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PubMedDate not supplied

Gastric acid secretion, parietal cell sensitivity, and endoscopic characteristics of duodenal ulcer patients with and without stigmata of recent bleeding.

Duodenal ulcer patients with stigmata of recent hemorrhage are at high risk of rebleeding. Whether the acid secretory capacity, the parietal cell sensitivity and endoscopic characteristics are different in patients with and without stigmata of recent hemorrhage are unclear. To investigate these, we studied 885 patients with active duodenal ulcer. Among them 693 patients presented with pain only and the rest with gastrointestinal bleeding. Within the latter group, 135 patients had no or minor stigmata (i.e., flat spot) of bleeding while 37 patients had major stigmata of bleeding (i.e., visible vessel and visible clot). The basal acid output and gastric acid output in response to infusion of graded doses of pentagastrin from 93.8 to maximal dose of 6000 ng/kg.hour (maximal acid output) were measured. The dose of pentagastrin required for half maximal response to gastric acid output was taken to represent the sensitivity of the parietal cells to pentagastrin (D50c). The results demonstrated that the basal acid output, maximal acid output, and D50c were not significantly different among the three groups. Endoscopically the size and site of the ulcer were similar, but patients with major stigmata of bleeding had significantly higher degrees of duodenal inflammation and deformity. We conclude that gastric acid secretion and D50c were not significantly different in patients with major and minor stigmata of recent bleeding, indicating that gastric acid may not play a significant role in precipitating gastrointestinal bleeding.

Adult↗
PubMedDate not supplied

Adding a sclerosant to endoscopic epinephrine injection in actively bleeding ulcers: a randomized trial.

We compared the efficacy of epinephrine injection and epinephrine injection followed by sodium tetradecyl sulfate in controlling active ulcer bleeding. Out of 2814 patients who underwent endoscopy for gastrointestinal bleeding, 200 patients with actively bleeding ulcers seen at the time of endoscopy were randomized to receive epinephrine injection alone (99 patients) or epinephrine injection followed by 3% sodium tetradecyl sulfate (101 patients). After the procedure the patients were transferred to the surgical gastroenterology ward and were treated by surgeons who were unaware of the mode of treatment. The patients underwent routine endoscopy 24 hours later, and epinephrine injection was repeated if active bleeding was seen again. Emergency surgery was performed for the following: (1) arterial spurting not controlled endoscopically, (2) failure of the blood pressure or pulse to stabilize after 4 units of blood, (3) total transfusion of more than 8 units of blood, or (4) rebleeding as defined by hematemesis with pulse greater than 100 beats/min or blood pressure less than 100 mm Hg after stabilization. The two groups were comparable in age, sex, site of ulcer, and severity of bleeding. Initial hemostasis was obtained at the time of endoscopy in 94% of the epinephrine group and 97% of the epinephrine plus sodium tetradecyl sulfate group. No difference in outcome was seen in the two groups as measured by emergency surgery requirement, blood transfusion, hospital stay, and hospital mortality. Endoscopic epinephrine injection is effective in controlling active ulcer bleeding. The additional injection of sodium tetradecyl sulfate confers no additional advantage.

Double-Blind Method↗
PubMed1996

Push enteroscopic cauterization: long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia.

BACKGROUND: This study assessed the long-term effectiveness of push enteroscopic cauterization of bleeding intestinal angiodysplasia. METHODS: We retrospectively reviewed the clinical course of patients who underwent push and sonde enteroscopy for obscure gastrointestinal bleeding and were diagnosed with intestinal angiodysplasias. RESULTS: One hundred twelve patients bleeding from small intestinal angiodysplasias were identified. After excluding those lost to follow-up (29), data were collected from 83 patients. Fifty-five patients (29 men; mean age, 73 years; mean units of packed red blood cells transfused, 21.4; average bleeding history, 22 months) were cauterized. Twenty-eight patients (12 men; mean age, 71; mean units of packed red blood cells transfused, 15.8; average bleeding history, 22 months) were not cauterized. The noncauterized group (follow-up, 26 +/- 14 months; mean +/- SD) continued to bleed, requiring 2.16 +/- 3.86 units of packed red blood cells transfused per month (units/month) before and 0.97 +/- 1.46 units/month after diagnosis (NS). The cauterized group (follow-up, 30 +/- 18 months) significantly improved, requiring 2.40 +/- 2.97 units/month before treatment and 0.32 +/- 0.91 units/month after cauterization (p < 0.0001, paired t test). CONCLUSION: Cauterization of endoscopically accessible small intestinal angiodysplasias may decrease rebleeding.

