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Shou-jiang Tang, Simon Zanati, Elena Dubcenco, Naveen Arya, Gregory Monkewich, Maria Cirocco, Gabor Kandel, Gregory B Haber, Paul Kortan, Norman E Marcon

The Center for Therapeutic Endoscopy and Endoscopic Oncology, St Michael’s Hospital, University of Toronto, Toronto, Ontario

BACKGROUND: Wireless capsule endoscopy (CE) is being increasingly used in the investigation of obscure GI bleeding, but at least some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy.

METHODS: We reviewed the results of CE done in our center in a 12 month period for obscure GI bleeding.

RESULTS: Of 46 patients with obscure GI bleeding, CE found a definite cause in 19 (41%), and a probable cause in another 10 (22%) with overall diagnostic yield of 63%. One of these lesions was within reach of conventional gastroscopy, 2 within reach of push enteroscopy, 4 within reach of colonoscopy and 1 within reach of retrograde enteroscopy through a stoma. The percentage of patients with a bleeding source within reach of routine endoscopy but missed during pre-CE endoscopy was significantly higher for those patients having endoscopy only in the community versus from our center: 30% (8 out of 27) versus 0% (0 out of 19).

CONCLUSIONS: CE has value diagnosing bleeding lesions not only within the small bowel, but also in the stomach and colon. However, “second look” endoscopy should be considered before ordering CE for obscure GI bleeding.

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