Capsule Endoscopy Does Not Improve GI Bleeding Outcomes


Last Updated: 2010-03-02 19:41:24 -0400 (Reuters Health)

NEW YORK (Reuters Health) - While capsule endoscopy can improve the diagnosis of obscure gastrointestinal (GI) bleeding, this does not seem to translate into better outcomes, according to a report in Gastroenterology published online on February 4.

Dr. Loren Laine and colleagues from the University of Southern California, Los Angeles, assessed the outcomes of 136 patients -- 54 with overt bleeding, 82 with occult bleeding - who had negative upper endoscopy, colonoscopy, and push enteroscopy findings. The researchers randomized their subjects to capsule endoscopy or to small bowel contrast radiography.

The patients were followed up with complete blood count at 1, 2, 3, 6, 9, and 12 months. The primary endpoint was further bleeding. Secondary endpoints included diagnostic yield, additional interventions, blood transfusions after randomization, and subsequent hospitalization for bleeding.

The authors report that the diagnostic yield was significantly better with the capsule than with small bowel radiography (30% vs. 7%; p = 0.0007). But their study suggests that the higher diagnostic yield "may not translate into improved outcomes," they say.

Further bleeding was observed in 30% of patients in the capsule group and 24% in the small bowel radiography group. More patients presenting with overt bleeding than with occult bleeding experienced further bleeding (39% vs. 20%).

There were no significant differences between the groups in the need for subsequent diagnostic or therapeutic interventions for bleeding, subsequent hospitalizations for bleeding, or subsequent blood transfusions.

"Most patients do well whether or not abnormalities are identified, and additional diagnostic or therapeutic interventions may be required whether or not the capsule identifies a source of bleeding," the researchers conclude. "The ability to control the capsule and to perform diagnostic and therapeutic interventions may be necessary to significantly improve clinical outcomes with capsule endoscopy in a population with obscure gastrointestinal bleeding."

Gastroenterology 2010.

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