OBJECTIVES: Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram.
METHODS: Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality.
RESULTS: A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P = 0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P = 0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality.
CONCLUSIONS: In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.
BACKGROUND AND AIMS: The position of capsule endoscopy (CE) relative to push enteroscopy (PE) in the diagnostic algorithm of obscure gastrointestinal bleeding is unclear, as previous studies involved the use of both techniques in all patients. We therefore conducted a trial in which patients were randomized to undergo one or other exploration.
METHODS: All consecutive patients referred for obscure gastrointestinal bleeding were randomized between CE and PE as the first-line exploration. The alternative method was only used if the first-line method revealed no definite bleeding source, or if required for clinical reasons during follow-up.
RESULTS: CE and PE, used as the first-line exploration, identified a bleeding source in 20 of 40 patients and 9 of 38 patients, respectively (50% vs 24%; P = .02). CE missed lesions in 8% of patients, and all these lesions were located in sites accessible to standard endoscopy. PE missed lesions in 26% of patients. At the end of the 12-month follow-up period, the strategy based on CE as first-line exploration followed by PE if necessary only was similar to PE followed by CE in terms of diagnostic yield, clinical outcome, and therapeutic impact, but reduced the percentage of patients needing the alternative exploration (25% vs 79%; P < .001).
CONCLUSIONS: CE has a higher diagnostic yield than PE in obscure gastrointestinal bleeding, and a strategy based on CE as first-line exploration avoids unnecessary explorations.
Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram.
METHODS:
Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality.
RESULTS:
A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P = 0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P = 0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality.
CONCLUSIONS:
In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.
Type of action (intervention/test)»Diagnostic test
