Endoscopy 2012; 44(09): 884
DOI: 10.1055/s-0032-1310014
Letters to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Active bleeding without identifiable lesion on capsule endoscopy

R. Rerknimitr
S. Aniwan
V. Viriyautsahakul
P. Kullavanijaya
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Publication History

Publication Date:
27 August 2012 (online)

With read with great interest the paper by Lecleire et al. on the role of emergency capsule endoscopy in severe obscure-overt gastrointestinal bleeding (OOGIB) [1]. We agree with the authors that this study has emphasized the benefit of an emergency approach by capsule endoscopy in patients with persistent bleeding despite negative esophagogastroduodenoscopy (EGD) and colonoscopy. However, we question the therapeutic decision-making in those patients (n = 12) in whom capsule endoscopy was only able to locate the active bleeding site but failed to reveal the cause of bleeding. In this group, two patients were moribund and two patients underwent further endoscopy. Without further investigation reported, another five young patients suspected for Meckel’s bleeding underwent surgery directly and another three patients received conservative treatment. In our opinion, these patients deserve further investigation before invasive surgical treatment or conservative treatment can be offered. Repeat capsule endoscopy has been reported to be a good strategy for the approach of OOGIB and resulted in a change in management in 39 % – 63 % of patients [2] [3]. In addition, double-balloon endoscopy, if carried out within 24 hours, has been reported to be useful in OOGIB [4].