Small Bowel Endoscopy Diagnostic Yield and Reasons of Obscure GI Bleeding in Chinese Patients

Gastroenterology Research and Practice, Aug 2014

Aim. To investigate the diagnostic yield and etiologies of patients with obscure gastrointestinal bleeding (OGIB) using capsule endoscopy (CE) or double-balloon enteroscopy (DBE). Method. We studied the data of 532 consecutive patients with OGIB that were referred to Xinqiao Hospital in Chongqing from December 2005 to January 2012. A lesion that was believed to be the source of the bleeding (ulceration, mass lesion, vascular lesion, visible blood, inflammation, or others) was considered to be a positive finding. We analyzed the diagnostic yield of CE and SBE and the etiologies of OGIB. Result. CE and SBE have similar diagnostic yields, at 71.9% (196/231) and 71.8% (251/304), respectively. The most common etiology was erosions/ulceration (27.1%) followed by mass lesion (19.4%) and angiodysplastic/vascular lesions (13.9%). By stratified analysis, we found that erosions/ulceration (27.1%) was the most common etiology for the 21–40-year age group. Mass lesion was the most common etiology in the 41–60-year age group. However, in the >60 years age group, angiodysplastic/vascular lesions were significantly increased compared with the other groups, even though erosions/ulceration was most common. Conclusion. In this study, we found that CE and SBE have similar diagnostic yields and erosions/ulceration was the most common reason for OGIB, followed by mass lesion and angiodysplasias.

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Small Bowel Endoscopy Diagnostic Yield and Reasons of Obscure GI Bleeding in Chinese Patients

Small Bowel Endoscopy Diagnostic Yield and Reasons of Obscure GI Bleeding in Chinese Patients Ya-Fei He, Ning-Bo Hao, Wu-Chen Yang, Li Yang, Zhong-Li Liao, Chao-Qiang Fan, Jin Yu, Jian-Ying Bai, Shi-Ming Yang, and Hong Guo Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China Received 23 April 2014; Revised 22 June 2014; Accepted 6 July 2014; Published 11 August 2014 Academic Editor: R. Eliakim Copyright © 2014 Ya-Fei He et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Aim. To investigate the diagnostic yield and etiologies of patients with obscure gastrointestinal bleeding (OGIB) using capsule endoscopy (CE) or double-balloon enteroscopy (DBE). Method. We studied the data of 532 consecutive patients with OGIB that were referred to Xinqiao Hospital in Chongqing from December 2005 to January 2012. A lesion that was believed to be the source of the bleeding (ulceration, mass lesion, vascular lesion, visible blood, inflammation, or others) was considered to be a positive finding. We analyzed the diagnostic yield of CE and SBE and the etiologies of OGIB. Result. CE and SBE have similar diagnostic yields, at 71.9% (196/231) and 71.8% (251/304), respectively. The most common etiology was erosions/ulceration (27.1%) followed by mass lesion (19.4%) and angiodysplastic/vascular lesions (13.9%). By stratified analysis, we found that erosions/ulceration (27.1%) was the most common etiology for the 21–40-year age group. Mass lesion was the most common etiology in the 41–60-year age group. However, in the >60 years age group, angiodysplastic/vascular lesions were significantly increased compared with the other groups, even though erosions/ulceration was most common. Conclusion. In this study, we found that CE and SBE have similar diagnostic yields and erosions/ulceration was the most common reason for OGIB, followed by mass lesion and angiodysplasias. 1. Introduction Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or iron deficiency anemia after a negative initial evaluation by gastric and colonic endoscopy [1]. It has been reported that OGIB is responsible for 5% of all gastrointestinal bleeding and that most of the lesions are in the small bowel [2]. In the past, the conventional diagnostic strategies for small intestine disease including small intestine radiography, abdominal computed tomography (CT), angiography, and red blood cell scanning have had a low diagnostic rate because of the length and unique anatomical structure of the small bowel [2–6]. Recently, with the development of capsule endoscopy (CE) and double-balloon enteroscopy (DBE), the study of the small bowel has been revolutionized. It has been demonstrated that CE is superior for detecting abnormal lesions noninvasively, with a higher rate of complete small bowel examination, and SBE is superior for endoscopic treatment [7, 8]. So CE and DBE are complementary methods for OGIB. In previous studies, the main etiology for OGIB was considered to be angiodysplastic lesions [9, 10]. However, recent studies have suggested that this was true only in western populations and that ulceration was the most common etiology in Asian populations [9, 11, 12]. In this study, 532 patients with OGIB in our hospital from 2006 to 2012 were examined by CE or DBE and the etiologies were retrospectively analyzed. 2. Methods2.1. Patients OGIB was defined as overt bleeding (hematemesis, hematochezia, or melena) or occult bleeding (positive fecal occult blood test, iron deficiency anemia, or an acute drop in hemoglobin) in a patient with no pathologic causes that could be identified on conventional endoscopies. The exclusion criteria were as follows: serious physical condition, suspected perforation of the GI tract, bleeding tendency, and a lack of informed consent. Between December 2005 and January 2012, 545 consecutive patients who underwent CE and/or DBE for the indication of OGIB at the Department of Gastroenterology (Xinqiao Hospital, Third Military Medical University) were evaluated for inclusion and 532 patients that underwent CE or DBE were finally included. The studies had got the informed consent of all the patients included. Choosing CE or DBE for the examining was determined by the patients with the suggesting of doctors. 2.2. CE CE studies (OMOM Jinshan Science and Technology (Group) Co., Ltd., Chongqing, China) were performed according to the standard protocol. Patients were asked to fast overnight after ingestion of 2 L polyethylene glycol-electrolyte solution before ingesting the capsule. Two hours after capsule ingestion, patients were allowed to drink and after 4 hours they were allowed to eat. Sensor array and recorder techniques were performed periodically to check the pos (...truncated)


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Ya-Fei He, Ning-Bo Hao, Wu-Chen Yang, Li Yang, Zhong-Li Liao, Chao-Qiang Fan, Jin Yu, Jian-Ying Bai, Shi-Ming Yang, Hong Guo. Small Bowel Endoscopy Diagnostic Yield and Reasons of Obscure GI Bleeding in Chinese Patients, Gastroenterology Research and Practice, 2014, 2014, DOI: 10.1155/2014/437693