Active bleeding without identifiable lesion on capsule endoscopy
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) . 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  . In addition, double-balloon endoscopy, if carried out within 24 hours, has been reported to be useful in OOGIB .
- 1 Lecleire S, Iwanicki-Caron I, Di-Fiore A et al. Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding. Endoscopy 2012; 44: 337-342
- 2 Svarta S, Segal B, Law J et al. Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management. Can J Gastroenterol 2010; 24: 441-444
- 3 Jones BH, Fleischer DE, Sharma VK et al. Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 1058-1064
- 4 Mönkemüller K, Neumann H, Meyer F et al. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy 2009; 41: 715-717