Case studyVideo capsule endoscopy in life-threatening GI hemorrhage after negative primary endoscopy (with video)
Section snippets
Methods
In the following case reports patients underwent primary endoscopic evaluation after hemodynamic stabilization. In each case, primary upper and lower endoscopy failed to reveal a source of bleeding. Feasible alternative diagnostic tools were attempted as well. In the absence of, inapplicability of, or nondiagnostic nature of alternative tests, VCE was chosen as the next diagnostic test of choice. Patients gave informed consent.
Discussion
VCE is a well-established diagnostic tool for nonemergency occult and obscure GI bleeding. Occult bleeding refers to grossly unidentifiable blood loss, whereas obscure bleeding refers to persistent or recurrent bleeding from an unknown source, unidentifiable with primary endoscopy. Either may present in the form of iron deficiency anemia or a positive fecal occult blood test.23, 24 Although the evaluation of occult and obscure bleeding is well established and well studied in
Conclusions
VCE has been demonstrated in this noncontrolled clinical setting to be a valuable diagnostic tool in life-threatening GI hemorrhage after negative primary endoscopy. VCE is a simple, relatively safe, and potentially beneficial diagnostic tool. Although VCE may not always yield a diagnosis, the small risk-to-reward ratio warrants its consideration as an early diagnostic tool. Patients and physicians benefit from more accurate information before proceeding with invasive diagnostic testing and
References (33)
- et al.
Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study
Clin Gastroenterol Hepatol
(2004) - et al.
Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding
Gastrointest Endosc
(2004) - et al.
Management of severe upper gastrointestinal bleeding in the patient with liver disease
Med Clin North Am
(1996) - et al.
Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: association with relevant endoscopic disease
Gastrointest Endosc
(1995) Management of the adult patient with acute lower gastrointestinal bleeding
Am J Gastroenterol
(1998)Radiological intervention in upper and lower gastrointestinal bleeding
Baillieres Clin Gastroenterol
(1995)- et al.
Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge
Gastroenterology
(1988) - et al.
Role of capsule endoscopy in patients with obscure digestive bleeding
Gastroenterol Hepatol
(2003) - et al.
Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease
Gastrointest Endosc Clin North Am
(2006) - et al.
The value of wireless capsule endoscopy in patients with complicated celiac disease
Gastrointest Endosc
(2005)
Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding
Gastrointest Endosc
Video capsule endoscopy detection of jejunal carcinoid in life-threatening hemorrhage, first trimester pregnancy
Gastrointest Endosc
Occult gastrointestinal bleeding
Gastroenterol Clin North Am
Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study
Gastrointest Endosc
A pilot trial comparing the diagnostic utility and reproducibility of Given diagnostic imaging system to conventional enteroscopy in the evaluation of chronic obscure gastrointestinal bleeding
Am J Gastroenterol
A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding
Gastrointest Endosc
Cited by (0)
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication