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&#x25; overt OGIB). VCE had greater diagnostic yield (72.5&#x25; versus 48.7&#x25;; P&#x3c;0.05), especially in the distal small bowel (58&#x25; versus 13&#x25;; P&#x3c;0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3&#x25; versus 35.0&#x25;; P&#x3c;0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0&#x25; versus 38.5&#x25;; P not significant], chronic [32.5&#x25; versus 45.6&#x25;; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5&#x25; versus 48.7&#x25;; P&#x3c;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.

Dev S Segarajasingam

Stephen C Hanley

Alan N Barkun

Kevin A Waschke

Pascal Burtin

Jos&#xe9;e Parent

Serge Mayrand

Carlo A Fallone

Gilles Jobin

Ernest G Seidman

Myriam Martel

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

BACKGROUND: Despite improvements in therapies for inflammatory bowel diseases (IBDs), patient quality of life continues to be significantly impacted.OBJECTIVE: To assess the impact of IBD on patients and families with regard to leisure, relationships, mental well-being and financial security, and to evaluate the quality and availability of IBD information.METHODS: An online survey was advertised on the Crohn&#x2019;s and Colitis Canada website, and at gastroenterology clinics at the University of Alberta Hospital (Edmonton, Alberta) and University of Calgary Hospital (Calgary, Alberta).RESULTS: The survey was completed by 281 IBD patients and 32 family members. Among respondents with IBD, 64&#x25; reported a significant or major impact on leisure activities, 52&#x25; a significant or major impact on interpersonal relationships, 40&#x25; a significant or major impact on financial security, and 28&#x25; a significant or major impact on planning to start a family. Patient information needs emphasized understanding disease progression (84&#x25;) and extraintestinal symptoms (82&#x25;). There was a strong interest in support systems such as health care insurance (70&#x25;) and alternative therapies (66&#x25;). The most common source of information for patients was their gastroenterologist (70&#x25;); however, most (70&#x25;) patients preferred to obtain their information from the Crohn&#x2019;s and Colitis Canada website.CONCLUSIONS: The impact of IBD on interpersonal relationships and leisure activities was significant among IBD patients and their families. Understanding the disease, but also alternative treatment options, was of high interest. Currently, there is a discrepancy between interest in information topics and their availability. Respondents reported a strong desire to obtain information regarding disease progression, especially extraintestinal symptoms.

Helen M Becker

Daniel Grigat

Subrata Ghosh

Gilaad G Kaplan

Levinus Dieleman

Eytan Wine

Richard N Fedorak

Aida Fernandes

Remo Panaccione

Herman W Barkema

Living with Inflammatory Bowel Disease: A Crohn&#x2019;s and Colitis Canada Survey

BACKGROUND: The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.OBJECTIVE: To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.METHODS: Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.RESULTS: The overall response rate was 76&#x25;. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2&#x25; were male, 54.7&#x25; were Caucasian, 38.2&#x25; had hepatitis C and 26.3&#x25; had an annual household income &#x3e;$75,000. Overall, 95.4&#x25; of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1&#x25; versus 7.8&#x25; for LB), no discomfort after (96.2&#x25; versus 14.6&#x25; LB) and no feelings of anxiety after FS explanation (78.2&#x25; versus 12.7&#x25; LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2&#x25; versus 48.3&#x25; LB) and short wait for the test result (95.5&#x25; versus 30.2&#x25; LB). Most (75.3&#x25;) respondents were willing to self-pay for FS, with 26.3&#x25; willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95&#x25; CI 0.07 to 0.53]).CONCLUSIONS: FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.

Victoria Y Kan

Vladimir Marquez Azalgara

Jo-Ann E Ford

WC Peter Kwan

Siegfried R Erb

Eric M Yoshida

Patient Preference and Willingness to Pay for Transient Elastography versus Liver Biopsy: A Perspective from British Columbia

Hideki Kobara

Makoto Oryu

Hirohito Mori

Shintaro Fujihara

Noriko Nishiyama

Yasuhiro Goda

Taiga Chiyo

Tae Matsunaga

Maki Ayaki

Tatsuo Yachida

Toshiaki Nakatsu

Tsutomu Masaki

Tissue Sampling using a Submucosal Tunnelling Technique for Indefinite Gastric Amyloidosis

Inflammatory Bowel Disease: Appreciating Disability and Impact of Disease

About this journal

Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

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Canadian Journal of Gastroenterology and Hepatology - Table of contents 2015

Canadian Journal of Gastroenterology and Hepatology | Hindawi

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Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology

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