Aged↗
PubMed1997

Cure with omeprazole plus amoxicillin versus long-term ranitidine therapy in Helicobacter pylori-associated peptic ulcer bleeding.

BACKGROUND: Long-term prophylaxis with ranitidine reduces the risk of recurrent bleeding in patients with a history of bleeding peptic ulcers. To date, no randomized study has been performed to compare cure of Helicobacter pylori infection versus H2 blocker prophylaxis in patients with bleeding peptic ulcer. METHODS: In a prospective randomized study, 95 consecutive patients with H. pylori-associated peptic ulcer bleeding were randomized to either ranitidine prophylaxis (150 mg at night) for 2 years or to H. pylori-eradication with omeprazole 60 mg twice daily plus amoxicillin 750 mg three times daily for 10 days. RESULTS: (Intention-to-treat analysis). Forty-eight patients were enrolled in the ranitidine group; 47 in the omeprazole-plus-amoxicillin group. Mean follow-up was 576 days (77 to 730). Ulcer recurrence rate was 31.3% in the ranitidine group (group 1) versus 6.37% in the eradication group (group 2; p = 0.0018). More patients had recurrent bleeding in group 1 (8.3%) than in group 2 (4.2%) but we were not able to show a statistically significant difference with respect to recurrent bleeding between groups (p = 0.29). Definite cure of H. pylori infection was achieved in 89.3%. CONCLUSIONS: Cure of H. pylori infection reduces recurrence of peptic ulcer and therefore rebleeding more effectively than does long-term maintenance therapy with an H2 blocker.

Adult↗
PubMed1998

Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope.

BACKGROUND: The use of push enteroscopy to evaluate patients with obscure gastrointestinal bleeding has increased in recent years, and diagnostic yield has been reported to be 50% to 65%. This yield may be an overestimate of accuracy, as some lesions found during enteroscopy are within reach of a standard endoscope. METHODS: Ninety-five patients underwent push enteroscopy for obscure gastrointestinal bleeding. There were 58 men and 37 women with a mean age of 67 years (range 32 to 93 years). Diagnostic yield and patient outcome were assessed. RESULTS: A suspected source of bleeding was found in 39 of 95 patients (16 of these patients had endoscopic treatment of their lesions). Proximal lesions (at or above the main duodenal papilla) accounted for 25 of 39 sources (64%), including Cameron ulcers and arteriovenous malformations of the stomach/proximal duodenum. Distal lesions accounted for 14 of 39 sources (36%) with arteriovenous malformations (n=0) being most common. Patients who underwent some form of treatment (medical, surgical, or endoscopic) because of an enteroscopic finding had a statistically better outcome than patients without a lesion (73% vs. 47%, p < 0.05). CONCLUSIONS: Push enteroscopy identified a presumed bleeding source in 41 % of patients with obscure gastrointestinal bleeding. However, 64% were within reach of a standard endoscope. Repeat standard endoscopy should be considered before push enteroscopy for obscure gastrointestinal bleeding, and during enteroscopy meticulous attention should be given to the proximal gastrointestinal tract in addition to the distal duodenum and jejunum.

Adult↗
PubMed1999

Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay.

BACKGROUND: The impact of upper endoscopy in patients with upper gastrointestinal hemorrhage treated in community practice is unknown. Thus we examined the effectiveness of endoscopy performed within 24 hours of admission (early endoscopy). METHODS: Medical records of 909 consecutive hospitalized patients with upper gastrointestinal hemorrhage who underwent endoscopy at 13 hospitals in a large metropolitan area were reviewed. We evaluated unadjusted and severity-adjusted associations of early endoscopy with recurrent bleeding or surgery to control hemorrhage, length of hospital stay, and associations of endoscopic therapy in patients with bleeding ulcers or varices. RESULTS: Early endoscopy was performed in 64% of patients and compared with delayed endoscopy and was associated with clinically significant reductions in adjusted risk of recurrent bleeding or surgery (odds ratio [OR] 0.70: 95% CI [0.44, 1.13]) and a 31% decrease in adjusted length of stay (95% CI: [24%, 37%]). In patients at high risk for recurrent bleeding, the use of early endoscopic therapy to control hemorrhage was associated with reductions in recurrent bleeding or surgery (OR 0.21: 95% CI [0.10, 0.47]) and length of stay (-31%: 95% CI [-44%, -14%). CONCLUSION: In this study of community-based practice, the routine use of endoscopy, and in selected cases endoscopic therapy, performed early in the clinical course of patients with upper gastrointestinal hemorrhage was associated with reductions in length of stay and, possibly, the risk of recurrent bleeding and surgery.

