Gastrointestinal Bleeding Diagnosed by Capsule Endoscopy – A Change towards More Patients with Bleeding-related Drugs

Main Article Content

Alexander Hann
Louisa Graf
Thomas Seufferlein
Eugen Zizer

Abstract

Background: Video capsule endoscopy (VCE) is the standard procedure for a work-up of a suspected bleeding source after negative gastroscopy and colonoscopy. Popularity of this procedure increased in the last decade. In this work we aimed to identify the changes in patient characteristics and how those changes influence bleeding related findings. In particular the assumed higher risk of gastrointestinal bleeding of the new oral anticoagulants (nOAC) compared to phenprocoumon was of interest.

Methods: Consecutive VCE examinations performed at our center from January 2004 to March 2018 were identified retrospectively. Baseline characteristics of the patients, VCE results and treatment that was initiated were analyzed.

Results: 560 VCE were included in the analysis. The rate of VCE per month increased from 2.3/month in the period of January 2004 – December 2012 up to 5.0/month in January 2013 – March 2018. Accompanied by this increase the examined patients suffered from significantly more comorbidities (72 vs. 82%, p 0.001) and used a higher number of bleeding-related drugs (47 vs. 66%, p <0.001), especially nOACs. Age above 65 and bleeding-related drugs were significantly associated with angiodysplasias found on VCE examinations. NOACs and phenprocoumon showed no difference in their correlation to angiodysplasias.

Conclusion: This single center retrospective analysis revealed a steep increase in VCE examinations over the last years with an increase in the prevalence of comorbidities and the use of bleeding-related drugs. Interestingly, use of both nOACs and phenprocoumon did not result in a significant higher rate of angiodysplasias in the VCE.

Keywords:
Video capsule endoscopy, small bowel bleeding, nOAC, VCE.

Article Details

How to Cite
Hann, A., Graf, L., Seufferlein, T., & Zizer, E. (2020). Gastrointestinal Bleeding Diagnosed by Capsule Endoscopy – A Change towards More Patients with Bleeding-related Drugs. Journal of Advances in Medicine and Medical Research, 32(19), 1-10. https://doi.org/10.9734/jammr/2020/v32i1930662
Section
Original Research Article

References

Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017;152(3):497–514.

Rondonotti E, Spada C, Adler S, May A, Despott EJ, Koulaouzidis A, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. 2018;50(4):423–46.

Kunihara S, Oka S, Tanaka S, Otani I, Igawa A, Nagaoki Y, et al. Third-generation capsule endoscopy outperforms second-generation based on the detectability of esophageal varices. Gastroenterol Res Pract. 2016;2016:9671327.

Tontini GE, Wiedbrauck F, Cavallaro F, Koulaouzidis A, Marino R, Pastorelli L, et al. Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos). Gastrointest Endosc. 2017;85(2):401-408.e2.

Monteiro S, de Castro FD, Carvalho PB, Moreira MJ, Rosa B, Cotter J. PillCam® SB3 capsule: Does the increased frame rate eliminate the risk of missing lesions? World J Gastroenterol. 2016;22(10):3066–8.

Hosoe N, Watanabe K, Miyazaki T, Shimatani M, Wakamatsu T, Okazaki K, et al. Evaluation of performance of the Omni mode for detecting video capsule endoscopy images: A multicenter randomized controlled trial. Endosc Int Open. 2016;4(8):E878-882.

Subramanian SK, Lourenço CB, Chilingaryan G, Sveistrup H, Levin MF. Arm motor recovery using a virtual reality intervention in chronic stroke: Randomized control trial. Neurorehabil Neural Repair. 2013;27(1):13–23.

Olano C, Pazos X, Avendaño K, Calleri A, Ketzoian C. Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia. Endosc Int Open. 2018;6(6):E688–93.

Esaki M, Matsumoto T, Yada S, Yanaru-Fujisawa R, Kudo T, Yanai S, et al. Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci. 2010;55(8):2294–301.

Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254–65.

Moukarbel GV, Signorovitch JE, Pfeffer MA, McMurray JJV, White HD, Maggioni AP, et al. Gastrointestinal bleeding in high risk survivors of myocardial infarction: The VALIANT Trial. Eur Heart J. 2009;30(18):2226–32.

Brigden ML. When bleeding complicates oral anticoagulant therapy. How to anticipate, investigate, and treat. Postgrad Med. 1995;98(3):153–4,159–62,164–5, passim.

Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170(16):1433–41.

Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62.

Miller CS, Dorreen A, Martel M, Huynh T, Barkun AN. Risk of gastrointestinal bleeding in patients taking non-vitamin K antagonist oral anticoagulants: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-1683.e3.

Saurin J-C, Delvaux M, Gaudin J-L, Fassler I, Villarejo J, Vahedi K, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: Blinded comparison with video push-enteroscopy. Endoscopy. 2003;35(7):576–84.

Song JH, Hong SN, Chang KD, Jeon RS, Kim J-O, Kim J, et al. The etiology of potential small-bowel bleeding depending on patient’s age and gender. United European Gastroenterol J. 2018;6(8):1169–78.

Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.

Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.

