Clinical impact of capsule endoscopy on further strategy and long-term clinical outcome in patients with obscure bleeding

BackgroundCapsule endoscopy (CE) is highly effective in detecting small-bowel lesions in patients with obscure GI bleeding (OGIB). Little is known about the impact of CE on further management and outcomes in patients with OGIB.ObjectiveTo evaluate the impact of CE on the management and outcomes of patients with OGIB.DesignRetrospective cohort study.SettingTertiary-referral center.PatientsA total of 92 patients referred for obscure-overt bleeding (N = 36) or obscure-occult bleeding (N = 56).InterventionsCE was performed after a negative endoscopic examination of the upper-GI and lower-GI tract. Follow-up was performed by collecting information from the referring physicians.Main Outcome MeasurementsNeed for transfusion, overt bleeding, anemia.ResultsNinety-two patients (52 men, 40 women), with a mean age of 66.5 years (range 22-90 years) and a mean follow-up time of 635.5 days (range 81-1348 days) were studied. Relevant lesions were found in 55 of 92 patients (59.8%). After a CE, invasive small-bowel investigations were more often done in patients with a positive CE result (P = .01). Invasive endoscopic or surgical therapy was far more often performed in patients with a positive CE finding (P < .001). The outcome after a CE was favorable in 61 of 92 patients (66.3%) and was defined by the absence of overt bleeding and a normal Hb value on the latest available laboratory result. In the younger age category, a 100% resolution of OGIB was observed after long-term follow-up. On the contrary, angiodysplasia was a predictor for a less favorable clinical outcome (P = .04).LimitationsRetrospective analysis.ConclusionsA CE has an important impact on a further diagnostic workup, therapeutic strategy, and long-term clinical evolution in patients with OGIB, with a favorable outcome in 66.3% of patients after CE-guided therapy.