Capillary refilling sign demonstrated by capsule endoscopy

Patients with occult GI bleeding frequently are referred for evaluation of the small intestine as a potential source of bleeding after a negative upper endoscopy and colonoscopy. Capsule endoscopy is a novel technique for examination of the small intestine of patients with chronic GI bleeding. It increasingly is being used as a first-line diagnostic modality in the evaluation of chronic GI bleeding because of patient preference owing to the absence of discomfort and the high sensitivity compared with push enteroscopy in the diagnosis of small bowel lesions. 1. Lewis B.S. Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc. 2002; 56: 349-353 Abstract Full Text Full Text PDF PubMed Scopus (531) Google Scholar , 2. Costamagna G. Shah S.K. Riccioni M.E. Foschia F. Mutignani M. Perri V. et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002; 123: 999-1005 Abstract Full Text Full Text PDF PubMed Scopus (784) Google Scholar , 3. Ell C. Remke S. May A. Helou L. Henrich R. Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy. 2002; 34: 685-689 Crossref PubMed Scopus (666) Google Scholar Although the primary purpose of capsule endoscopy is the evaluation of suspected small bowel bleeding, experience with push enteroscopy has demonstrated that a substantial proportion of patients presumed to have such bleeding actually have lesions within the stomach that have been overlooked at EGD. 4. Chak A. Koehler M.K. Sundaram S.N. Cooper G.S. Canto M.I. Sivak M.V. Diagnostic and therapeutic impact of push enteroscopy: analysis of factors associated with positive findings. Gastrointest Endosc. 1998; 47: 18-22 Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar A patient is described in whom capsule endoscopy demonstrated capillary blanching followed by refilling of red lesions in the gastric antrum, previously mistaken as hemorrhagic gastritis, indicating the presence of an underlying vascular, instead of inflammatory, disorder.