Negative Video Capsule Endoscopy Had a High Negative Predictive Value for Small Bowel Lesions, but Diagnostic Capability May Be Lower in Young Patients with Overt Bleeding

Figure 1

Flowchart of subsequent investigations and clinical course of study patients. Note.^∗Repeated EGD and colonoscopy were performed in the same session of VCE. 1Five small bowel lesions included three small bowel tumors, detected by CTE, one Meckel’s diverticulum, detected by CTE, and one TB ileitis, diagnosed by balloon-assisted enteroscopy with biopsy.2Six upper/lower GI lesions included a pancreatic rest, one patient with H. pylori-associated gastritis, one patient with colonic diverticulosis, one patient with colonic Dieulafoy’s lesion, and two patients with bleeding internal hemorrhoids. All lesions except colonic Dieulafoy’s lesion were found in the first EGD and colonoscopy but were not suspected to be the causes of bleeding. Definite diagnoses of these lesions were made after obtaining negative VCE results in combination with resolution of bleeding after receiving treatment^.3Four small bowel lesions, which were discovered at a rebleeding episode, included two small bowel tumors, diagnosed by CTE, one Meckel’s diverticulum, detected by balloon-assisted enteroscopy, and one small bowel angiodysplasia, detected by small bowel enteroscopy.⁴Thirteen upper/lower GI lesions, which were discovered at rebleeding episode, included one esophageal ulcer and one duodenal ulcer from upper GI sources, four colonic diverticular bleedings, one colonic Dieulafoy’s lesion, one colonic telangiectasia, two colonic ulcers, including solitary rectal ulcer syndrome and ischemic ulcer, and three internal hemorrhoids from lower GI sources.