Prospective Controlled Multicentric Trial Comparing Capsule Endoscopy With Intraoperative Enteroscopy: Long Term Results In Patients With Chronic Gastrointestinal Bleeding

Prospective Controlled Multicentric Trial Comparing Capsule Endoscopy with Intraoperative Enteroscopy: Long Term Results in Patients with Chronic Gastrointestinal Bleeding Harald Schmidt, Dirk Hartmann, Frank Kinzel, Dieter Schilling, Georg Bolz, Peter Reitzig, Henning E. Adamek, Hartmut Hollerbuhl, Klaus Guenther, Klaus Schoenleben, Juergen F. Riemann, Hans J. Schulz Background: Capsule Endoscopy (CE) is a very precise and efficant non-invasive diagnostic procedure in patients with chronic gastrointestinal bleeding. Long term clinical outcome data of patients undergoing CE and intraoperative enteroscopy (IOE) for investigation of obscure gastrointestinal bleeding are lacking. The aimof this porspective trial was to evaluate the diagnostic and therapeutic value of CE in long term follow up. Methods: 33 patients with obscure gastrointestinal bleeding (23 men, 10 women, mean age 61.6617.7 years) underwent CE and IOE between 02/2002-07/2003. Complete data of 29 patients were available (4 patients lost in follow up). Clinical outcome was assessed with a standartised patient questionnaire and personal communication with reffering doctors. Results: A defintive bleeding source was detected and effective traeted with argon plasma coagulation or surgical resection in 25 patients (18 angiodysplasia, 2 erosive-ulcerous lesions, 1 hemangioma, 1 Meckel’’s diverticulum, 1 ileum diverticulosis, 1 jejunal polyp, 1 lymphoma). Mean follow up was 310.3 days (range 32-553 days). Clinical signs of recurrent gastrointestinal bleeding occurred in 9 of 29 patients (1 positiv faecal occult blood test, 2 anemia, 2 red blood on stool, 2melena, 2 hematochezia). In 5 of these patients (17.2%) no further therapywas necessary, 4 patients (13.8%) needed blood transfusions (range 2-62 units). In 2 of these patients (6.9%) further endoscopic interventions (argon plasma coagulation) were necessary to controll rebleeding caused by recurrent angiodysplasias. The 4 patients without bleeding source in CE showed no signs of gastrointestinal rebleeding during follow up. Conclusion: Confirmed by our long term results Capsule Endoscopy (CE) followed by therapeutic intraoperative enteroscopy or surgical intervention is a very precise and efficiant non-invasive diagnostic procedure in patients with severe chronic gastrointestinal bleeding.