease or for patients with symptoms such as chronic diarrhea and chronic abdominal pain (when accompanied by inflammatory markers), and for less frequent small bowel diseases, has been increasingly demonstrated in recent publications [18–22].
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