Impact of small bowel capsule endoscopy in obscure gastrointestinal bleeding patients

Background and aim: About 5% of all patients with gastrointestinal bleeding are classified as obscure gastrointestinal bleeders (OGIB). OGIB is the most frequent indication of small bowel capsule endoscopy (CE). We retrospectively analysed the clinical outcome and therapeutical impact of CE examinations performed by OGIB indications in a 3 year period. Patients and methods The Hungarian National Health Insurance started to reimburse small bowel CE in August 2011. Since that time we performed a total of 228 small bowel CE examinations in OGIB patients. The clinical appearance of bleeding in 35 patients was melaena, 40 patients had haematochezia and in 4 patients both. The remaining 149 patients had iron deficiency anaemia with FOBT positivity. A total of 185 CE-s were indicated by our own expert group and 43 patients were referred by other hospitals. We analysed the number of enteroscopies, need for surgery and all therapeutical changes initiated by the CE examination results. Results: The mean age of the CE patients was 60.3 year. At the CE record readings bleeding and/or anaemia sources were recognized in 106 (46.4%) cases. A total of 62 (27.2%) CE-s were negative and in additional 60 (26.3%) cases CE recordings showed non-significant lesions. The most frequent findings were arteriovenous malformations detected in 70 (30.7%) cases. Surgery was indicated in 14 patients based on the CE results. In 18 cases CE was followed by enteroscopy out of them in 5 patients the CE findings were simply confirmed and in additional 7 patients endotherapy by APC was achieved. In 79 patients CE examinations were followed by changes in medical therapy. Capsule endoscopy findings resulted therapeutical consequences in 48.6% of all patients (111/228). Conclusion: Small bowel capsule endoscopy findings resulted notable changes in further medical or interventional therapy almost in every second OGIB patients.