Adult↗
PubMed2002

Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses.

PURPOSE: We assessed the safety and efficacy of ureteroscopy and holmium:YAG laser lithotripsy for treating upper urinary tract calculi in patients with known and uncorrected bleeding diathesis. MATERIALS AND METHODS: We retrospectively reviewed the charts at 2 tertiary stone centers to identify patients with known bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi) underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved warfarin administration for various conditions in 17 patients, liver dysfunction in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean international normalized ratio, platelet count and bleeding time were 2.3, 50 x 109/l. and greater than 16 minutes in patients on warfarin and in those with liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively. RESULTS: Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30 procedures were completed successfully without significant complication. In a patient treated concomitantly with electrohydraulic lithotripsy significant retroperitoneal hemorrhage required blood transfusion. CONCLUSIONS: Upper tract urinary calculi in patients with uncorrected bleeding diathesis can be safely managed by contemporary small caliber ureteroscopes and the holmium laser as the only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperatively correcting hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoiding electrohydraulic lithotripsy is crucial for decreasing bleeding complications in this cohort of patients.

Adult↗
PubMed1986

Postoperative anatrophic nephrolithotomy bleeding.

We reviewed 530 patients treated with anatrophic nephrolithotomy during a 14.5-year period. Significant postoperative renal bleeding occurred in 34 cases (6.4 per cent). The average postoperative blood transfusion requirement in this group was 5,279 cc. Bleeding patients were significantly older and they had worse renal function compared to the nonbleeding group. If bleeding did not begin immediately it usually started 5 to 8 days postoperatively. Bleeding dyscrasias were identified in 6 patients and correction allowed nonoperative management in 4. Epsilon aminocaproic acid was helpful only in the treatment of patients with slow, lower volume bleeding. Eight patients required 9 open renal explorations to control bleeding. Two arteriovenous fistulas and 1 false aneurysm were identified. An attempt at angiographic embolization of an arteriovenous fistula was unsuccessful. Only 1 patient required a nephrectomy (1 of 34 or 2.9 per cent) and there was no mortality. A treatment plan for this complication is described.

Adult↗
PubMed2001

von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia.

OBJECTIVE: To estimate the prevalence of von Willebrand disease and other bleeding disorders in women with and without diagnosed menorrhagia. METHODS: Women with menorrhagia were identified among members of a health maintenance organization in the southeastern United States through a computer search for appropriate International Classification of Diseases, 9th Revision codes. A random sample of members with no such code was selected as controls. The study included 121 women with menorrhagia and 123 controls. Subjects were interviewed in person, and blood was drawn for coagulation testing. Laboratory results for menorrhagia patients were compared with those in controls using race and blood type specific ranges developed from the control group. A test was considered abnormal if it exceeded two standard deviations below the control mean. RESULTS: Bleeding disorders (von Willebrand disease, factor deficiency, or a platelet abnormality) were diagnosed in 10.7% of menorrhagia patients and 3.2% of controls (P =.02). von Willebrand disease was present in eight menorrhagia patients (6.6%) and in one control (0.8%) (P =.02); separate analyses by race revealed a von Willebrand disease prevalence of 15.9% among white and 1.4% among black menorrhagia patients (P =.01). Women with bleeding disorders did not differ significantly from controls in other symptoms of bleeding. CONCLUSION: The prevalence of inherited bleeding disorders among white women with menorrhagia was substantial, consistent with European data published recently. For unknown reasons, the prevalence of von Willebrand disease was lower among black women. These findings indicate the importance of considering inherited bleeding disorders as a cause of menorrhagia.

Adolescent↗
PubMed2003

Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial.

