An Unusual Cause of Obscure Gastrointestinal Bleeding Using an Abdominal CT Scan with Contrast: A Case Report of Small Intestinal GIST at the Duodenojejunal Junction

Background/Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. However, they only constitute approximately 1% of all primary GI tumors. GISTs are most commonly found in the stomach (60% - 70%) and small intestine (20% - 30%). Colorectal (5%) and esophageal (Presentation of Clinical Case: A 33-year-old male, presented to the emergency department for melena and dizziness in January 2023. He was hospitalized several times for anemia with multiple blood transfusions since 2017 and never made a final diagnosis. From 2017 to 2019 he underwent esophagogastroduodenoscopy (EGD) and ileocolonoscopy 3 times which always gave a negative result. At this time, laboratory results showed microcytic anemia with hemoglobin 7 g/dl. We performed an EGD and ileocolonoscopy again but still showed negative then we did an abdominal CT scan with contrast with demonstrated a solid exophytic hypervascular mass measuring 62 × 38 × 73 mm that appeared to arise from the duodenojejunal junction. The surgeon decided to proceed with surgical resection of the mass and the histopathologist confirmed the diagnosis of GISTs. The patients were discharged in stable condition after the surgery and followed up every 3 - 6 months with the oncologist. Conclusion: The presentation of chronic GI bleeding with negative results in EGD and ileocolonoscopy, and abdominal CT scan with contrast could provide useful information in order to obtain a diagnosis of bleeding GISTS. Teamwork is the cornerstone in the management of the case. After the resection of the mass by the surgeon, the histopathologist allowed us to establish the definitive diagnosis and the oncologist will follow up with this patient in order to prevent the relapse of symptoms.

Diagnosis of obscure gastrointestinal bleeding by intraoperative enteroscopy in 81 consecutive patients

AIM： To analyze the results and complications of intraoperative enteroscopy （IOE） by investigating a series of selected patients with bleeding suspected to originate from the small intestine. METHODS： Eighty-one patients （mean age： 65 years） including 40 males （49.4%） and 41 females （50.6%） with obscure gastrointestinal bleeding underwent IOE between 1990 and 2004. The patients were identified from a database and data were selected from the patients＇ charts retrospectively. All the patients had undergone at least one non-diagnostic esophagogastroduodenoscopy, colonoscopy, standard enteroscopy and a negative abdominal ultrasound scan before IOE. RESULTS： The median minimal hemoglobin level in the patients was 59＋15g/L and 72.8% of the patients required transfusion of packed erythrOoltes previously. A bleeding source was detected in 68 （84%） of the patients during IOE. Angiodysplasiae were found in 44 patients （54.3%） and 9 patients （11.1%） were affected by ulcers in the small intestine. A tumor in the small intestine was detected in another 6 patients. The treatment consisted of argon-plasma-coagulation, surgical suture or limited resection in most of the patients. CONCLUSION： Intra-operative enteroscopy is still used for the diagnosis of suspected small bowel bleeding. Recent developments such as wireless capsule endoscopy and double balloon enteroscopy, may lead to the replacement of IOE in the future.

Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered during DBE.RESULTS: There were 228 (150 antegrade and 78 retrograde) DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD) of the patients was 62 ± 16 years old. There were 94 females (52.5%). The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6%) had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs); 27 (15.1%) had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions.CONCLUSION: A significant proportion of patients (24.6%) had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

Double-balloon enteroscopy for obscure gastrointestinal bleeding: A single center experience in China

AIM: To evaluate the diagnostic value of double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB). METHODS: The data about 75 OGIB patients who underwent DBE in January 2007-June 2009 in our hospital were retrospectively analyzed. RESULTS: DBE was successfully performed in all 75 patients without complication. Of the 75 patients, 44 (58.7%) had positive DBE findings, 22 had negative DBE findings but had potential bleeding at surgery and capsule endoscopy, etc . These 66 patients were finally diagnosed as OGIB which was most commonly caused by small bowel tumor (28.0%), angiodysplasia (18.7%) and Crohn’s disease (10.7%). Lesions occurred more frequently in proximal small bowel than in distal small bowel (49.3% vs 33.3%, P = 0.047). CONCLUSION: DBE is a safe, effective and accurate procedure for the diagnosis of OGIB.

Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding

AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ndings.RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding

AIMTo define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODSSmall-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.RESULTSWe retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).CONCLUSIONIn this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.

Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding

AIM: To investigate the clinical differences between small intestinal injuries in low-dose aspirin (LDA) users and in non-steroidal anti-inflammatory drug (NSAID) users who were examined by capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB).

Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding

AIM:To investigate the potential benef it of Fujinon in-telligent chromo endoscopy(FICE)-assisted small bowel capsule endoscopy(SBCE)for detection and character-ization of small bowel lesions in patients with obscure gastroenterology bleeding(OGIB).METHODS:The SBCE examinations(Pillcam SB2,Giv-en Imaging Ltd)were retrospectively analyzed by two GI fellows(observers)with and without FICE enhance-ment.Randomization was such that a fellow did not assess the same examination with and without FICE enhancement.The senior consultant described f indings as P0,P1 and P2 lesions(non-pathological,intermedi-ate bleed potential,high bleed potential),which were considered as reference f indings.Main outcome mea-surements:Inter-observer correlation was calculated using kappa statistics.Sensitivity and specif icity for P2 lesions was calculated for FICE and white light SBCE.RESULTS:In 60 patients,the intra-class kappa cor-relations between the observers and reference f indings were 0.88 and 0.92(P2),0.61 and 0.79(P1),for SBCE using FICE and white light,respectively.Overall 157 le-sions were diagnosed using FICE as compared to 114 with white light SBCE(P = 0.15).For P2 lesions,the sensitivity was 94% vs 97% and specif icity was 95% vs 96% for FICE and white light,respectively.Five(P2 le-sions)out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE.Significantly more P0 lesions were diagnosed when FICE was used as compared to white light(39 vs 8,P < 0.001).CONCLUSION:FICE was not better than white light for diagnosing and characterizing signif icant lesions on SBCE for OGIB.FICE detected signif icantly more non-pathological lesions.Nevertheless,some vascular le-sions could be more accurately characterized with FICE as compared to white light SBCE.

Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding

AIM： To assess the diagnostic success and outcome among patients with obscure gastrointestinal bleeding who underwent total enteroscopy with double-balloon endoscopy.

Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

AIMTo determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield.METHODSRetrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center.RESULTSFour hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.CONCLUSIONDBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.

Yield of capsule endoscopy in obscure gastrointestinal bleeding:A comparative study between premenopausal and menopausal women

AIM To evaluate differences in capsule endoscopy(CE) performed in the setting of obscure gastrointestinal bleeding(OGIB) among premenopausal women(PMW) and menopausal women(MW).METHODS Retrospective, single-center study, including female patients submitted to CE in the setting of OGIB between May 2011 and December 2016. Patients were divided into 2 groups according to age, considering fertile age as ≤ 55 years and postmenopausal age as > 55 years. The diagnostic yield(DY), the rebleeding rate and the time to rebleed were evaluated and compared between groups. Rebleeding was defined as a drop of Hb > 2 g/dL or need for transfusional support or presence of melena/hematochezia.RESULTS A hundred and eighty three female patients underwent CE for OGIB, of whom 30.6%(n = 56) were PMW and 69.4%(n = 127) were MW. The DY was 30.4% in PMW and 63.8% in MW. The most common findings were angiodysplasias in both groups(PMW: 21.4%, MW: 44.9%)(P = 0.003). In PMW, only 1.8% required therapeutic endoscopy. In 17.3% of MW, CE findingsled to additional endoscopic treatment. Rebleeding at 1, 3 and 5 years in PMW was 3.6%, 10.2%, 10.2% and 22.0%, 32.3% and 34.2% in MW. Postmenopausal status was significantly associated with higher DY(P < 0.001), TY(P = 0.003), rebleeding(P = 0.031) and lower time to rebleed(P = 0.001).CONCLUSION PMW with suspected OGIB are less likely to have significant findings in CE. In MW DY, need for endoscopic treatment and rebleeding were significantly higher while time to rebleed was lower.

