Role of capsule endoscopy in suspected small bowel bleeding: Capsule First Strategy

Aims Clinical guidelines recommend capsule endoscopy (CE) as the first-line examination in patients with gastrointestinal bleeding (GIB) after an inconclusive gastroscopy and colonoscopy. However, this algorithm may lead to unnecessary procedures and delays in performing CE, thereby reducing its diagnostic yield. Current evidence suggests that early use of CE could be a cost-effective strategy.

The aims of this study were to assess the diagnostic yield of CE following an inconclusive gastroscopy, to analyze the number of invasive procedures that could be avoided, and to evaluate predictive factors for achieving a definitive diagnosis with capsule endoscopy.

Methods This is a retrospective, single-center study including patients with GIB who underwent gastroscopy, colonoscopy, and CE from January 2020 to April 2024.

Results A total of 97 patients were included, of whom gastroscopy was inconclusive in 76 (78.4%). The mean age was 66±19 years, with 44.7% female. Cardiovascular history was noted in 67.1% of patients, renal in 22.4%, respiratory in 18.4%, and hepatic in 11.8%. Additionally, 39.5% were on anticoagulants, 22.4% on antiplatelet agents, and 2.6% reported recent NSAID use. GIB presented as melena in 78.9% of cases and as hematochezia in 21.1%. Colonoscopy was diagnostic in 19 patients (25%), CE in 47 (61,8%), both in 3 (3.95%), and inconclusive in 7 (9.21%). CE demonstrated a superior diagnostic yield compared to colonoscopy (65.7% vs. 29%, p<0.05). Of the 50 patients with pathological findings on CE, 26 underwent enteroscopy (52%), with therapeutic intervention in 21 of these cases (80.7%). In multivariate analysis, GIB presenting as melena was independently associated with a definitive diagnosis via CE (p=0.035).

Conclusions Early use of CE in patients with GIB and an inconclusive gastroscopy may be useful in guiding further diagnostic procedures, especially when bleeding presents as melena. In our cohort, 61.84% of colonoscopies could potentially have been avoided. Prospective randomized studies are needed to confirm these results.

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Artikel online veröffentlicht:
27. März 2025