Kametaka Daisuke, Iwamuro Masaya, Inokuchi Toshihiro, Kawano Seiji, Hiraoka Sakiko, Otsuka Motoyuki
Division of Endoscopy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
BMC Gastroenterol. 2025 Jun 5;25(1):434. doi: 10.1186/s12876-025-04044-1.
Small-bowel capsule endoscopy (SBCE) is an essential diagnostic tool for obscure gastrointestinal bleeding, particularly for identifying bleeding sources in the small intestine. The timing of SBCE is thought to affect its diagnostic yield; however, the optimal timing remains unknown.
This retrospective study analyzed 131 patients with overt gastrointestinal bleeding managed with SBCE at our institution between May 2015 and December 2022. Patients were categorized into four groups based on the interval between their last bleeding episode and SBCE: 1–7, 8–14, 15–28, and ≥ 29 days.
Positive findings were observed in approximately 50% of the cases across all intervals, with no statistically significant differences in the detection rates. Vascular lesions were detected primarily within 1–14 days, whereas inflammatory lesions, tumors, and diverticula were identified across all intervals. Notably, 25% of the patients with negative SBCE findings were later diagnosed with sources of non-small bowel bleeding, highlighting the value of follow-up endoscopic evaluations.
Our findings suggest that SBCE can be effective regardless of the time after a bleeding event, contrary to previous recommendations emphasizing its early use. Clinicians should consider performing SBCE whenever feasible to improve the diagnostic outcomes for gastrointestinal bleeding, irrespective of the elapsed time since the last episode.
小肠胶囊内镜检查（SBCE）是诊断不明原因胃肠道出血的重要工具，尤其用于识别小肠出血源。SBCE的检查时机被认为会影响其诊断率；然而，最佳时机仍不清楚。
这项回顾性研究分析了2015年5月至2022年12月期间在我院接受SBCE检查的131例显性胃肠道出血患者。根据最后一次出血发作与SBCE之间的间隔时间，将患者分为四组：1 - 7天、8 - 14天、15 - 28天和≥29天。
在所有间隔时间内，约50%的病例有阳性发现，检出率无统计学显著差异。血管病变主要在1 - 14天内被检测到，而炎症性病变、肿瘤和憩室在所有间隔时间内均有发现。值得注意的是，25%的SBCE检查结果为阴性的患者后来被诊断为非小肠出血源，这凸显了后续内镜评估的价值。
我们的研究结果表明，与之前强调早期使用的建议相反，无论出血事件后的时间如何，SBCE都可能有效。临床医生应在可行时考虑进行SBCE，以改善胃肠道出血的诊断结果，而不管自上次发作以来经过的时间。
