Brief Article
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World J Gastrointest Endosc. Mar 16, 2013; 5(3): 122-127
Published online Mar 16, 2013. doi: 10.4253/wjge.v5.i3.122
Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding
Supot Pongprasobchai, Songla Chitsaeng, Tawesak Tanwandee, Sathaporn Manatsathit, Udom Kachintorn
Supot Pongprasobchai, Songla Chitsaeng, Tawesak Tanwandee, Sathaporn Manatsathit, Udom Kachintorn, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Pongprasobchai S designed the research; Pongprasobchai S and Chitsaeng S performed the research; Pongprasobchai S and Chitsaeng S analyzed the data; Pongprasobchai S, Tanwandee T, Manatsathit S and Kachintorn U wrote the paper.
Supported by The Gastroenterological Association of Thailand
Correspondence to: Supot Pongprasobchai, MD, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. supot.pon@mahidol.ac.th
Telephone: +66-2-4197281 Fax: +66-2-4115013
Received: April 16, 2012
Revised: August 22, 2012
Accepted: January 23, 2013
Published online: March 16, 2013
Abstract

AIM: To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB).

METHODS: The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients’ medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients’ management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients’ outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients.

RESULTS: Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy’s (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients’ management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001).

CONCLUSION: In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

Keywords: Angiodysplasia; Etiology; Gastrointestinal Bleeding; Obscure; Capsule Endoscopy; Outcome; Small bowel ulcer; Wireless