Authors' objectives:

The aim of this report was to assess video capsule gastrointestinal endoscopy usefulness for digestive bleeding of unknown origin.

Authors' results and conclusions: For this report 11 narrative revisions, 1 meta-analysis, 3 randomized controlled clinical trials and 6 case series were used. In addition, documents that set their view on the topic, from the American Society of Digestive Endoscopy (ASGE), the U.S. Food and Drugs Administration, 5 health technology assessments from American, Canadian, British and Australian agencies, and 7 coverage policies from north-American groups, including Medicaid, were chosen. In general the medical literature found shows poor evidence. A meta-analysis was performed incorporating evidence from observational studies available to the moment on video capsule endoscopy (VCE) vs intestinal transit. The results related to the diagnostic usefulness of both tests assesed were 58% (CI 95% 46,3-67,7) for the capsule, and 4% (CI 0,5-12,0%) conventional contrast radiology. With respect to enteroscopy, VCE is a better diagnostic tool (VCE 40-83% vs. enteroscopy 21-50%). VCE is especially useful to detect lesions beyond the enteroscope reach.

Authors' recommendations: The present evidence on safety and diagnostic usefulness of the video capsule is enough to support the use of this procedure for occult digestive bleeding. The sensitivity, specificity and predictive values are not known because there is no standard comparative method. Many agencies and organizations agree to support its use in the assessment of small bowel bleeding in persons with objective gastrointestinal bleeding of uncertain and recurrent origin (iron deficiency anemia, positive fecal occult blood or visible bleeding) who have undergone upper and lower endoscopies, if these studies were unable to identify the source. In addition, the patient must have been studied with push enteroscopy and radiologic techniques for the small bowel. The most common identified sources are angiodysplasia and malignant tumors. Another supported use is in the diagnosis of patients with suspected Crohn's disease, who have no disease evidence using conventional diagnostic tests, including small bowel transit and bidirectional endoscopy. This indication is limited due to the costs and rate of complications in these patients. Prior standard evaluation should rule-out bowel obstruction, stenosis or the presence of fistulas, since VCE is clearly contraindicated in these situations. Finally, more long term studies to establish the clinical significance of many of the findings on VCE and more randomized clinical trials (RCT) are necessary to settle the role of VCE replacing enteroscopy, as a second step in the investigation. Besides, more clinical experience in the use of this method is required.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)