Magnetically assisted capsule endoscopy in suspected acute upper GI bleeding versus esophagogastroduodenoscopy in detecting focal lesions

• Published in: Gastrointestinal endoscopy 2019-09, Vol.90 (3), p.430-439
• Main Authors: Ching, Hey-Long, Hale, Melissa F., Sidhu, Reena, Beg, Sabina, Ragunath, Krish, McAlindon, Mark E.
• Format: Article
• Language: English
• Subjects: Aged; Capsule Endoscopy - methods; Cohort Studies; Duodenal Ulcer - diagnosis; Endoscopy, Digestive System - methods; Esophageal and Gastric Varices - diagnosis; Esophageal Diseases - diagnosis; Female; Gastrointestinal Hemorrhage - diagnosis; Humans; Intestinal Diseases - diagnosis; Intestine, Small; Magnets; Male; Middle Aged; Peptic Ulcer - diagnosis; Prospective Studies; Sensitivity and Specificity; Stomach Ulcer - diagnosis; Upper Gastrointestinal Tract
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2019.04.248

Acute upper GI bleeding is common and requires investigation with EGD, but endotherapy is not always necessary. Magnetically assisted capsule endoscopy (MACE) uses a capsule steerable by an external magnet and allows examination of the upper GI tract and small bowel, but its role in acute upper GI bleeding has not been assessed. We conducted a prospective cohort study comparing the diagnostic yield of MACE and EGD in patients with suspected acute upper GI bleeding. Patient tolerance, mucosal visibility by MACE, and frequency of small-bowel bleeding were assessed. Whether or not MACE could safely predict discharge of patients was also determined. Thirty-three patients were included for analysis (median age, 60 years; 75.8% male). MACE detected more focal lesions (peptic, vascular, and fresh/altered blood without a clear source) than EGD (40 versus 25, respectively, P = .02) but statistical significance was not reached for significant lesions (considered to be the bleeding source; 14 vs 13, respectively, P = 1). Capsule endoscopy identified an additional cause for bleeding in the small bowel in 18%. Visualization by MACE was excellent in most areas; views of the esophagus, gastroesophageal junction, fundus, and duodenal bulb were suboptimal. MACE was better tolerated than unsedated EGD and correctly identified patients who were safe for discharge. MACE had higher diagnostic yield for focal lesions and was better tolerated than EGD. It also correctly predicted safe discharge for patients with acute upper GI bleeding. (Clinical trials registration number: NCT02690376.) [Display omitted]