PAN-INTESTINAL CAPSULE ENDOSCOPY AS FIRST-LINE PROCEDURE IN PATIENTS WITH SUSPECTED MID OR LOWER GASTROINTESTINAL BLEEDING

Introduction. Pan-intestinal capsule endoscopy (PCE) evaluates the small-bowel and colon, non-invasively.
Aim: Evaluate diagnostic accuracy and safety of PCE vs. colonoscopy as first-line examination in suspected mid-lower gastrointestinal bleeding (MLGIB).
Methods. Prospective, single-centre, single-blinded cohort study. Consecutive patients with suspected MLGIB submitted to PCE followed by same-day colonoscopy. Diagnostic accuracy for potentially haemorrhagic lesions (PHL) (combined diagnosis by PCE + colonoscopy) and incidence of adverse events were assessed.
Results. One-hundred suspected MLGIB patients, mean age 66,5 [70 (18-92)] years, 65% females. PHL were diagnosed in 46% of patients, corresponding to small-bowel and/or colon angioectasias in 70%. PCE correctly identified individuals without PHL in 50%, identifying 96% (44/46) of all individuals with PHL, vs. 50% (23/46) for colonoscopy. PHL were detected by PCE-only in 65% (30/46), both examinations in 28% (13/46), and colonoscopy-only in 6% (3/46). PHL were diagnosed at the ileo-colonic territory in 28% of patients; in those cases, PCE established the diagnosis in 25/28 (89%) of cases, vs. conventional colonoscopy in 23/28 (82%), p=0,125. Interventional procedures were performed at colonoscopy in 13/81 patients with IDA (16%) vs. 6/19 patients with overt bleeding (31,6%), p<0,01. No significant adverse events occurred with PCE vs. 2% with colonoscopy.
Conclusions: While assessing patients with MLGIB, PCE dismisses further invasive procedures in more than half of patients. Moreover, PCE is safe and more effective than colonoscopy in identifying PHL both in the small-bowel and colon. Our results support the potential use of PCE as a first-line examination in patients with suspected MLGIB.