Year 2022 / Volume 114 / Number 4
Original
Capsule enteroscopy versus radionuclide scintigraphy for the diagnosis of obscure gastrointestinal bleeding

208-212

DOI: 10.17235/reed.2021.7633/2020

Miguel Mascarenhas Saraiva, Tiago Ribeiro, Patrícia Andrade, Hélder Cardoso, Guilherme Macedo,

Abstract
Background: capsule enteroscopy (CE) and 99mTc red blood cell (RBC) scintigraphy are frequently used in the investigation of obscure gastrointestinal bleeding (OGIB). There are few data comparing both diagnostic modalities. This study aimed to assess the performance of CE and scintigraphy for the diagnosis of OGIB. Methods: patients who underwent CE and scintigraphy for OGIB were selected and analyzed retrospectively. The hemorrhagic potential of CE findings was rated using Saurin's classification. The concordance between both diagnostic techniques for bleeding detection and localization was analyzed. Results: eighty-five patients (62 % female), with a median age of 63 years, were included in the study. Capsule enteroscopy identified 37 patients (43 %) with high hemorrhagic potential (P2) lesions. Most scintigraphy exams were positive for gastrointestinal bleeding (82 %). No concordance was found in the detection of lesions with hemorrhagic potential between CE and scintigraphy (kappa < 0). The distribution of P0, P1 and P2 findings was similar in patients with positive or negative scintigraphy (p = 0.526). There was no agreement regarding the location of P2 findings in CE and the bleeding detected by scintigraphy (kappa < 0). Patients with P2 lesions had significantly lower median levels of hemoglobin (p = 0.002) at presentation. No significant differences were found in hemoglobin values between patients with positive and negative scintigraphy (p = 0.058). Conclusion: significant diagnostic discrepancy was observed between CE and scintigraphy. The findings of CE correlated better with hemoglobin values at presentation than scintigraphy results. Therefore, scintigraphy does not appear to be useful in the diagnostic workup of OGIB.
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References
References
1. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015;47(4):352-76. DOI: 10.1055/s-0034-1391855
2. Leung WK, Ho SS, Suen BY, et al. Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: a prospective randomized study with long-term follow-up. Am J Gastroenterol 2012;107(9):1370-6. DOI: 10.1038/ajg.2012.212
3. Laine L, Sahota A, Shah A. Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography. Gastroenterology 2010;138(5):1673-80.e1; quiz e11-2. DOI: 10.1053/j.gastro.2010.01.047
4. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005;100(11):2407-18. DOI: 10.1111/j.1572-0241.2005.00274.x
5. Teshima CW, Kuipers EJ, van Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol 2011;26(5):796-801. DOI: 10.1111/j.1440-1746.2010.06530.x
6. Shim K-N, Moon JS, Chang DK, et al. Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding. Clin Endosc 2013;46(1):45-53. DOI: 10.5946/ce.2013.46.1.45
7. Farhat R, Kim DT, French TD, et al. A Novel Technique to Measure the Intensity of Abnormality on GI Bleeding Scans: Development, Initial Implementation, and Correlation With Conventional Angiography. Clin Nucl Med 2018;43(2):82-6. DOI: 10.1097/rlu.0000000000001920
8. Speir EJ, Newsome JM, Bercu ZL, et al. Correlation of CT Angiography and (99m)Technetium-Labeled Red Blood Cell Scintigraphy to Catheter Angiography for Lower Gastrointestinal Bleeding: A Single-Institution Experience. J Vasc Interv Radiol 2019;30(11):1725-32.e7. DOI: 10.1016/j.jvir.2019.04.019
9. Duraiswamy S, Schmulewitz N, Rockey DC. The role of 99m Tc-RBC scintigraphy in lower gastrointestinal hemorrhage. J Investig Med 2016;64(4):854-60. DOI: 10.1136/jim-2016-000077
10. Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018;50(4):423-46. DOI: 10.1055/a-0576-0566
11. Saurin JC, Delvaux M, Gaudin JL, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy 2003;35(7):576-84. DOI: 10.1055/s-2003-40244
12. Feuerstein JD, Ketwaroo G, Tewani SK, et al. Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy. AJR Am J Roentgenol 2016;207(3):578-84. DOI: 10.2214/ajr.15.15714
13. Fisher L, Lee Krinsky M, Anderson MA, et al. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc 2010;72(3):471-9. DOI: 10.1016/j.gie.2010.04.032
14. Gurajala RK, Fayazzadeh E, Nasr E, et al. Independent usefulness of flow phase (99)mTc-red blood cell scintigraphy in predicting the results of angiography in acute gastrointestinal bleeding. Br J Radiol 2019;92(1094):20180336. DOI: 10.1259/bjr.20180336
15. Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010;71(2):280-6. DOI: 10.1016/j.gie.2009.09.031
16. Marmo R, Rotondano G, Rondonotti E, et al. Capsule enteroscopy vs. other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study. Eur J Gastroenterol Hepatol 2007;19(7):535-42. DOI: 10.1097/MEG.0b013e32812144dd
17. Gurudu SR, Bruining DH, Acosta RD, et al. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc 2017;85(1):22-31. DOI: 10.1016/j.gie.2016.06.013
18. Wetwittayakhlang P, Wonglhow J, Netinatsunton N, et al. Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up. BMC Gastroenterol 2019;19(1):216. DOI: 10.1186/s12876-019-1137-3
19. Otani K, Watanabe T, Shimada S, et al. Clinical Utility of Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Obscure Gastrointestinal Bleeding. Digestion 2018;97(1):52-8. DOI: 10.1159/000484218