OBJECTIVE: To compare bleeding profiles of a traditional 28-day oral contraceptive pill cycle with continuous administration. METHODS: After a 28-day run-in cycle, women were randomized to either 28-day cycles (21 active pills and a pill-free week) or continuous use of the same 20 microg ethinyl estradiol/100 microg levonorgestrel formulation for 12 study cycles (336 days). The number of bleeding and spotting days were measured by daily diary. A subset underwent cycle 1 (n = 16), and nine (n = 14) pelvic ultrasound and endometrial histology sampling. Blood pressure, weight, hemoglobin, and adverse events were measured at revisit. The sample size with 80% power to detect a 67% reduction in bleeding days required 27 subjects in each arm. RESULTS: Of the 79 subjects randomized, 28 (70%) of the 28-day cycle and 32 (82%) of the continuous-use subjects completed the entire study (P =.6). With continuous use, 49%, 68%, and 88% of women reported no bleeding during cycles 2, 6, and 12, respectively. Amenorrhea or infrequent bleeding was present in 68% of continuous users during cycles 1-3 and increased to 88% during cycles 10-12. Spotting during cycle days 1-21 increased initially with continuous use but reduced over time, and by 9 months was less than the spotting reported by cyclic users. Adverse events, blood pressure, weight, and hemoglobin findings were similar between groups. CONCLUSION: Extension of the 28-day oral contraceptive cycle to continuous use with a low-estrogen dose combination oral birth control pill resulted in significantly fewer bleeding days.

Adult↗
PubMed1998

Bleeding pattern and endometrial changes during continuous combined hormone replacement therapy. The Ogen/Provera Study Group.

OBJECTIVE: To establish the optimum oral daily dose of micronized medroxyprogesterone acetate, given in combination with a fixed oral dose of estrone (E1) sulfate as hormone replacement therapy, that provides endometrial protection and induces cessation of vaginal bleeding. METHODS: This multicenter, randomized, double-blind study was conducted for 2 years. Five hundred sixty-eight postmenopausal women were randomized to take E1 sulfate 1.25 mg daily and one of three doses of medroxyprogesterone acetate (2.5, 5, or 10 mg) daily. Any vaginal bleeding was recorded by patients in a daily diary, and endometrial biopsies were performed at entry into the study and at 3, 12, and 24 months. RESULTS: Forty-two percent of all women reported some bleeding at month 3 of therapy. However, by month 6, 76.5, 80.1, and 80.9% of women were amenorrheic in the 2.5-, 5-, and 10-mg medroxyprogesterone acetate groups, respectively. Over time, the percentage of women with no bleeding increased in each group, and by 24 months 91.5, 89.9, and 94.3% were amenorrheic in the 2.5- and 10-mg medroxyprogesterone acetate groups, respectively. Approximately 10% of women continue to have some bleeding, regardless of the dose of medroxyprogesterone acetate. There were no statistically significant differences in the number of women with bleeding at any time point between the three groups. There were no cases of endometrial hyperplasia reported in the study population over the 2 years. CONCLUSION: All three studied doses of medroxyprogesterone acetate, given in combination with 1.25 mg of E1 sulfate, provide adequate endometrial protection and render approximately 80% of women amenorrheic by 6 months of therapy.

Adult↗
PubMed1979

Angiography in chronic/recurrent gastrointestinal bleeding: a nine year study.

Undiagnosed chronic/recurrent gastrointestinal bleeding, as defined, is a severe problem to those afflicted, both physically and psychologically as well as socioeconomically. During the past nine years, 60 such patients received aortography and panvisceral arteriography (that is, celiac, superior mesenteric, and inferior mesenteric arteriography) in a search for the lesions that may be responsible for the bleeding. Results of angiography were "positive" in 26 patients for a diagnostic yield of 43 per cent. Fifteen of the 26 patients with positive angiographic findings demonstrated arteriovenous malformations of the gastrointestinal tract. Two separate lesions were identified in three patients. This series is compared with other published series of angiography for chronic gastrointestinal bleeding. One difference from the other series is the demonstration of three patients with arteriovenous malformation of the gastric antrum. The diagnostic angiographic features of this condition are presented, along with the interestng finding of état mammelonné in two of the three patients. Another difference from the other series is the demonstration of four arteriovenous malformations involving the left side of the colon, whereas other series report none in this location. One possible explanation for this descrepancy is our routine use of inferior mesenteric arteriography in all cases of chronic gastrointestinal bleeding. Ten arteriovenous malformations of the colon are reported along with a review of the angiographic diagnostic features in this condition. The precise incidence of false-positive and false-negative diagnoses is unknown since surgery was not performed on all patients. However, each patient studied represented a total failure, by traditional diagnostic studies, to determine the cause of bleeding. The incidence of positive findings with angiography (43 per cent) in patients with undiagnosed chronic/recurrent gastrointestinal bleeding is sufficient to encourage the continued use of panvisceral arteriography in this condition.

