Small bowel capsule endoscopy in obscure gastrointestinal bleeding: A matched cohort comparison of patients with normal vs surgically altered gastric anatomy - 20/08/22
, Gabriel Rahmi b, Maria Elena Riccioni c, Geoffroy Vanbiervliet d, Gabriele Wurm Johansson e, Chloé Leandri f, Peter Baltes g, Clotilde Duburque h, Franck Cholet i, Anastasios Koulaouzidis j, k, l, m, Lucille Quénéhervé ion behalf of the
I-CARE group and the PREPINTEST study group
Highlights |
• | What is already known on this subject?Small bowel capsule endoscopy (CE) is feasible in most patients with surgically-altered gastric anatomy (SAGA) and obscure gastrointestinal bleeding. |
• | What are the new findings?Orally ingested SBCE in patients with SAGA have a longer small bowel transit time, a lower completion rate but a similar diagnostic yield, with significantly more frequent inflammatory/ulcerated lesions, as compared to non-operated patients paired on age, gender and overt vs obscure of bleeding. |
• | How might it impact on clinical practice in the foreseeable future?First, oral ingestion should be considered in most patients with SAGA when SBCE is indicated for OGIB, whereas indications for endoscopic delivery of CE should be limited. Second, different preparation modalities (possibly with the use of boosters), may be considered in patients with SAGA. |
Abstract |
Background |
Little is known about small bowel capsule endoscopy (SBCE) outcomes in patients with surgically altered anatomy.
Aims |
To assess the feasibility and diagnostic yield of orally ingested SBCE to investigate obscure gastrointestinal bleeding (OGIB) in patients with surgically altered gastric anatomy, compared to native gastric anatomy.
Methods |
207 patients with OGIB were selected from an open, multicenter, retrospective cohort (SAGA study) and match-paired according to age, gender and bleeding type (overt/occult) to 207 control patients from a randomized controlled trial (PREPINTEST). Primary outcomes were the diagnostic yield (P1 or P2 findings), completion rate, adverse events rate, and small bowel transit time (SBTT).
Results |
The diagnostic yield was not statistically different between groups (44.9% in SAGA vs 42.5% in control patients). Inflammatory/ulcerated lesions were significantly more frequent in patients with SAGA (43.0% vs 29.3%). The median SBTT was significantly longer in the SAGA group than in control patients (283 vs 206 minutes), with a significantly lower completion rate (82.6% vs 89.9%); Adverse events were scarce (0.5% vs 0.0%).
Conclusion |
Patients with surgically altered gastric anatomy should benefit from SBCE investigation for OGIB as much as non-operated patients.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Capsule endoscopy, Gastrectomy, Gastrointesintal bleeding, Small bowel bleeding
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Vol 46 - N° 7
Articolo 101921- Agosto 2022 Ritorno al numero
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