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CAPSULE ENDOSCOPY FOR OBSCURE GASTROINTESTINAL BLEEDING IN THE TROPICS: REPORT FROM INDIA
Author(s) -
Ghoshal Uday C,
Lakshmi Chandrasekharan P,
Kumar Sunil,
Das Kshaunish,
Misra Asha,
Rai Praveer,
Mohindra Samir,
Saraswat Vivek A,
Kumar Ashok,
Choudhuri Gourdas
Publication year - 2011
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2010.01035.x
Subject(s) - medicine , occult , capsule endoscopy , obscure gastrointestinal bleeding , lesion , gastroenterology , capsule , endoscopy , radiology , surgery , pathology , botany , alternative medicine , biology
Background: Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). Experience in CE in OGIB in the tropics is limited. Methods: Eighty‐six patients with OGIB were evaluated clinically and using CE (Given Imaging, Yoqneam, Israel) 89 times (twice in three patients) during a 64‐month period. Images were downloaded and examined by a single investigator using software (Rapid Reader; Given Imaging, Yoqneam, Israel). Patients received specific treatment and were followed up. Intraoperative findings, response to specific treatment and outcome on follow up (10.3 ± 14.1 months) were considered to confirm CE findings. Results: Of 86 patients (aged 54.5 ± 16.3 years, 63 males), 64 and 22 had OGIB‐overt and OGIB‐occult, respectively. Lesions were equally detected in OGIB‐overt and OGIB‐occult patients (48/64, 75% vs 18/22, 81.8%, P = ns). Lesions were detected in 64 of 86 (74.4%) patients [vascular malformations with or without fresh bleeding in 24 (37.5%), tumors in 12 (18.8%), strictures in 15 (23.4%), ulcers in five (7.8%), hookworm in five (7.8%), and more than one lesion in three patients (4.7%)]. Endoscopic insertion of the capsule was required in four patients, and in six it was retained, although none developed intestinal obstruction (surgical removal in two). The sensitivity, specificity, positive and negative predictive values of CE to detect the lesion(s) were 92.9%, 68.2%, 84.8%, and 83.3%, respectively. Conclusion: CE is safe and is equally effective in detecting lesion(s) in occult and overt OGIB. Worm infestation and small bowel tuberculosis are unique and important causes of OGIB in the tropics.