Triage of patients with obscure gastrointestinal bleeding by capsule endoscopy.

Bruil, A.B. (2014) Triage of patients with obscure gastrointestinal bleeding by capsule endoscopy. thesis, Medicine.

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Abstract

Background and aim: Capsule endoscopy (CE) is the first-line diagnostic method for patients with obscure gastrointestinal bleeding (OGIB). Nevertheless, a substantial number of patients have non-diagnostic CE findings and there is still no consensus in literature about the best policy in this specific subgroup. This study collected long-term data on patients with OGIB who underwent CE with or without subsequent balloon-assisted enteroscopy (BAE). Our main aim was to determine the role of CE in triage of patients with OGIB. Patients and methods: 578 patients were enrolled in this retrospective study. CE was performed after a negative conventional work-up of OGIB by upper endoscopy and colonoscopy. CE results were classified as diagnostic (positive) or non-diagnostic (negative) results. Clinical characteristics were analyzed to find predictors associated with rebleeding within 2 years. Subsequent BAE was performed in 104 patients for diagnostic and therapeutic purposes. Results: Positive CE results were found in 28% (159/578) of cases, including 7 small bowel tumors. 3 tumors were missed by initial CE. The diagnosis was made within maximally 20 days by other modalities, including BAE. A hemoglobin (Hb) of ≤5.0 mmol/L at onset of OGIB was an independent factor associated with an increased risk for rebleeding after a nondiagnostic CE (hazard ratio= 4.831[3.034-7.693], p=0.000). Premenopausal women (2/46) had a significantly lower risk for rebleeding compared to postmenopausal women (34/161) (p=0.008). The diagnostic yield of subsequent BAE guided by a positive CE result was significantly enhanced towards 74% (52/70), whereas after a non-diagnostic CE a diagnosis was made in only 9% (3/34) of patients. Conclusions: A diagnostic CE provides a directing role for endoscopic interventions in patients with OGIB. In patients who present with a low Hb level at onset of OGIB, further examination is recommendable, even after a non-diagnostic CE procedure. Premenopausal women can be considered as low-risk group for rebleeding after a negative CE examination. Despite the fact that CE is the first-line method for visualization of the small bowel, the miss rate for small bowel tumors is still considerably. BAE can be an useful tool in cases with a high clinical suspicion.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijholt, Dr. I.M.
Supervisor name:	Al-Toma, Dr. A. and Stolk, Dr. M.F.J. and St. Antonius hospital, Nieuwegein
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:47
Last Modified:	25 Jun 2020 10:47
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/841

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