Andresen D. Deutscher Herzbericht 2018. Deutsche Herzstiftung (Hg.); 2018.

Nennstiel S, Machanek A, von Delius S, Neu B, Haller B, Abdelhafez M, et al. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United European Gastroenterol J. 2017;5(8):1129–35.

Li L, Chen C, Li Y, Zhang B. The role of capsule endoscopy in the diagnosis and treatment of obscure gastrointestinal bleeding in older individuals. Eur J Gastroenterol Hepatol. 2016;28(12):1425–30.

Brito HP, Ribeiro IB, de Moura DTH, Bernardo WM, Chaves DM, Kuga R. Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis. World J Gastrointest Endosc. 2018;10(12):400-421.

Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11–21.

Jairath V, Kahan BC, Gray A, Doré CJ, Mora A, James MW, et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): A pragmatic, open-label, cluster randomised feasibility trial. Lancet. 2015;386(9989):137–44.

Pérez-Cuadrado-Robles E, Yung DE, Koulaouzidis A. Angioectasias in the elderly: Interpreting the data. United European Gastroenterol J. 2018;6(5): 791.Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017;152(3):497–514.

Rondonotti E, Spada C, Adler S, May A, Despott EJ, Koulaouzidis A, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. 2018;50(4):423–46.

Kunihara S, Oka S, Tanaka S, Otani I, Igawa A, Nagaoki Y, et al. Third-generation capsule endoscopy outperforms second-generation based on the detectability of esophageal varices. Gastroenterol Res Pract. 2016;2016:9671327.

Tontini GE, Wiedbrauck F, Cavallaro F, Koulaouzidis A, Marino R, Pastorelli L, et al. Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos). Gastrointest Endosc. 2017;85(2):401-408.e2.

Monteiro S, de Castro FD, Carvalho PB, Moreira MJ, Rosa B, Cotter J. PillCam® SB3 capsule: Does the increased frame rate eliminate the risk of missing lesions? World J Gastroenterol. 2016;22(10):3066–8.

Hosoe N, Watanabe K, Miyazaki T, Shimatani M, Wakamatsu T, Okazaki K, et al. Evaluation of performance of the Omni mode for detecting video capsule endoscopy images: A multicenter randomized controlled trial. Endosc Int Open. 2016;4(8):E878-882.

Subramanian SK, Lourenço CB, Chilingaryan G, Sveistrup H, Levin MF. Arm motor recovery using a virtual reality intervention in chronic stroke: Randomized control trial. Neurorehabil Neural Repair. 2013;27(1):13–23.

Olano C, Pazos X, Avendaño K, Calleri A, Ketzoian C. Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia. Endosc Int Open. 2018;6(6):E688–93.

Esaki M, Matsumoto T, Yada S, Yanaru-Fujisawa R, Kudo T, Yanai S, et al. Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci. 2010;55(8):2294–301.

Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254–65.

Moukarbel GV, Signorovitch JE, Pfeffer MA, McMurray JJV, White HD, Maggioni AP, et al. Gastrointestinal bleeding in high risk survivors of myocardial infarction: The VALIANT Trial. Eur Heart J. 2009;30(18):2226–32.

Brigden ML. When bleeding complicates oral anticoagulant therapy. How to anticipate, investigate, and treat. Postgrad Med. 1995;98(3):153–4,159–62,164–5, passim.

Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170(16):1433–41.

Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62.

Miller CS, Dorreen A, Martel M, Huynh T, Barkun AN. Risk of gastrointestinal bleeding in patients taking non-vitamin K antagonist oral anticoagulants: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-1683.e3.

Saurin J-C, Delvaux M, Gaudin J-L, Fassler I, Villarejo J, Vahedi K, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: Blinded comparison with video push-enteroscopy. Endoscopy. 2003;35(7):576–84.

Song JH, Hong SN, Chang KD, Jeon RS, Kim J-O, Kim J, et al. The etiology of potential small-bowel bleeding depending on patient’s age and gender. United European Gastroenterol J. 2018;6(8):1169–78.

Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.

Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.

Andresen D. Deutscher Herzbericht 2018. Deutsche Herzstiftung (Hg.); 2018.

Nennstiel S, Machanek A, von Delius S, Neu B, Haller B, Abdelhafez M, et al. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United European Gastroenterol J. 2017;5(8):1129–35.

Li L, Chen C, Li Y, Zhang B. The role of capsule endoscopy in the diagnosis and treatment of obscure gastrointestinal bleeding in older individuals. Eur J Gastroenterol Hepatol. 2016;28(12):1425–30.

Brito HP, Ribeiro IB, de Moura DTH, Bernardo WM, Chaves DM, Kuga R. Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis. World J Gastrointest Endosc. 2018;10(12):400-421.

Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11–21.

Jairath V, Kahan BC, Gray A, Doré CJ, Mora A, James MW, et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): A pragmatic, open-label, cluster randomised feasibility trial. Lancet. 2015;386(9989):137–44.

Pérez-Cuadrado-Robles E, Yung DE, Koulaouzidis A. Angioectasias in the elderly: Interpreting the data. United European Gastroenterol J. 2018;6(5): 791.