Clin Endosc.  2014 Sep;47(5):409-414. 10.5946/ce.2014.47.5.409.

Should Capsule Endoscopy Be the First Test for Every Obscure Gastrointestinal Bleeding?

Affiliations
  • 1Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea. shimkn@ewha.ac.kr

Abstract

Obscure gastrointestinal bleeding (OGIB) refers to gastrointestinal (GI) bleeding of unclear origin that persists or recurs after negative findings on esophagogastroduodenoscopy and colonoscopy. OGIB accounts for approximately 5% of all types of GI bleeding. More than 80% of OGIB cases originate in the small bowel. The ability to detect OGIB in the small bowel has significantly advanced and been revolutionized since the introduction of the capsule endoscopy and double-balloon enteroscopy techniques in 2000 and 2001, respectively. With these new methods for small-bowel evaluation, new guidelines have been proposed for the diagnosis and management of OGIB. However, some issues remain unsolved. The purpose of this article is to review the various modalities used for evaluating OGIB, including capsule endoscopy and double-balloon enteroscopy, and to help guide clinicians in their decisions on which modality will be the most effective.

Keyword

Capsule endoscopy; Double-balloon enteroscopy; Gastrointestinal hemorrhage

MeSH Terms

Capsule Endoscopy*
Colonoscopy
Diagnosis
Double-Balloon Enteroscopy
Endoscopy, Digestive System
Gastrointestinal Hemorrhage
Hemorrhage*

Figure

  • Fig. 1 Korea Gut Image Study Group guidelines for obscure gastrointestinal bleeding. Adapted from Shim et al. Clin Endosc 2013;46:45-53.29 Dashed arrows indicate less-preferred options. GI, gastrointestinal; EGD, esophagogastroduodenoscopy; CE, capsule endoscopy; CTE, computed tomography enterography; DE, deep enteroscopy; PE, push enteroscopy; SB, small bowel; IOE, intraoperative enteroscopy.

  • Fig. 2 American Society for Gastrointestinal Endoscopy guidelines in the management of overt gastrointestinal bleeding. Dashed arrows indicate less-preferred options. Positive test results should direct specific therapy. Because diagnostic tests can be complementary, more than one test may be needed, and the first-line test may be based on institutional expertise and availability. Adapted from ASGE Standards of Practice Committee et al. Gastrointest Endosc 2010;72:471-479, with permission from Elsevier.18 GI, gastrointestinal; EGD, esophagogastroduodenoscopy; PE, push enteroscopy; CT, computed tomography; OGIB, obscure gastrointestinal bleeding.

  • Fig. 3 American Society for Gastrointestinal Endoscopy guidelines for the management of occult gastrointestinal bleeding. Dashed arrows indicate less-preferred options. Positive test results should direct specific therapy. Because diagnostic tests can be complementary, more than one test may be needed, and the first-line test may be based on institutional expertise and availability. Adapted from ASGE Standards of Practice Committee et al. Gastrointest Endosc 2010;72:471-479, with permission from Elsevier.18 GI, gastrointestinal; EGD, esophagogastroduodenoscopy; CT, computed tomography; Hb, hemoglobin.


Cited by  2 articles

Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center
Carlijn Hermans, Arnold Stronkhorst, Annemarie Tjhie-Wensing, Jan Kamphuis, Bas van Balkom, Rob Dahlmans, Lennard Gilissen
Clin Endosc. 2017;50(1):69-75.    doi: 10.5946/ce.2016.079.

What is the Role of Double-Balloon Endoscopy in Patients Presenting with Obscure Gastrointestinal Bleeding?
Jung Ho Kim, Kwang An Kwon
Clin Endosc. 2017;50(1):8-10.    doi: 10.5946/ce.2017.023.


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