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Capsule endoscopy superior for yield, similar in long-term outcomes to angiography
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The diagnostic yield of capsule endoscopy was greater than angiography and led to comparable long-term outcomes in patients with obscure gastrointestinal bleeding in a recent study.
Researchers randomly assigned 60 patients with acute overt obscure gastrointestinal bleeding (OGIB) to undergo either small-bowel capsule endoscopy (CE) (n=30) or three-vessel visceral angiography (n=30). Incidences of mortality, transfusion and readmission for bleeding or anemia were followed up in all patients for a mean of 48.5 months.
CE detected small-bowel tumors in three patients, bleeding in the small bowel distal to duodenum in four, small-bowel ulcers and erosions in six and bleeding stomach lesions in three participants. Angiography findings included Meckel’s diverticulum and jejunal hypervascular tumor in one patient each, and four patients displayed angiodysplasia in the small bowel and colon. CE had a higher diagnostic yield than angiography (53.3% positivity vs. 20.0%, P=.016 for difference), as well as a lower cumulative risk for rebleeding, but this difference was not considered statistically significant (16.7% of patients vs. 33.3%, P=.1).
Incidences of readmission due to rebleeding (16.7% vs. 16.7%, P=1.0), additional transfusion (10% vs. 10%, P=1.0), surgery for small-bowel diseases (10% in the CE group vs. 6.7% in angiography, P=1.0) and mortality (13.3% vs. 13.3%, P=1.0) were similar between groups. Four angiography patients experienced continuous bleeding while hospitalized for the procedure and were transferred to CE, while no CE patient was crossed to angiography (P=.11 for difference). More participants in the CE group underwent post-procedural balloon-directed enteroscopy than angiography patients (23.3% vs. 3.3%, P=.05).
“We have shown that the diagnostic yield of immediate CE is superior to angiography in patients with active overt OGIB,” the researchers wrote. “There was also no significant difference [in] the long-term outcomes between the two groups. With the relatively low diagnostic yield of angiography and the increasing availability of deep enteroscopy and other competing technology like CT enterography, we believe that future clinical trials should be directed to compare the performance of CE with these new modalities.”
Disclosure: Wai K. Leung, MD, reported involvement in a colon capsule endoscopy trial sponsored by Given Imaging.
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