Is there a role for angiography in patients with obscure overt bleeding?

Obscure gastrointestinal hemorrhage remains a challenging but uncommon clinical scenario. Video capsule endoscopy (VCE) has been recommended as the third diagnostic test after normal upper and lower endoscopic examinations. A recent randomized controlled trial comparing immediate VCE to angiography demonstrated a superior diagnostic yield for VCE compared with angiography. However, long-term outcomes, including rebleeding, hospitalization rates, and death, did not differ between the two cohorts. Although VCE appears to be superior to other testing modalities for overall diagnostic yield, the clinical outcomes ultimately depend upon the type of lesion detected. Vascular lesions, mainly small bowel angiodysplasia, can be expected to have the highest rates of rebleeding, despite endoscopic therapy, and have been associated with the presence of comorbid conditions.