Prediction models for recurrence in patients with small bowel bleeding

Obscure gastrointestinal bleeding(OGIB)has traditionally been defined as gastrointestinal bleeding whose source remains unidentified after bidirectional endoscopy.OGIB can present as overt bleeding or occult bleeding,and small bowel lesions are the most common causes.The small bowel can be evaluated using capsule endoscopy,device-assisted enteroscopy,computed tomography enterography,or magnetic resonance enterography.Once the cause of smallbowel bleeding is identified and targeted therapeutic intervention is completed,the patient can be managed with routine visits.However,diagnostic tests may produce negative results,and some patients with small bowel bleeding,regardless of diagnostic findings,may experience rebleeding.Predicting those at risk of rebleeding can help clinicians form individualized surveillance plans.Several studies have identified different factors associated with rebleeding,and a limited number of studies have attempted to create prediction models for recurrence.This article describes prediction models developed so far for identifying patients with OGIB who are at greater risk of rebleeding.These models may aid clinicians in forming tailored patient management and surveillance.

Distribution of bleeding gastrointestinal angioectasias in a Western population

AIM:To define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy. METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1, 2007 and October 1, 2010. The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia, angiodysplasia, or arteriovenous malformation. Of these cases, chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy, colonoscopy and small bowel capsule endoscopy within the past three years. Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis. Thirty-five patients with confirmed, bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis. RESULTS:A total of 127 cases were reviewed. Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia. The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos. This anal- ysis excluded 26 additional cases due to insufficient records/images for review, incomplete capsule examination, poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review. Thirty-five cases met criteria for final analysis. All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher. Twenty of 35 patients were taking aspirin (81 mg or 325 mg), clopidogrel, and/or warfarin, with 8/20 on combination therapy. The number and location of angioectasis was documented for each case. Lesions were then classified into the following segments of the gastrointestinal tract:esophagus, stomach, duodenum, jejunum, ileum, right colon and left colon. The location of lesions within the small bowel observed by capsule endoscopy was generally defined by percentage of total small bowel transit time with times of 0%-9%, 10%-39%, and 40%-100% corresponding to the duodenum, jejunum and ileum, respectively. Independent review of complete capsule studies allowed for deviation from this guideline if capsule passage was delayed in one or more segments. In addition, the location and number of angioectasias observed in the small bowel was further modified or confirmed by subsequent device-assisted enteroscopy (DAE) performed in the 83% of cases. In our study population, angioectasias were most commonly found in the jejunum (80%) followed by the duodenum (51%), stomach (22.8%), and right colon (11.4%). Only two patients were found to have angioectasias in the ileum (5.7%). Twenty-one patients (60%) had angioectasias in more than one location.CONCLUSION:Patients being considered for endoscopic ablation of symptomatic angioectasias should undergo push enteroscopy or anterograde DAE and reinspection of the right colon.

Application of double-balloon enteroscopy in jejunal diverticular bleeding

AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.

Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding

AIM:To identify patients' characteristics associated with double balloon endoscopy(DBE)outcomes in investigation of obscure gastrointestinal bleeding(OGIB).METHODS:Retrospective study performed at an academic tertiary referral center.Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.RESULTS:We included fifty-five DBE between August 2010 and April 2012.The mean age of the sample was 67 with 32 males(58.2%).Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy.Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio(OR):13.72,P=0.008],absence of blood transfusions within a year of the DBE(OR:7.16,P=0.03)and absence of ulcers or arteriovenous malformations(AVMs)on prior esophagogastroduodenoscopy(EGD)or colonoscopy(OR:19.30,P=0.033).Non-therapeutic DBE was associated with performing two or more DBE per day(OR:18.579,P=0.007),gastrointestinal bleeding episode within a week of the DBE(OR:11.48,P=0.003),fewer blood transfusion requirements prior to DBE(OR:4.55,P=0.036)and absence of ulcers or AVMs on prior EGD or colonoscopy(OR:8.47,P=0.027).CONCLUSION:Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements,previous endoscopic findings and possibly endoscopist fatigue.

Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

Wireless capsule endoscopy(CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal(GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.

