IS IT WORTH REPEATING CAPSULE ENDOSCOPY (CE) IN SUSPECTED SMALL BOWEL BLEEDING?

Aims Repeat CE procedures over 9 years for a suspicion of ongoing SB bleeding were identified from a database. Patient demographics, CE findings and additional investigations were recorded. Potential factors associated with improved yields were explored.

Methods Repeat CE procedures over 9 years for a suspicion of ongoing SB bleeding were identified from a database. Patient demographics, CE findings and additional investigations were recorded. Potential factors associated with improved yields were explored.

Results 339/3,735 (9%) had >1 CE. 152/339 (46%) for bleeding, male 86/152 (57%), mean age 63.9, range 18-92 years, mean CE interval was 461 days (1 - 2576). Haemoglobin (Hb) was available in 81 (52%), low in 65 (80%), mean 11.1.

1^stCE findings: normal 19 (13%), angiodysplasia 24 (16%), active bleeding of unclear origin 30 (20%), inflammation 20 (13%), gastric abnormality 20 (13%), incomplete/retained CE 33 (22%), other 6 (4%). 2^ndCE completion rate was 96% (n=146) and overall yield was 55% (n=83). Positive or negative index CE did not influence the diagnostic yield of subsequent CE, 8/19 (42%) normal vs 75/133 (56%) abnormal, p =0.1. Patients with active bleeding or angiodysplasia were almost 3 times more likely to have a positive 2^ndCE (OR = 2.8, p = 0.004, 95%CI 1.3 to 5.6). Older patients (>70) were also more likely to have a positive 2^ndCE, OR 2.3, p=0.01, 95%CI 1.17 to 4.45. Subjects with index retained/incomplete CE were more likely to have a subsequent incomplete study, OR 7, p = 0.01, 95%CI 1.55 to 30.62.

Conclusions Second look CE in obscure bleeding can be an effective clinical tool with a diagnostic yield of 55%. Along with clinical suspicion, older age and initial small bowel bleeding/vascular lesion are predictive of higher yield.