Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2004 Dec;96(12):1653–1656.

Value of early capsular endoscopy for severe gastrointestinal bleeding.

Clinton L Cummings 1
PMCID: PMC2568665  PMID: 15622697

Abstract

This case illustrates the importance of early capsule endoscopy in cases of severe rectal bleeding when initial diagnostic tests do not document the site of bleeding. Although this case occurred in a community hospital capable of performing capsule endoscopy, I practice at a city hospital that serves the poor and underserved and currently does not have capsule endoscopy capability. Over the years, we have seen several cases of severe rectal bleeding where the site of bleeding was never identified, despite multiple diagnostic procedures short of capsule endoscopy. Often times, the bleeding stops spontaneously or ends in emergency surgery where morbidity or mortality is increased. Physicians like myself need to be made aware of this relatively new diagnostic tool that provides added value to standard diagnostic tests for evaluating severe rectal bleeding of unknown etiology. Early identification of the site of rectal bleeding may curtail the need for multiple transfusions, resolve economical burden, and reduce morbidity and mortality associated with severe rectal bleeding.

Full text

PDF
1653

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appleyard M., Glukhovsky A., Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding. N Engl J Med. 2001 Jan 18;344(3):232–233. doi: 10.1056/NEJM200101183440316. [DOI] [PubMed] [Google Scholar]
  2. Barkin J. S., Chong J., Reiner D. K. First-generation video enteroscope: fourth-generation push-type small bowel enteroscopy utilizing an overtube. Gastrointest Endosc. 1994 Nov-Dec;40(6):743–747. [PubMed] [Google Scholar]
  3. Davies G. R., Benson M. J., Gertner D. J., Van Someren R. M., Rampton D. S., Swain C. P. Diagnostic and therapeutic push type enteroscopy in clinical use. Gut. 1995 Sep;37(3):346–352. doi: 10.1136/gut.37.3.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fiorito J. J., Brandt L. J., Kozicky O., Grosman I. M., Sprayragen S. The diagnostic yield of superior mesenteric angiography: correlation with the pattern of gastrointestinal bleeding. Am J Gastroenterol. 1989 Aug;84(8):878–881. [PubMed] [Google Scholar]
  5. Hayat M., Axon A. T., O'Mahony S. Diagnostic yield and effect on clinical outcomes of push enteroscopy in suspected small-bowel bleeding. Endoscopy. 2000 May;32(5):369–372. doi: 10.1055/s-2000-9003. [DOI] [PubMed] [Google Scholar]
  6. Howarth D. M., Tang K., Lees W. The clinical utility of nuclear medicine imaging for the detection of occult gastrointestinal haemorrhage. Nucl Med Commun. 2002 Jun;23(6):591–594. doi: 10.1097/00006231-200206000-00013. [DOI] [PubMed] [Google Scholar]
  7. Iddan G., Meron G., Glukhovsky A., Swain P. Wireless capsule endoscopy. Nature. 2000 May 25;405(6785):417–417. doi: 10.1038/35013140. [DOI] [PubMed] [Google Scholar]
  8. Lewis B. S. Enteroscopy. Gastrointest Endosc Clin N Am. 2000 Jan;10(1):101-16, vii. [PubMed] [Google Scholar]
  9. Lewis B. S. Enteroscopy: endangered by the capsule? Endoscopy. 2002 May;34(5):416–417. doi: 10.1055/s-2002-25295. [DOI] [PubMed] [Google Scholar]
  10. Mylonaki M., Fritscher-Ravens A., Swain P. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut. 2003 Aug;52(8):1122–1126. doi: 10.1136/gut.52.8.1122. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Rockey D. C. Occult gastrointestinal bleeding. N Engl J Med. 1999 Jul 1;341(1):38–46. doi: 10.1056/NEJM199907013410107. [DOI] [PubMed] [Google Scholar]
  12. Seensalu R. The sonde exam. Gastrointest Endosc Clin N Am. 1999 Jan;9(1):37–59. [PubMed] [Google Scholar]
  13. Swaniker F., Soldes O., Hirschl R. B. The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel's diverticulum. J Pediatr Surg. 1999 May;34(5):760–765. doi: 10.1016/s0022-3468(99)90370-6. [DOI] [PubMed] [Google Scholar]
  14. Zuckerman G. R., Prakash C., Askin M. P., Lewis B. S. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000 Jan;118(1):201–221. doi: 10.1016/s0016-5085(00)70430-6. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES