Tu1544 CLINICAL UTILITY OF EMERGENCY CAPSULE ENDOSCOPY FOR DIAGNOSING THE SOURCE AND NATURE OF ON-GOING OVERT OBSCURE GASTROINTESTINAL BLEEDING

In patients with on-going overt obscure gastrointestinal bleeding (OGIB), prompt detection of the bleeding source is crucial to treatment success. However, there is no consensus on the optimal timing of diagnostic capsule endoscopy (CE). We investigated the clinical utility of emergency CE for detecting the source of on-going overt OGIB. We retrospectively evaluated 146 consecutive patients (85 men; mean age, 68 years) who, between February 2009 and July 2018, underwent emergency CE at Hiroshima University Hospital to detect the source of on-going overt OGIB (6% of patients who underwent CE during the study period). Patients with a bleeding source located outside the small-bowel were excluded. The remaining 127 patients were stratified according to the timing of CE relative to the onset of bleeding: patients in Group A (n=15, 12 men; mean age, 75 years; age range, 62–83 years) underwent CE within 48 hours of bleeding onset, whereas patients in Group B (n=112, 73 men; mean age, 65 years; age range, 17–88 years) underwent CE at >48 hours after bleeding onset. All patients underwent double-balloon endoscopy, and the final diagnosis obtained via DBE was compared against the CE findings. CE was performed using a PillCam® SB2 or SB3 capsule (Covidien, Mansfield, MA, USA). The CE lesion detection rate was significantly higher in Group A (12/15 patients, 80%) than in Group B (53/112 patients, 47%) (p=0.0174). Both groups contained more men than women, with a similar ratio (Group A: 37% women, 5/15; Group B: 42% women, 47/112; p=0.5189) and with no significant difference in age (Group A: 80% aged ≥65 years, 12/15; Group B: 54% aged ≥65 years, 67/112; p=0.0837). There was no significant difference in the prevalence or nature of concomitant diseases, in the hemoglobin level, in transfusion requirements, or in the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or anti-platelet drugs. Vascular lesions (especially angioectasia) were the most frequent finding in both groups. Endoscopic hemostasis was performed for all vascular lesions, except in one patient from Group B who had an ileal arteriovenous fistula. Endoscopic hemostasis was difficult in this case, and surgery was required. The diagnostic concordance rate between emergency CE and double-balloon endoscopy was 100% in Group A and 92.9% in Group B. Rebleeding after endoscopic treatment was confirmed in only one patient in Group B (2%, 1/53). Emergency CE represents a useful diagnostic modality in patients with on-going overt OGIB, potentially improving detection rates and reducing rebleeding risk.