Capsule Endoscopy in the Detection of Non-Small Bowel Lesions Missed By Endoscopy

Background and aims: Capsule endoscopy (CE) is indicated in cases with obscure gastrointestinal bleeding (OGIB). However, lesions detected by CE are frequently within the reach of conventional Upper or lower GI endoscopy. We evaluated the accuracy of CE in the study of OGIB, examining the incidence of CE detected non-small bowel lesions (NSBL) missed by conventional endoscopy and studying its impact on patient management. Methods: We retrospectively analyzed 2010 CE procedures performed in a tertiary care center (IBD-Unit Referral Centre in Bologna), comparing the findings on CE to those on prior colonoscopy and upper GI endoscopy performed within 3 months and two weeks of the CE procedure, respectively. We evaluated the impact of CE findings on patient management. Results: CE revealed abnormal findings in 1608 out of 2010 patients. Previously missed NSBLs were revealed on CE in 283 cases. Of these, 265 pre-CE endoscopic reports were found to not conform to reporting guidelines. NSBLs on CE led to management changes in 271 patients. Conclusion: This study confirms the utility of CE in patients with OGIB. However, in a considerable number of cases, CE identified lesions missed by conventional endoscopy, suggesting that a second look prior to CE may be appropriate in some patients.