Capsule Endoscopy Favored Over Angiography for ‘Overt’ Obscure GI Bleeding

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 08 – Compared with angiography, capsule endoscopy offers higher diagnostic yield and comparable long-term outcomes for patients with visible gastrointestinal bleeding from an obscure source.

“Since capsule endoscopy has no immediate therapeutic potential, most guidelines favor angiography in patients with active overt obscure GI bleeding,” Dr. Wai K. Leung from The Chinese University of Hong Kong told Reuters Health by email. “The results of the current prospective randomized study provide evidence to support the role of immediate capsule endoscopy in patients with overt OGIB.”

As reported online July 24 in the American Journal of Gastroenterology, Dr. Leung and colleagues randomly assigned 60 patients with overt OGIB to capsule endoscopy (using the Pillcam SB from Given Imaging, Yoqneam, Israel) or angiography.

The diagnostic yield was significantly higher with the capsule (16/30 patients, or 53.3%) than with angiography (6/30 patients, or 20%; p=0.016).

During a median follow-up of 48.5 months, the cumulative bleeding rate did not differ significantly after capsule endoscopy vs angiography (16.7% vs 33.3%; p=0.23), nor did hospitalization and transfusion rates.

Eight patients died during follow-up (four in each group). No death was related to bleeding.

“Our data support the idea that capsule endoscopy may be preferred over angiography, even if it does not improve clinical efficacy, because it is less invasive, avoids radiation exposure, and has comparable long-term outcome,” the investigators conclude.

“Angiography may still be favored in a subgroup of patients with massive bleeding due to the possibility of therapeutic embolization for control of bleeding,” Dr. Leung said. “Moreover, the diagnostic yield of angiography increases during active bleeding episode.”

“The other important and unresolved issue related to overt OGIB is the position and timing of balloon assisted enteroscopy,” Dr. Leung said.

Also, Dr. Leung said, “The next important study is to compare the diagnostic yield and outcome of direct capsule endoscopy or direct enteroscopy in patients with overt OGIB.”

The current study had no commercial funding.

Am J Gastroenterol 2012.

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