20. Ribeiro I, Pinho R, Rodrigues A, et al. Obscure gastrointestinal bleeding: Which factors are associated with positive capsule endoscopy findings? Rev Esp Enferm Dig 2015;107(6):334-9.
21. Shahidi NC, Ou G, Svarta S, et al. Factors associated with positive findings from capsule endoscopy in patients with obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2012;10(12):1381-5. DOI: 10.1016/j.cgh.2012.08.035
22. Shimada S, Watanabe T, Nadatani Y, et al. Clinical factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding: a single-center study. Scand J Gastroenterol 2017;52(11):1219-23. DOI: 10.1080/00365521.2017.1349174
23. Saperas E, Dot J, Videla S, et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 2007;102(4):731-7. DOI: 10.1111/j.1572-0241.2007.01058.x
References
1. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015;47(4):352-76. DOI: 10.1055/s-0034-1391855
2. Leung WK, Ho SS, Suen BY, et al. Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: a prospective randomized study with long-term follow-up. Am J Gastroenterol 2012;107(9):1370-6. DOI: 10.1038/ajg.2012.212
3. Laine L, Sahota A, Shah A. Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography. Gastroenterology 2010;138(5):1673-80.e1; quiz e11-2. DOI: 10.1053/j.gastro.2010.01.047
4. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005;100(11):2407-18. DOI: 10.1111/j.1572-0241.2005.00274.x
5. Teshima CW, Kuipers EJ, van Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol 2011;26(5):796-801. DOI: 10.1111/j.1440-1746.2010.06530.x
6. Shim K-N, Moon JS, Chang DK, et al. Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding. Clin Endosc 2013;46(1):45-53. DOI: 10.5946/ce.2013.46.1.45
7. Farhat R, Kim DT, French TD, et al. A Novel Technique to Measure the Intensity of Abnormality on GI Bleeding Scans: Development, Initial Implementation, and Correlation With Conventional Angiography. Clin Nucl Med 2018;43(2):82-6. DOI: 10.1097/rlu.0000000000001920
8. Speir EJ, Newsome JM, Bercu ZL, et al. Correlation of CT Angiography and (99m)Technetium-Labeled Red Blood Cell Scintigraphy to Catheter Angiography for Lower Gastrointestinal Bleeding: A Single-Institution Experience. J Vasc Interv Radiol 2019;30(11):1725-32.e7. DOI: 10.1016/j.jvir.2019.04.019
9. Duraiswamy S, Schmulewitz N, Rockey DC. The role of 99m Tc-RBC scintigraphy in lower gastrointestinal hemorrhage. J Investig Med 2016;64(4):854-60. DOI: 10.1136/jim-2016-000077
10. Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018;50(4):423-46. DOI: 10.1055/a-0576-0566
11. Saurin JC, Delvaux M, Gaudin JL, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy 2003;35(7):576-84. DOI: 10.1055/s-2003-40244
12. Feuerstein JD, Ketwaroo G, Tewani SK, et al. Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy. AJR Am J Roentgenol 2016;207(3):578-84. DOI: 10.2214/ajr.15.15714
13. Fisher L, Lee Krinsky M, Anderson MA, et al. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc 2010;72(3):471-9. DOI: 10.1016/j.gie.2010.04.032
14. Gurajala RK, Fayazzadeh E, Nasr E, et al. Independent usefulness of flow phase (99)mTc-red blood cell scintigraphy in predicting the results of angiography in acute gastrointestinal bleeding. Br J Radiol 2019;92(1094):20180336. DOI: 10.1259/bjr.20180336
15. Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010;71(2):280-6. DOI: 10.1016/j.gie.2009.09.031
16. Marmo R, Rotondano G, Rondonotti E, et al. Capsule enteroscopy vs. other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study. Eur J Gastroenterol Hepatol 2007;19(7):535-42. DOI: 10.1097/MEG.0b013e32812144dd
17. Gurudu SR, Bruining DH, Acosta RD, et al. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc 2017;85(1):22-31. DOI: 10.1016/j.gie.2016.06.013
18. Wetwittayakhlang P, Wonglhow J, Netinatsunton N, et al. Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up. BMC Gastroenterol 2019;19(1):216. DOI: 10.1186/s12876-019-1137-3
19. Otani K, Watanabe T, Shimada S, et al. Clinical Utility of Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Obscure Gastrointestinal Bleeding. Digestion 2018;97(1):52-8. DOI: 10.1159/000484218
20. Ribeiro I, Pinho R, Rodrigues A, et al. Obscure gastrointestinal bleeding: Which factors are associated with positive capsule endoscopy findings? Rev Esp Enferm Dig 2015;107(6):334-9.
21. Shahidi NC, Ou G, Svarta S, et al. Factors associated with positive findings from capsule endoscopy in patients with obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2012;10(12):1381-5. DOI: 10.1016/j.cgh.2012.08.035
22. Shimada S, Watanabe T, Nadatani Y, et al. Clinical factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding: a single-center study. Scand J Gastroenterol 2017;52(11):1219-23. DOI: 10.1080/00365521.2017.1349174
23. Saperas E, Dot J, Videla S, et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 2007;102(4):731-7. DOI: 10.1111/j.1572-0241.2007.01058.x
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Mascarenhas Saraiva M, Ribeiro T, Andrade P, Cardoso H, Macedo G. Capsule enteroscopy versus radionuclide scintigraphy for the diagnosis of obscure gastrointestinal bleeding. 7633/2020


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Publication history

Received: 03/11/2020

Accepted: 10/05/2021

Online First: 21/05/2021

Published: 07/04/2022

Article revision time: 180 days

Article Online First time: 199 days

Article editing time: 520 days


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