Capsule Endoscopy or Mesenteric Angiogram in Patients With Overt Gastrointestinal Bleeding (GIB) of Obscure Origin

Capsule Endoscopy or Mesenteric Angiogram in Patients With Overt Gastrointestinal Bleeding of Obscure Origin: A Randomized Study

To compare the diagnostic yield of mesenteric angiogram with CE in patients with active obscure GIB.

Gastrointestinal bleeding (GIB) of obscure origin is a common conditions resulting in recurrent hospitalization and extensive investigations. Mesenteric angiogram is one of the standard radiological investigations for GIB of obscure origin, and its diagnostic yield ranged from 40-80%. Capsule endoscopy (CE) is a newly available investigation for small bowel examination, especially in bleeding of obscure origin. The diagnostic yield is particularly high in patients with ongoing bleeding. This is a prospective randomized study to compare the diagnostic yield of mesenteric angiogram with CE in patients with overt GIB of obscure origin. The results will help to define the optimal management strategy for this group of patients.

Inclusion Criteria:

• All patients admitted to PWH medical or surgical wards with melena or hematochezia in whom OGD and colonoscopy fail to identify site of bleeding.
• Normal or non-diagnostic OGD and colonoscopy
• Informed consent
• Patients presented with shock will be resuscitated for urgent endoscopy

Exclusion Criteria:

• Patients remained in shock despite resuscitation.
• Moribund patients
• Terminal malignancy
• Presence of pacemaker or ICD
• Suspected or confirmed intestinal obstruction
• Swallowing difficulties
• Renal failure that preclude angiographic examination
• Pregnancy
• Age <18
• Refused consent