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Canadian Journal of Gastroenterology and Hepatology
Volume 29, Issue 2, Pages 85-90
http://dx.doi.org/10.1155/2015/897567
Original Article

Randomized Controlled Trial Comparing Outcomes of Video Capsule Endoscopy with Push Enteroscopy in Obscure Gastrointestinal Bleeding

Dev S Segarajasingam,1 Stephen C Hanley,2 Alan N Barkun,3,4 Kevin A Waschke,3 Pascal Burtin,5 Josée Parent,3 Serge Mayrand,3 Carlo A Fallone,3 Gilles Jobin,6 Ernest G Seidman,3 and Myriam Martel3

1Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital and School of Population Health, The University of Western Australia, Crawley, Australia
2Division of General Surgery, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
3Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
4Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
5Endoscopy Unit, Gustave Roussy Institute of Oncology, Villejuif, Greater Paris, France
6Division of Gastroenterology, Montreal University, Montreal, Quebec, Canada

Received 11 September 2014; Accepted 14 January 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear.

OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE).

METHODS: Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers.

RESULTS: Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05).

CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.