Capsule Endoscopy Followed By Intraoperative Enteroscopy And Therapy In Patients With Chronic Gastrointestinal Bleeding: Long Term Results Of A Prospective Controlled Multicentric Trial

Background: Capsule Endoscopy (CE) has a high diagnostic yield in patients with chronic gastrointestinal bleeding. Long term clinical outcome data of patients undergoing CE and intraoperative enteroscopy (IOE) for investigation and therapeutic intervention of chronic gastrointestinal bleeding are limited. The aim of this prospective trial was to find out value of CE in long term follow up. Methods: 50 patients with obscure gastrointestinal bleeding underwent CE and IOE between 02/2002-08/2004 (35 men, 15 women, mean age 60.9 ± 16.8 years). Data of 47 patients were available (3 patients lost in follow up). Clinical outcome was assessed with a standartised patient questionnaire and personal communication with reffering doctors. Results: Bleeding sources were detected and effective treated (argon plasma coagulation or surgical resection) in 35 patients (22 angiodysplasia, 5 erosive-ulcerous lesions, 2 active bleeding without seeing a bleeding source, 3 tumor, 1 Meckel´s diverticulum, 1 varices, 1 bleeding ileum diverticulosis) Suspicous lesions occured in 6 patients. No lesions were found in 6 patients. Mean follow up was 346.3 days (range 47-814 days). Clinical signs of recurrent gastrointestinal bleeding occurred in 12 of 47 patients (3 positiv faecal occult blood test, 2 anemia, 2 red blood on stool, 3 melena, 2 hematochezia). Therapy was necesary In 3 of these patients (6.4%) no further therapy was necessary, 9 patients (19.1%) needed blood transfusions (range 2-62 units) or repeated endoscopic interventions (argon plasma coagulation) or both to controll rebleeding. Recurrent angiodysplasias were the main reason for rebleeding. The 6 patients without bleeding source in CE showed no signs of gastrointestinal rebleeding during follow up. Conclusion: Our long term results show, that Capsule Endoscopy (CE) followed by a therapeutic intervention (intraoperative enteroscopy or surgery) is a precise and efficiant non-invasive diagnostic procedure in patients with severe chronic gastrointestinal bleeding.