[Role of capsule endoscopy in patients with portal hypertension and obscure gastrointestinal bleeding].

BACKGROUND AND AIMS

Limited number of data are available on small bowel changes due to portal hypertension. The present retrospective, comparative study was aimed to analyse the diagnostic yield and to describe the findings with capsule endoscopy of cirrhotic patients with obscure gastrointestinal bleeding.

PATIENTS AND METHODS

Capsule endoscopy findings of 11 cirrhotic patients with portal hypertension and 22 non-cirrhotic patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy were compared. Capsule video recordings were evaluated by two investigators at both workplaces. Patients after capsule endoscopy were followed-up until a mean of 19 (1-42) months.

RESULTS

In total 7 men and 5 women were examined at two medical centres in 48 months with a mean age of 66.2 (+/-7.6) years. The average period between the first clinical symptoms and capsule endoscopy was 15.7 (+/-14.9) months. During this period patients were hospitalized in an average of 2.8 (+/-1.3) times and 7.9 examinations were performed per patients prior to capsule endoscopy. A small bowel bleeding source was diagnosed in all 11 patients. Two definitive bleeding sources were observed in 7 patients (63%). Lesions connected to portal hypertension were found in all patients (8 angiodysplasias, 2 portal hypertensive enteropathies and 1 bowel varix). During the follow-up period rebleeding occurred in 27.3% of cirrhotic patients compared with 18.2% rebleeding rate in the control group.

CONCLUSION

Capsule endoscopy is a useful method in patients with portal hypertension and obscure gastrointestinal bleeding after negative upper endoscopy and colonoscopy. Multiple angiodysplasias are often diagnosed in the background of small bowel bleedings, and several bleeding sources frequently occur in these patients.