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Obscure Gastrointestinal Bleeding (obscure + gastrointestinal_bleeding)
Selected AbstractsMANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING BASED ON THE CLASSIFICATION OF CAPSULE ENDOSCOPIC BLEEDING FINDINGSDIGESTIVE ENDOSCOPY, Issue 3 2010Mitsunori Maeda Background:, Double-balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time-consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB. Methods:, From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE-I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis. Results:, Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE-Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively. Conclusions:, The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE-I > II > III > IV > 0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE. [source] Clinical application of wireless capsule endoscopyJOURNAL OF DIGESTIVE DISEASES, Issue 2 2003Zhi Zheng GE BACKGROUND: Diagnostic modalities for identifying lesions within the small bowel have been quite limited. Wireless capsule endoscopy (WCE) is a new, innovative technique that can detect very small mucosal lesions in the entire small bowel and can be used in the outpatient setting. The present study explored the diagnostic value, tolerance and safety of WCE in the identification of small bowel pathology that was not detected with conventional small bowel imaging studies. METHODS: From May through September 2002, 15 patients with suspected small bowel diseases were prospectively examined, Of them, 12 presented with persistent obscure gastrointestinal bleeding and negative findings on upper endoscopy, colonoscopy, small bowel radiography, and bleeding-scan scintig-raphy or mesenteric angiography. RESULTS: Wireless capsule endoscopy identified pathologic small bowel findings in 11 of the 15 patients (73%): angioectasias, Dieulafoy's lesion, polypoid lesion, submucosal mass, Crohn's disease, carcinoid tumor, lipoma, aphthous ulcer, and hemorrhagic gastritis; four of the patients had two lesions. The images displayed were considered to be good. The capsule endoscopes remained in the stomach for an average of 82 min (range 6,311 min) and the mean transit time in the small bowel was 248 min (range 104,396 min). The mean time of recording was 7 h 29 min (from 5 h to 8 h 30 min). The mean time to reach the cecum was 336 min (180,470 min). The average number of the images transmitted by the capsule was 57 919 and the average time the physician took to review the images transmitted by the capsule was 82 min (range 30,120 min). The average time of elimination of the capsule was 33 h (range 24,48 h). All 15 patients reported that the capsule was easy to swallow, painless, and preferable to conventional endoscopy. No complications were observed. CONCLUSIONS: Wireless capsule endoscopy is safe, well tolerated, and useful for identifying occult lesions of the small bowel, especially in patients who present with obscure gastrointestinal bleeding. [source] Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008David Gilbert Abstract Background and Aim:, Medicare reimbursement for capsule endoscopy for the investigation of obscure gastrointestinal bleeding in Australia requires endoscopy and colonoscopy to have been performed within 6 months. This study aims to determine the diagnostic yield of repeating these procedures when they had been non-diagnostic more than 6 months earlier. Methods:, Of 198 consecutive patients who were referred for the investigation of obscure gastrointestinal bleeding, 50 underwent repeat endoscopy and colonoscopy solely to enable reimbursement (35 females and 15 males; mean age 59.4 [range: 21,82] years). The average duration of obscure bleeding was 50.16 (range: 9,214) months. The mean number of prior endoscopies was 3 (median: 2) and 2.8 colonoscopies (median: 2). The most recent endoscopy had been performed 18.9 (median: 14; range: 7,56) months, and for colonoscopy, 19.1 (median 14; range 8-51) months earlier. Results:, A probable cause of bleeding was found at endoscopy in two patients: gastric antral vascular ectasia (1) and benign gastric ulcer (1). Colonoscopy did not reveal a source of bleeding in any patient. Capsule endoscopy was performed in 47 patients. Twenty four (51%) had a probable bleeding source identified, and another five (11%) a possible source. These included angioectasia (17 patients), mass lesion (2), non-steroidal anti-inflammatory drug enteropathy (2), Cameron's erosions (2), and Crohn's disease (1). Four patients undergoing repeat capsule endoscopy had a probable bleeding source detected. Conclusion:, The yield of repeat endoscopy and colonoscopy immediately prior to capsule endoscopy is low when these procedures have previously been non-diagnostic. Such an approach is also not cost-effective. [source] Best candidates for capsule endoscopy for obscure gastrointestinal bleedingJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2007Zhi-Zheng Ge Abstract Background and Aim:, Capsule endoscopy (CE) has an important role in the diagnosis of patients with obscure gastrointestinal bleeding. However, there was still controversy regarding the best candidates for CE. The present retrospective study aimed to access the best candidates for CE. Methods:, There were 91 consecutive patients referred to the present study for 94 CE examinations from May 2002 to January 2005. They were divided into two groups (41 with active bleeding, and 50 with previous bleeding). Results:, The CE findings were positive in 74.7%, suspicious in 11% of cases and negative in 14.3% of cases, respectively. The positive and suspected positive yield of CE were 75.6% and 19.5% in the active bleeding group, 74% and 4% in the previous bleeding group (P = 0.01), 75.7% and 21.6% in the overt bleeding group, 75% and 0% in the occult bleeding group (P = 0.206), 89.7% and 3.4% in patients who bled 2 weeks previously, 52.38% and 4.76% in patients who bled >2 weeks previously (P = 0.003), 75.6% and 19.5% in active bleeding group, 89.7% and 3.4% in patients who bled 2 weeks ago (P = 0.128). Conclusions:, The best candidates for the procedure are those with active bleeding, or active bleeding in the previous 2 weeks. [source] Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleedingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009L. C. FRY Summary Background, Double-balloon enteroscopy (DBE) is a useful method for evaluation of obscure gastrointestinal bleeding (OGIB). Aim To determine the incidence of lesions within reach of conventional upper and lower endoscopes as the cause of OGIB in patients referred for DBE. Methods All patients undergoing DBE for OGIB during a 3.5-year period at a university hospital were studied. OGIB was defined according to American Gastroenterological Association (AGA) guidelines. Results One hundred and forty-three DBEs were performed in 107 patients for obscure overt (n = 85) and obscure occult (n = 22) GIB. Lesions outside the SB as possible sources of GIB were found in 51 patients (47.6%) and a definite source of bleeding outside the small bowel (SB) was detected in 26 patients (24.3%). Lesions considered to explain a definite source of GIB were: gastric ulcer (n = 3), duodenal ulcer (n = 3), Cameron's lesions (n = 2), gastric antral vascular ectasias (n = 4), radiation proctitis (n = 1), radiation ileitis (n = 2), duodenal angiodysplasias (n = 1), haemorrhoids with stigmata of recent bleed (n = 1), colon angiodysplasias (n = 3), colon diverticulosis (n = 3), colonic Crohn's disease (n = 1), anastomotic ulcers (n = 1). Conclusions The frequency of non-SB lesions definitely explaining the source of GIB in patients referred for DBE was 24.3%. Therefore, repeat esophago-gastroduodenoscopy (EGD) and ileocolonoscopy should be taken into consideration before DBE. [source] | ||||||||||