• Video capsule endoscopy (VCE)
• long-term
• obscure gastrointestinal bleeding (OGIB)
• re-bleeding rate
• risk factors

• Carcinoid Tumor/complications
• Carcinoid Tumor/diagnosis
• Carcinoid Tumor/therapy
• Diagnosis, Differential
• Female
• Humans
• Ileal Neoplasms/complications
• Ileal Neoplasms/diagnosis
• Ileal Neoplasms/therapy
• Intestinal Neoplasms/complications
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/therapy
• Melena/diagnosis
• Melena/etiology
• Melena/therapy
• Middle Aged

Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes.

• Obscure gastrointestinal bleeding
• Capsule endoscopy
• Double balloon enteroscopy
• Outcomes
• Anaemia

AIM: To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB).

METHODS: The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients’ medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients’ management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients’ outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients.

RESULTS: Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy’s (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients’ management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001).

CONCLUSION: In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

• Angiodysplasia
• Etiology
• Gastrointestinal Bleeding
• Obscure
• Capsule Endoscopy
• Outcome
• Small bowel ulcer
• Wireless

AIM: To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children.

METHODS: Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden’s syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation.

RESULTS: The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (trans-anal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden’s syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identified in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved.

CONCLUSION: Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

• Double balloon enteroscopy
• Gastrointestinal
• Peutz Jeghers syndrome
• Wireless video capsule endoscopy
• Children

Until only a few years ago, most of the small bowel was beyond the range of conventional examinations because of its special anatomical position. The advent of capsule endoscopy (CE) represents a significant breakthrough for non-invasive and visual diagnosis of diseases in the small bowel. Since CE permits direct acquisition of images from the mucosa with high sensitivity and safety, it has become an important tool for diagnosis and surveillance of obscure gastrointestinal bleeding, Crohn's disease, familial adenomatous polyposis and other small bowel diseases. However, CE also has some weakness such as low specificity and risk of retention. In this review, we will compare CE with other imaging modalities in small bowel.

• Capsule endoscopy
• Small bowel follow-through
• Push enteroscopy
• Double-balloon enteroscopy
• Intraoperative enteroscopy
• Computed tomography enteroclysis
• Magnetic resonance enteroclysis
• Small bowel angiography

AIM: To investigate and evaluate the feasibility of the computer-aided screening diagnosis for enteric lesions in the capsule endoscopy (CE).

METHODS: After developing a series of algorithms for the screening diagnosis of the enteric lesions in CE based on their characteristic colors and contours, the normal and abnormal images obtained from 289 patients were respectively scanned and diagnosed by the CE readers and by the computer-aided screening for the enteric lesions with the image-processed software (IPS). The enteric lesions shown by the images included esoenteritis, mucosal ulcer and erosion, bleeding, space-occupying lesions, angioectasia, diverticula, parasites, etc. The images for the lesions or the suspected lesions confirmed by the CE readers and the computers were collected, and the effectiveness rate of the screening and the number of the scanned images were evaluated, respectively.

RESULTS: Compared with the diagnostic results obtained by the CE readers, the total effectiveness rate (sensitivity) in the screening of the commonly-encountered enteric lesions by IPS varied from 42.9% to 91.2%, with a median of 74.2%, though the specificity and the accuracy rates were still low, and the images for the rarely-encountered lesions were difficult to differentiate from the normal images. However, the number of the images screened by IPS was 5000 on average, and only 10%-15% of the original images were left behind. As a result, a large number of normal images were excluded, and the reading time decreased from 5 h to 1 h on average.

CONCLUSION: Though the total accuracy and specificity rates by the computer-aided screening for the enteric lesions with IPS are much lower than those by the CE readers, the computer-aided screening diagnosis can exclude a large number of the normal images and confine the enteric lesions to 5000 images on average, which can reduce the workload of the readers in the scanning of the images. This computer-aided screening technique can make a correct diagnosis as efficiently as possible in most of the patients.

• Enteric lesions
• Image processing
• Capsule endoscopy
• Diagnosis

• Capsule Endoscopy/methods
• Capsule Endoscopy/trends
• Female
• Forecasting
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Intestinal Diseases/diagnosis
• Intestine, Small/pathology
• Male
• Sensitivity and Specificity

• capsule endoscopy
• double balloon enteroscopy
• obscure glycemic index bleeding
• crohn's disease
• nonsteroidal anti-inflammatory drugs

• Capsule Endoscopes/adverse effects
• Capsule Endoscopes/trends
• Endoscopy, Gastrointestinal/methods
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/pathology
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/pathology
• Intestine, Small/pathology
• Risk Factors

Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.

• Capsule endoscopy
• Surgery
• Small bowel neoplasm
• Obscure gastrointestinal bleeding
• Angiodisplasia

• Capsule Endoscopy
• Digestive System Surgical Procedures
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/surgery
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/surgery
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/surgery
• Intestine, Small/pathology
• Intestine, Small/surgery
• Patient Selection
• Practice Guidelines as Topic