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165 PROSPECTIVE EVALUATION OF PATIENTS REFERRED FOR OBSCURE BLEEDING: HOW MANY PATIENTS ACTUALLY HAVE SMALL BOWEL BLEEDING? J Staples, J Al Ali, I Zandieh, R Enns We have found that many patients referred for obscure gastrointestinal bleeding have bleeding within reach of standard endoscopic procedures in over 30% of cases. However, in many patients referred, endoscopic examinations are repeated and abnormalities found, subsequently excluding them from even being considered within a 'capsule database'. The aim of this study was to prospectively evaluate referrals for obscure gastrointestinal bleeding (OGIB) and the subsequent investigations undertaken. The main focus was in identifying the subset of patients who ultimately did not undergo capsule endoscopy and their subsequent investigations and diagnoses.
Department of Medicine, University of British Columbia, Vancouver, British Columbia
METHODS: We prospectively evaluated all referrals for OGIB from June 2005 to October 2005 (ongoing evaluation is underway). The number of patients who ultimately did and did not undergo capsule endoscopy (CE) was identified along with their ultimate diagnoses. Investigations performed were at the discretion of the principle investigator.
RESULTS: We identified a total of 28 referrals during the study period for OGIB. Fifteen (54%) of these patients ultimately underwent CE. Ten (67%) patients had abnormal findings on the capsule study. Vascular ectasias of the small bowel were identified in five patients, ileocecal lesions in two patients, celiac disease in two patients and one patient was found to have gastric antral vascular ectasias. Thirteen (46%) patients initially referred for obscure gastrointestinal bleeding did not ultimately undergo capsule endoscopy. Further investigations, apart from CE, identified the culprit lesion in five patients (38%) including two patient's with Cameron's lesions, two patients with extensive diverticular disease (deemed significant) and one patient with a Meckel's diverticulum. The remaining eight patients (62%) who did not undergo capsule endoscopy were found to have no further objective evidence of gastrointestinal bleeding and continue to have active follow-up.
CONCLUSION: Approximately 50% of all patients initially referred for OGIB do not appear to require CE for small bowel assessment. The majority of these patients continue to have active follow-up with no objective evidence of gastrointestinal blood loss. A significant component have the culprit lesion identified on other investigations apart from capsule endoscopy. Further evaluation of ongoing referrals is currently underway to enhance resource utilization by attempting to maximize yield of appropriate investigations.