Capsule endoscopy for gastrointestinal bleeding with an obscure etiology.

BACKGROUND AND PURPOSE: Capsule endoscopy (CE) is a new diagnostic modality that is being utilized with increasing frequency for examination of lesions suspected to be of small bowel origin. The most common indication for CE is obscure gastrointestinal bleeding. This study investigated the safety and diagnostic value of CE in patients with obscure gastrointestinal bleeding.

METHODS: From February 1 to October 30, 2003, 35 patients with obscure gastrointestinal bleeding among 43 consecutive patients with suspected small bowel pathology were enrolled. The mean age of the patients was 50.5 years (range, 24-81 years). A negative panendoscopy and colonoscopic study were required for study eligibility. An M2A video capsule endoscope was swallowed by each patient after an overnight fast if plain abdominal radiograph done 1 day prior to the procedure was negative for obstruction. Bowel preparation using a mixed solution containing magnesium carbonate, citric acid anhydrous and potassium bicarbonate, and bisacodyl was performed only in selected patients.

RESULTS: Abnormal findings were noted in 31 of 35 patients (89%), 20 (57.2%) of whom had gastrointestinal pathology explaining their symptoms. Only 12 (34%) of the 20 patients had lesions solely in the small bowel. Angiodysplasia was the most common source of bleeding (37%), followed by Crohn's disease (14%). Other findings included Osler-Weber-Rendu's disease, gastrointestinal stromal tumor, vascular ectasia and small bowel diverticulum. Three capsules became lodged and did not provide images during subsequent transit through the colon, but serial abdominal plain radiographs done every 3 days after capsule ingestion showed passage of the capsules had occurred by 1 week. No discomfort or side effects were noted up to 2 months after ingestion.

CONCLUSION: CE is a safe, painless and effective method for diagnosing obscure gastrointestinal bleeding. A final diagnosis was reached in more than one half of the patients and positively affected treatment. The capsule produced clear and recognizable images of lesions even without bowel preparation. If done early, CE can aid in directing proper management in patients with suspected small bowel pathology.