John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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The place of videocapsule endoscopy in the diagnosis of gastrointestinal bleeding Volume 21, issue 6, Juin 2014

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Authors
CHU de Rouen,
hôpital Charles Nicolle,
département d’hépato-gastroenterologie,
unité d’endoscopie digestive,
76031 Rouen Cedex,
France ;
INSERM U-1073,
Rouen,
France
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Since its commercialization in 2001, capsule endoscopy (CE) is used in first line in unexplained gastrointestinal bleeding after standard upper and lower endoscopies called obscure gastrointestinal bleeding (OGIB). OGIB account for 5% of gastrointestinal bleeding but are often associated with a high cost due to a non-standardized medical diagnostic and therapeutic management. Given the high diagnosis yield of CE in HDO that reach 60%, CE replaced in first intention radiological exploration such as double-contrast enteroclysis and CT scan. Invasive small bowel explorations also show excellent diagnosis yield in OGIB and enable hemostasis of bleeding lesions in the same time. However, these procedures require a prolonged general anesthesia and are not available in all centers. The key role of CE is to select patients requiring a treatment and to propose the adequate technique. CE can also show upper and lower bleeding lesions that were missed by standard endoscopies. CE should be performed early after the bleeding in order to improve its diagnosis yield. Predictive factors of positive diagnosis by CE in OGIB are an overt bleeding, age more than 60 years and male gender. Recent data suggest that an emergency CE performed in patients with OGIB and hemodynamic failure can identify the bleeding lesion or the bleeding site in 90% of cases, and to lead the patient to the more adequate therapeutic strategy. This last indication, associated with the future development of therapeutic CE, allows warranting a key role of CE in OGIB in the next years.