Adult↗
PubMed1991

Gastrointestinal tract bleeding. Common dilemmas in management.

An accurate diagnosis is the prerequisite in defining gastrointestinal tract bleeding at any level. Flexible endoscopy is the mainstay of diagnosis, and, particularly in the colon, it may be used as a therapeutic tool in conjunction with fulguration. Radionuclide scanning and arteriography have a place in diagnosis when endoscopy fails. The management of variceal bleeding is, in the main, injection sclerotherapy, operation being reserved for patients who rebleed after injection sclerotherapy or in whom a long-term course of sclerotherapy fails. The management of patients with colonic bleeding depends on the accurate pinpointing of bleeding before operation followed by limited excision of the located bleeding site. Some sources of lower gastrointestinal-tract bleeding can be treated by therapeutic endoscopy.

Endoscopy, Gastrointestinal↗
PubMed2003

Roux-en-Y bleeding after living donor liver transplantation: a novel technique for surgical treatment.

Upper gastrointestinal bleeding (GIB) is one of the most common gastroenterologic complications following liver transplantation. The aim of this study is to define the prevalence of GIB due to Roux- en Y (R-Y) enteral anastomoses after living donor liver transplantation (LDLT) and recommend an anastomotic technique for easy surgical intervention. Ninety-five patients underwent 96 LDLT from June 1999 through January 2003. R-Y biliary reconstruction was employed in 43 patients. Anastomoses were end-to-side (ES) in the first 25 patients and side-to-side (SS) type in the last 18 patients. GIB occurred in 13 patients (30%). The R-Y anastomotic line was shown to be the bleeding site in 10 patients. Anastomoses were in ES fashion in 7 of 10 patients (70%). In other words 28% of ES and 17% of SS anastomoses displayed a bleeding episode after LDLT. Four patients required surgical intervention (Three ES, one SS), namely an operative rate of 9%. The type of the jejunojejunostomy, the UNOS or Child-Pugh scores, the presence of preexisting portal hypertension, the duration of portal vein clamping, the GRWR of patients, revealed no statistical significant difference between bleeding and non- bleeding patients. Although statistical analyses did not reveal any significant difference (P =.47), GIB was higher among patients with an ES type of anastomoses. As a result we recommend a jejunojejunostomy in SS fashion on the antimesenteric borders of the jejunal segments with a 3-4 cm blind intestinal segment. The surgical procedure for R-Y bleeding may then be performed without disrupting the jejunojejunostomy.

Anastomosis, Roux-en-Y↗
PubMed2000

Prospective study on the application of the Baveno II Consensus Conference criteria in patients with cirrhosis and gastrointestinal bleeding.

BACKGROUND/AIMS: This study aimed to evaluate the Baveno II criteria defining key events in variceal bleeding. METHODS: These criteria were applied to 196 patients with cirrhosis admitted for upper gastrointestinal bleeding due to portal hypertension and enrolled in a trial. Blood pressure, heart rate, hematocrit and clinical signs of upper digestive tract hemorrhage were recorded for 5 days. The blind overall clinical judgment of hemodynamic stability was recorded separately by the Steering Committee. RESULTS: The evaluation of several hemodynamic criteria was left to the judgment of the clinician. The first time point for the control of bleeding, fixed at 6 h after admission, was impractical since 13% of the patients had not yet received specific treatment. The independent judgment did not agree in 38% of 82 cases without control of bleeding. In 15% of cases this was due to tachycardia. Calculation of several judgment criteria was not defined in the Baveno II criteria: survival without bleeding at 5 days, transfusion rate, and length of hospital stay. CONCLUSIONS: Although the Baveno II criteria have improved the definitions of key events, the criteria are hampered by limits such as false positive criteria of failure to control bleeding. We make several proposals for improvement.