Effect of small bowel transit time on accuracy of video capsule endoscopy in evaluating suspected small bowel bleeding

BACKGROUND Obscure small bowel bleeding is defined as gastrointestinal bleeding(GIB)that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy(VCE)being the next gold standard step for evaluation.Small bowel transit time(SBTT)is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.AIM To determine if SBTT within the VCE study,correlates to overall detection of obscure small bowel bleeds.Furthermore,we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.METHODS This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center,Philadelphia,between 2015 and 2019.Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB.Patients with incomplete VCEs,poor preparation,or with less than 6 mo of follow up were excluded.A re-bleeding event was defined either as overt or occult within a 6-mo timeframe.Overt rebleeding was defined as Visible melena or hematochezia with>2 gm/dL drop in hemoglobin defined an overt re-bleeding event;whereas an unexplained>2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.RESULTS Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008.However,the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.CONCLUSION In terms of SBTT and association with accuracy of VCE finding a bleeding focus,220 min was found to be adequate transit time to accurately find a bleeding focus,when present.It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.

Three cases of jejunal tumors detected by standard upper gastrointestinal endoscopy:A case series

BACKGROUND In patients with obscure gastrointestinal bleeding,re-examination with standard upper endoscopes by experienced physicians will identify culprit lesions in a substantial proportion of patients.A common practice is to insert an adult-sized forward-viewing endoscope into the second part of the duodenum.When the endoscope tip enters after the papilla,which is a marker for the descending part of the duodenum,it is difficult to endoscopically judge how far the duodenum has been traversed beyond the second part.CASE SUMMARY We experienced three cases of proximal jejunal masses that were diagnosed by standard upper gastrointestinal endoscopy and confirmed with surgery.The patients visited the hospital with a history of melena;during the initial upper gastrointestinal endoscopy and colonoscopy,the bleeding site was not confirmed.Upper gastrointestinal bleeding was suspected;thus,according to guidelines,upper endoscopy was performed again.A hemorrhagic mass was discovered in the small intestine.The lesion of the first patient was thought to be located in the duodenum when considering the general insertion depth of a typical upper gastrointestinal endoscope;however,during surgery,it was confirmed that it was in the jejunum.After the first case,lesions in the second and third patients were detected at the jejunum by inserting the standard upper endoscope as deep as possible.CONCLUSION The deep insertion of standard endoscopes is useful for the diagnosis of obscure gastrointestinal bleeding.

Fields of applications,diagnostic yields and findings of OMOM capsule endoscopy in 2400 Chinese patients

AIM:To retrospectively analyze the fields of application,diagnostic yields and findings of OMOM capsule endoscopy in Chinese patients.METHODS:A database including 2400 Chinese patients who received OMOM capsule endoscopy in 27 endoscopy centers in China was retrieved from the Jianshan Science and Technology Ltd.OMOM capsule endoscopy database.The patient's age,gender,fields of application,the potentially relevant findings,pyloric transit time(PTT),small bowel transit time(SBTT),and complete small-bowel examination rate(CSER) were recorded and analyzed.RESULTS:Two thousand four hundred patients aged 9-91 years(mean,49 years),of whom 1510 were males(62.9%),underwent 2400 OMOM capsule endoscopy procedures.One thousand two hundred and thirty two(51.3%) were referred with obscure gastrointestinal bleeding(OGIB),642(26.8%) with abdominal pain,and 223(9.3%) with chronic diarrhea.The overall diagnostic yield was 47.7%(1144/2400).The diagnostic yield of OMOM capsule endoscopy in OGIB subgroup was much higher than in the non-OGIB subgroup(62.4% vs 32.1%,P<0.001).The most common findings of the small bowel in Chinese patients with OGIB were arteriovenous malformation(28.1%) and tumors(18.9%).There was no significant difference in the diagnostic yield between the male and female patients with OGIB.However,the diagnostic yield in patients aged more than 60 was higher than in patients aged less than 60(69.8% vs 58.9%,P<0.001).The median PTT was 41 min(range:1-544 min) and the mean SBTT was 247.2 ± 88.9 min.The overall CSER was 86.8%.CONCLUSION:The OMOM capsule endoscopy is a valuable tool for small bowel evaluation with good overall diagnostic yield and CSER.

Capsule endoscopy in neoplastic diseases

Until recently, diagnosis and management of small-bowel tumors were delayed by the diffi culty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High- quality images of the small-bowel mucosa may be captured and small and ? at lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion’s endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push- and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings,remains to be determined through carefully-designed studies.