VCE, CTE both useful in diagnosis of small bowel bleeding
Both video capsule endoscopy (VCE) and computed tomography enterography (CTE) complement each other in the diagnosis of potential small bowel (SB) bleeding, suggests a recent study. Clinicians should consider CTE when VCE is negative.
In addition, severe bleeding and age <40 years independently predict a higher diagnostic yield for CTE, according to researchers.
In this study that compared the efficacy of VCE with CTE and identified factors predictive of a high diagnostic yield for CTE, the authors prospectively enrolled consecutive patients with potential SB bleeding. Participants underwent VCE and CTE within a 1-week interval.
Surgery or enteroscopy was utilized to achieve definitive diagnoses, except when a strategy of VCE and conservative management was suitable. Researchers then measured diagnostic yields and sensitivities of each investigation.
Of the 52 patients (41 with overt and 11 with occult bleeding) recruited in the study, 36 received a definitive diagnosis. The corresponding diagnostic yields and sensitivities were 59.6 and 30.8 percent (p=0.004) for VCE, and 72.2 and 44.4 percent (p=0.052) for CTE.
The combined sensitivity of VCE and CTE was 88.9 percent, which is significantly greater than VCE (p=0.03) or CTE (p<0.01) alone. VCE was better for ulcers, enteritis and angiodysplasia, while CTE was better for tumours and Meckel diverticula.
Age <40 years (odds ratio [OR], 7.3; 95 percent CI, 1.04 to 51.4; p=0.046) and severe bleeding (OR, 6.1; 1.4 to 25.5; p=0.014) were independent predictors of a higher diagnostic yield for CTE.
“In potential SB bleeding, CTE potentially detects some lesions missed by VCE, but few data have determined its clinical utility,” according to researchers.