Blood Transfusion↗
PubMed1988

Nadolol for prophylaxis of gastrointestinal bleeding in patients with cirrhosis. A randomized trial.

This controlled trial was designed to evaluate the prophylactic effect of nadolol on gastrointestinal bleeding in cirrhotic patients with large oesophageal varices who had never bled. Nadolol or placebo was given randomly to two groups of 53 patients. The percentage of patients free of gastrointestinal bleeding 1 year after inclusion in the study was 83 +/- 6% (mean +/- S.D.) in the nadolol group and 80 +/- 6% in the placebo group. In the nadolol and placebo groups, 40 and 47 patients, respectively, were compliant, i.e., took nadolol or placebo continuously. The percentage of patients who were free of bleeding 1 year after inclusion was 97 +/- 3% in the subgroup of compliant nadolol patients. This percentage was significantly higher than that of patients who were free of bleeding in the placebo group (P less than 0.03) as well as in the subgroup of compliant placebo patients (77 +/- 6%; P less than 0.02). We concluded that, although there was no overall significant effect of nadolol on the risk of bleeding in cirrhotic patients in good condition with large oesophageal varices, this study suggests that nadolol reduced the risk of bleeding in compliant patients.

Clinical Trials as Topic↗
PubMed1996

Non-steroidal anti-inflammatory drugs and variceal bleeding: a case-control study.

BACKGROUND/AIM: The aim of this case-control study was to assess the risk of bleeding from esophageal varices associated with aspirin and non-steroidal anti-inflammatory drug consumption. METHODS: Between January 1992 and May 1994, patients admitted for bleeding from esophageal or gastric lesions related to portal hypertension were matched with a control patient of the same age and sex, who was free of gastrointestinal bleeding. A structured interview was conducted with the cases and controls to determine drug consumption during the 2 weeks preceding admission. Fifty-nine cases and 59 controls were recruited. RESULTS/CONCLUSIONS: Use of aspirin was more prevalent among the cases than the controls (odds ratio 3.81; 95% confidence interval 1.36-11.64; p = 0.004). This difference remained significant in the subgroups of patients with a first episode of variceal bleeding (odds ratio 3.9; 95% confidence interval 1.2-13.9, p = 0.01), but was not significant in the subgroups of patients with a recurrent episode of variceal bleeding. The use of aspirin was associated with a high risk of a first episode of variceal bleeding, suggesting that patients with portal hypertension should avoid taking these drugs.

Adult↗
PubMed2003

[Role of capsule endoscopy in patients with obscure digestive bleeding].

INTRODUCTION: The identification and localization of lesions located in the small intestine that may provoke gastrointestinal bleeding is difficult. OBJECTIVE: To analyze the role of capsule endoscopy in patients with obscure digestive bleeding and to compare the results obtained with those of enteroscopy. PATIENTS AND METHODS: Twenty-one patients with obscure digestive bleeding (acute hemorrhage in 11 patients and chronic anemia in 10) and normal total fibergastroscopy and fibrocolonoscopy were analyzed. All patients were instructed to receive the capsule and enteroscopy was performed after 1 week. The results obtained using both procedures were independently compared and without knowledge of the results of the other procedure. RESULTS: Visualization of findings potentially related to gastrointestinal bleeding was significantly greater (p < 0.05) using the capsule (14 of 21 patients [66%]) than with enteroscopy (4 of 21 patients [19%]). The most frequent lesions were angiodysplasias and jejunal ulcers. In 4 patients, the results obtained led to a change in therapeutic approach. One patient with jejunal stenosis and two with ileal lesions underwent surgery, which confirmed the diagnosis of Crohn's disease in the first patient and carcinoid tumor in the remaining two. Another patient with evidence of angiodysplasia and bleeding was effectively treated with Argon-beam during enteroscopy. The capsule was well tolerated in all patients. In the patient with jejunal stenosis, capsule extraction was required during surgery. CONCLUSIONS: Capsule endoscopy allows adequate visualization of the entire small intestine and its diagnostic efficacy is greater than that of enteroscopy in patients with obscure digestive bleeding. Moreover, in our series, this procedure allowed modification of therapy in one out of every five patients.

Adolescent↗