Original Contribution
The American Journal of Gastroenterology (2007) 102, 731–737; doi:10.1111/j.1572-0241.2007.01058.x
Capsule Endoscopy Versus Computed Tomographic or Standard Angiography for the Diagnosis of Obscure Gastrointestinal Bleeding
Esteve Saperas MD1, Joan Dot MD1, Sebastian Videla MD1, Agustí Alvarez-Castells MD2, Mercedes Perez-Lafuente MD2, Jose Ramón Armengol MD1 and Juan-R Malagelada MD1
- 1Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- 2Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
Correspondence: Esteban Saperas, MD, Digestive System Research Unit, University Hospital Vall d'Hebron, P° Vall d´Hebron 119-129, 08035 Barcelona, Spain.
Received 24 July 2006; Accepted 2 November 2006.
Abstract
BACKGROUND AND AIMS:
Capsule endoscopy (CE) is superior to push enteroscopy and small bowel barium radiography in detecting the source of obscure GI bleeding. We now compared whether CE has a superior diagnostic yield than CT angiography (CTA) or standard mesenteric angiography (ANGIO) in patients with obscure GI bleeding.
METHODS:
From June 2004 to October 2005, consecutive patients admitted for OGIB underwent both CTA and ANGIO, followed by CE, performed blindly by independent examiners within the next 7 days. The primary end point of the study was the diagnostic yield for each technique, defined as the frequency of detection of lesions with a high probability of bleeding.
RESULTS:
Twenty-eight patients (16 men and 12 women, mean age 74 
2 yr) with OGIB (overt bleeding in 20 cases and chronic occult in 8) were prospectively evaluated. CTA or standard angiography could be performed in 25 of 28 patients (applicability 86%), because of contrast allergy (1 patient) and chronic renal failure (2 patients). A source of bleeding was detected by CE in a greater proportion of patients, 72% (18 of 25, 95% CI 50.6–87.9%), than CTA, 24% (6 of 25, 95% CI 9.4–45.1%, P = 0.005 vs CE), or ANGIO, 56% (14 of 25, 95% CI 34.9–75.6%, P = NS). Similarly, CE was able to diagnose 100% of patients diagnosed by CTA and 86% of patients diagnosed by ANGIO. Moreover, CE was positive in 12 of 19 (63%) negative cases on CTA and in 6 of 11 (55%) negative cases on ANGIO. As a result of the CE findings, therapeutic intervention was undertaken in 9 of 19 (47%) patients with positive results.
CONCLUSION:
CE detects more lesions than CTA or standard mesenteric angiography in patients with obscure GI bleeding and has a therapeutic impact in almost half of the patients with positive findings.
