What is the clinical yield of capsule endoscopy in the management of obscure bleeding in emergency service? [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2017; 23(1): 46-50 | DOI: 10.5505/tjtes.2016.79360  

What is the clinical yield of capsule endoscopy in the management of obscure bleeding in emergency service?

Muhammed Zübeyr Üçüncü1, Süleyman Bademler2, Mehmet İlhan2, Ali Fuat Kaan Gök2, Filiz Akyüz3, Recep Güloğlu2
1Arnavutköy Government Hospital, İstanbul
2İstanbul Universty İstanbul Medicine Faculty General Surgery
3stanbul Universty İstanbul Medicine Faculty Gastroenterology

BACKGROUND: The aim of this study was to investigate the efficacy of capsule endoscopy (CE) performed on patients who presented to emergency room with clinically evident gastrointestinal (GI) bleeding from unknown source and were hospitalized for follow-up.
METHODS: Total of 38 patients who underwent CE and were followed-up for evaluation of clinically perceptible GI bleeding with no obvious etiology in Istanbul Medical Faculty emergency surgery department were included in the study. Patient data, which were collected between January 1, 2007 and June 1, 2015, were reviewed retrospectively.
RESULTS: Of the 38 patients included in this study, 12 (32%) patients were women and 26 (68%) were men. Average age was 55.57 years (range: 20–88 years). Nine patients were using anticoagulants. Ten patients were followed-up in intensive care, and 7 patients underwent angiography. Angioembolization was performed for 1 patient who was diagnosed as having active bleed with CE. Average erythrocyte suspension replacement was 20.7 units. Total of 13 patients underwent surgery for bleeding found with CE. Eleven (34%) patients underwent double-balloon endoscopy, during which 5 patients were treated with cauterization and sclerotherapy was performed on 2. Four (18%) patients died during the study period: 2 died as result of bleeding from unknown source, 1 died of cholangiocarcinoma recurrence, and 1 died of anastomotic leakage. One patient was readmitted to hospital due to recurrence of bleeding. Nineteen (50%) patients were treated successfully based on CE findings. Diagnostic yield of CE was determined to be 78.9%. Average length of hospital stay was 32.68 days (range: 3–153 days).
CONCLUSION: CE is an effective tool to detect source of GI bleeding. CE should be first choice of evaluation method for patients admitted to emergency room with obscure overt GI bleeding once radiological imaging determines absence of obstruction.

Keywords: Capsule endoscopy, emergency service, obscure bleeding.


Nedeni bilinmeyen gastrointestinal sistem kanamalarda kapsül endoskopisinin acil servisteki yeri?

Muhammed Zübeyr Üçüncü1, Süleyman Bademler2, Mehmet İlhan2, Ali Fuat Kaan Gök2, Filiz Akyüz3, Recep Güloğlu2
1Arnavutköy Devlet Hastanesi,İstanbul
2İstanbul Üniversitesi,İstanbul Tıp Fakültesi,Genel Cerrahi Anabilim Dalı, İstanbul
3İstanbul Üniversitesi,İstanbul Tıp Fakültesi,Gastroenteroloji Bilim Dalı, İstanbul

AMAÇ: Bu çalışmanın amacı acilde nedeni bilinmeyen gastrointestinal (GİS) kanama tanısı ile yatırılarak takip edilen hastalarda kapsül endoskopisinin yerini irdelemek.
GEREÇ VE YÖNTEM: İstanbul Üniversitesi İstanbul Tıp Fakültesi Acil Cerrahi biriminde 1 Ocak 2007 ile 1 Haziran 2015 tarihleri arasında nedeni bilinmeyen aşikar GİS kanama tanısı ile takip edilen ve kapsül endoskopisi yaptığımız 38 hastanın verileri geriye dönük olarak incelendi.
BULGULAR: İstanbul Üniversitesi İstanbul Tıp Fakültesi Acil Cerrahi’de nedeni bilinmeyen GİS kanama tanısıyla takip edilen ve kapsül endoskopisi yapılabilen 38 hasta çalışmaya dahil edildi. On iki hasta kadın (%32) 26 hasta erkekti (%68). Ortalama yaş: 55.57 (20–88) idi. Dokuz hasta kan sulandırıcı ilaç kullanıyordu. 10 hasta yoğun bakımda takip edildi. Yedi hastaya anjiyo yapıldı aktif kanama saptanmadı. Kapsül endoskopisinde aktif kanama saptanan bir hastaya anjiyoembolizasyon yapıldı. Ortalama eritrosit süspansiyon replasmanı 20.7 ünite idi. On üç hasta kapsül endoskopisinde bulunan kanama odakları nedeniyle ameliyat edildi (%34). On bir hastaya çift balon endoskopisi yapıldı. Bunlardan beşine koterizasyon ikisine skleroterapi yapılarak müdahale edildi (%18). Dört hasta hayatını kaybetti. İki olgu kanama odağı saptanamadığı için bir olgu kolanjiyokarsinom nüksü nedeniyle bir olguda anastomoz kaçağı nedeniyle hayatını kaybetti. Bir olgu tekrar kanama nedeniyle hastaneye başvurdu. On dokuz hastaya kapsül endoskopisi bulgularına dayanılarak başarılı şekilde müdahale edildi (%50). Tanısal değer %78.9 olarak saptandı. Hastanede ortalama kalış süresi 32.68 (dağılım, 3–153 gün) idi.
TARTIŞMA: Kapsül endoskopisi kanama etiyolojisini saptamada etkindir. Acile başvuran hastalarda nedeni bilinmeyen kanamalarda radyolojik olarak obstrüksiyon bulunmayan olgularda ilk tercih edilecek yöntem kapsül endoskopi olmalıdır.

Anahtar Kelimeler: Acil servis, gizli kanama, kapsül endoskopi.


Muhammed Zübeyr Üçüncü, Süleyman Bademler, Mehmet İlhan, Ali Fuat Kaan Gök, Filiz Akyüz, Recep Güloğlu. What is the clinical yield of capsule endoscopy in the management of obscure bleeding in emergency service?. Ulus Travma Acil Cerrahi Derg. 2017; 23(1): 46-50

Corresponding Author: Muhammed Zübeyr Üçüncü, Türkiye


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