The impact of capsule endoscopy on surgical results in patients with obscure gastrointestinal bleeding.

Background: Obscure gastrointestinal bleeding (OGIB) that cannot be established applying traditional endoscopic methods represents 5 % of all gastrointestinal bleedings. Earlier, in cases of recurrent, overt bleedings the surgeons had to perform a laparotomy "blind" without diagnosis. The aim of our retrospective study was to analyse the effectiveness of surgical therapy in patients with OGIB investigated with capsule endoscopy (CE).

Methods: During 36-month period at two workplaces capsule endoscopy studies were evaluated in 61 patients with OGIB who had undergone non-diagnostic panendoscopy and colonoscopy. CE findings were divided into three groups according to the bleeding source: definitive bleeding source (48), uncertain bleeding potential (5) and negative findings (8). Surgical therapy was initiated in 18 cases with definitive bleeding sources.

Results: The mean age of 7 male and 11 female patients operated on was 63.4 (+/- 10.69) years. The period between the first clinical symptoms and the date of the operation was an average of 18.2 (+/- 26.11) months. During this period patients were hospitalized in an average of 6 (+/- 7.96) cases. In 17 cases (94 %) the surgical and pathological findings justified the definitive bleeding sources detected by CE. In one case of bleeding angiodysplasia with negative pathological findings the follow-up period without recurrent bleeding justified the validity of CE results and the success of surgical therapy.

Conclusions: CE offers a high impact on the surgical results in patients with OGIB. Through our CE examinations the correct localization of the bleeding sources always provided a reasonable support to perform an optimal small bowel resection.