Introduction Obscure gastrointestinal bleed (OGB) occurs in 5% of patients who present with gastrointestinal haemorrhage.1 In 2008, the British Society of Gastroenterology (BSG) published guidelines stating patients who present with obscure gastrointestinal bleeding with a negative gastroscopy and colonoscopy should undergo capsule endoscopy (CE).2
Methods A retrospective review of all patients presenting with OGB who underwent CE between 2005 and August 2009 was performed. Data were collected on patient demographics, indications, diagnosis and further management following CE. We evaluated the impact of CE in the management and outcome of patients with OGB in our hospital.
Results 161 patients, with a mean age of 61 years, were referred for CE for investigation of OGB of which 18.7% (n=30) patients had overt bleeding (OB) and 81% (n=131) had iron deficiency anaemia (IDA). 117 (72.5%) were females. Angiodysplasia was the most common finding in 27.5% of patients (n=44). Other findings included GAVE (3.7%), Crohn's (1.8%), duodenitis/jejunoileitis (3.7%), NSAID induced ulcers (3.7%), coeliac (0.6%), HHT (1.8%), unexplained ulcers (1.8%), phlebectasia (1.2%), lymphangiectasia (1.2%) and gastritis (3%) while CE was normal in 49% (n=79). The diagnostic yield was 63% and 44% in the OB and IDA groups, respectively (odds ratio 2.17). CE resulted in a change of management in 33% (n=53) of patients of which 46 (89.7%) had a positive outcome. In the OB group, 8 (27.5%) patients were diagnosed with active bleeding of which 1 underwent surgery, 1 had their NSAID stopped and 6 underwent argon plasma coagulation (APC) to treat angiodysplastic lesions. In the remaining 22 patients in the OB group, 8 (27.5%) were initiated on new medications (PPI/Iron), 6 (20%) underwent repeat endoscopic tests and 8 were reassured and discharged. In the IDA group, 7 (5.5%) patients had evidence of active bleeding and had APC to the angiodysplastic lesions. In the remaining 124 patients in the IDA group, 10 (7.6%) were started on new medications, 3 (2.5%) and 1 (0.5%) patient were diagnosed with Crohn's and Coeliac disease, respectively, and started on appropriate treatment, 2 (1.5%) had their NSAIDs stopped and 1 (0.5%) underwent repeat endoscopic investigation. The remaining 100 (69 normal, 31 with non-bleeding abnormalities) were reassured and advised to continue iron tablets.
Conclusion The high diagnostic yield of CE in OGB influences clinical management leading to improved outcomes. CE led to a change in management in 33% of patients while reassurance with a concrete management plan was obtained in the rest. More patients (73.3%) underwent a change in management plan in the OB group compared to the IDA though the numbers in the OB group were comparatively small (OR 8.8).