Elsevier

Gastrointestinal Endoscopy

Volume 69, Issue 2, February 2009, Pages 366-371
Gastrointestinal Endoscopy

Case study
Video capsule endoscopy in life-threatening GI hemorrhage after negative primary endoscopy (with video)

https://doi.org/10.1016/j.gie.2008.10.016Get rights and content

Background

Video capsule endoscopy (VCE) continues to evolve as a key diagnostic tool. Traditionally VCE has been used to detect occult and obscure GI bleeding in adult patients. VCE has not been documented or accepted as an early diagnostic tool for acute life-threatening GI hemorrhage.

Objective

Our purpose was to demonstrate the use of VCE as an early diagnostic tool in acute life-threatening GI hemorrhage.

Design

Case series.

Patients

Patients with life-threatening GI hemorrhage.

Interventions

VCE after negative primary endoscopy.

Results

VCE allowed rapid diagnosis and reliable data before surgical intervention. Although proving to be a beneficial diagnostic tool for acute GI hemorrhage, VCE was not associated with increased morbidity or mortality rates.

Limitations

This report only focuses on cases where VCE successfully led to a diagnosis. There is no prospective control group to which these patients can be compared. There were no other attempted acute VCE studies in patients with life-threatening bleeding during the time period of these case reports.

Conclusions

The use of VCE is a simple and relatively safe diagnostic tool in the evaluation of continuing GI hemorrhaging in endoscopy-negative patients. The use of VCE can be considered as a another useful tool in the armamentarium of the endoscopist in the evaluation of GI bleeding. Prospective studies should be undertaken to determine the appropriate timing and clinical use in this group of patients.

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)

Cited by (0)

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication

View full text