Endoscopy 2019; 51(04): S30
DOI: 10.1055/s-0039-1681257
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Capsule – enteroscopy Club B
Georg Thieme Verlag KG Stuttgart · New York

PAN-ENTERIC CAPSULE IN PATIENTS WITH MELENA AND A NEGATIVE UPPER ENDOSCOPY: A PILOT STUDY

A Mussetto
1   Gastroenterology, Santa Maria delle Croci Hospital, Ravenna, Italy
,
R Arena
1   Gastroenterology, Santa Maria delle Croci Hospital, Ravenna, Italy
,
O Triossi
1   Gastroenterology, Santa Maria delle Croci Hospital, Ravenna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Melena can be caused both by bleeding from upper sources and from mid/lower gastrointestinal bleeding. Colonoscopy is frequently used to investigate melena after a non-diagnostic EGD but retrospective studies showed that its diagnostic and therapeutic yield is low. Aim of our study was to perform a pan-enteric capsule endoscopy (PCE) with PillCam Colon2 capsule and evaluate its ability to avoid unnecessary colonoscopies when performed on patients with melena after an initial negative upper endoscopy.

Methods:

Between January and September 2018 patients with melena, negative gastroscopy and the need to be hospitalized for drop of haemoglobin level, were prospectively included. After a negative upper endoscopy examination, a PCE was performed after a split, high-volume preparation. After the passage through the stomach, the capsule was “forced” to acquire images of the small bowel at a rate similar to that of current-generation small-bowel capsules.

Results:

12 patients (8 female, mean age 76 years) met the criteria. Capsule was egested “on” in 11 out of 12 patients. PCE found small bowel findings in 6/12 patients (blood in lumen in 2 patients, angiodysplasias in 2 patients, ileal ulcer in one patient and jejunitis with substenosis in one patient); colon findings were revealed in 4 patients (polyps in 1 patient, diverticulosis with haemorrhagic stigmata in 1 patient, blood in caecum in 1 patient and right colon cancer in another patient) and both small bowel and colon findings in 2 patients. One patient had a negative, incomplete study. The pan-enteric study led to a double ballon enteroscopy in six cases and a colonoscopy in 5 patients.

Conclusions:

In this small, prospective, study, the PCE was useful to identify the site of bleeding in 92% of patients with melena and a negative gastroscopy and was able to guide the subsequent endoscopic treatments. In particular, PCE resulted in less unnecessary colon investigations.