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

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.

Nedeni bilinmeyen gastrointestinal sistem kanamalarda kapsül endoskopisinin acil servisteki yeri?

AMAÇ: Bu çalýþmanýn amacý acilde nedeni bilinmeyen gastrointestinal (GÝS) kanama tanýsý ile yatýrýlarak takip edilen hastalarda kapsül endoskopisinin yerini irdelemek.
GEREÇ VE YÖNTEM: Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Acil Cerrahi biriminde 1 Ocak 2007 ile 1 Haziran 2015 tarihleri arasýnda nedeni bilinmeyen aþikar GÝS kanama tanýsý ile takip edilen ve kapsül endoskopisi yaptýðýmýz 38 hastanýn verileri geriye dönük olarak incelendi.
BULGULAR: Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Acil Cerrahi’de nedeni bilinmeyen GÝS kanama tanýsýyla takip edilen ve kapsül endoskopisi yapýlabilen 38 hasta çalýþmaya dahil edildi. On iki hasta kadýn (%32) 26 hasta erkekti (%68). Ortalama yaþ: 55.57 (20–88) idi. Dokuz hasta kan sulandýrýcý ilaç kullanýyordu. 10 hasta yoðun bakýmda takip edildi. Yedi hastaya anjiyo yapýldý aktif kanama saptanmadý. Kapsül endoskopisinde aktif kanama saptanan bir hastaya anjiyoembolizasyon yapýldý. Ortalama eritrosit süspansiyon replasmaný 20.7 ünite idi. On üç hasta kapsül endoskopisinde bulunan kanama odaklarý nedeniyle ameliyat edildi (%34). On bir hastaya çift balon endoskopisi yapýldý. Bunlardan beþine koterizasyon ikisine skleroterapi yapýlarak müdahale edildi (%18). Dört hasta hayatýný kaybetti. Ýki olgu kanama odaðý saptanamadýðý için bir olgu kolanjiyokarsinom nüksü nedeniyle bir olguda anastomoz kaçaðý nedeniyle hayatýný kaybetti. Bir olgu tekrar kanama nedeniyle hastaneye baþvurdu. On dokuz hastaya kapsül endoskopisi bulgularýna dayanýlarak baþarýlý þekilde müdahale edildi (%50). Tanýsal deðer %78.9 olarak saptandý. Hastanede ortalama kalýþ süresi 32.68 (daðýlým, 3–153 gün) idi.
TARTIÞMA: Kapsül endoskopisi kanama etiyolojisini saptamada etkindir. Acile baþvuran hastalarda nedeni bilinmeyen kanamalarda radyolojik olarak obstrüksiyon bulunmayan olgularda ilk tercih edilecek yöntem kapsül endoskopi olmalýdýr.