Should We Read the Upper Gastrointestinal (UGI) Pictures When Performing a Small Bowel Capsule Enteroscopy (SBCE) in Case of Obscure GI Bleeding (OB)?

Background: SBCE has been designed for exploring the small bowel. OB is the main indication for performing SBCE. In case of OB, it has been previously shown that missed or underestimated UGI tract lesions may be the source of bleeding despite an initial negative endoscopic work-up. The goal of this retrospective multicenter study was to define the frequency and spectrum of UGI lesions that can be detected when reading SBCE. Methods: all consecutive SBCE performed within the last 2 years at 2 different endoscopic units for patients with OB were included in this study. We evaluated the cleanliness of UGI of anastomotic land marks, the level of gastric visibility, the presence of UGI lesions as well as their clinical significance. The SBCE findings were compared to previous oesogastroduodenoscopy (OGD). Results: 107 patients (40 males; 67 females; mean age: 60.5 ± 18.1 y) were enrolled in this study. The SBCE (Given Imaging) was performed in 50 patients (40%) for overt OB and in 57 patients for occult OB. The cleanliness of the UGI was excellent in 74% and moderate (mucosa partly covered with opaque fluid) in 26%. We perfectly observed the lower esophagus (Z line) in 17%, the vertical body in 80% and the antrum with pylorus in 90%. The upper fundus was visualized in 25%. SBCE discovered potentially bleeding UGI lesions in 25/107 (23%) patients, including hemorrhagic erosions (11/107), blood or clots (4/107), multiple erosions (4/107), portal hypertensive gastropathy (4/107), angioectasias (3/107), antral ulcers (2/107) and a Cameron's ulcer (1/107). In 20 out of these 25 patients, the initial OGD did not mention UGI lesions. In the global population, a SB lesion was detected in 40/107 (37%) of the patients. In 12 patients (11%), only the detected UGI lesions may explain the OB. Regarding the UGI lesions, there was no statistical difference between patients with occult or obscure OB. Conclusions: when performing SBCE, the vertical gastric body, antrum and pylorus are seen in the majority of the patients. UGI lesions are detected in 23% and potentially responsible for OB in 11% of the cases. A careful reading of gastric images is recommended when reading SBCE, even after an initial negative OGD.