Capsule Endoscopy Guided Bowel Resection for Obscure Gastrointestinal Hemorrhage

Introduction

Gastrointestinal (GI) bleeding is a common cause of anemia, although its precise location can be obscure at times. Noninvasive tests to determine the source of bleeding include technetium-99m scans to identify ectopic gastric mucosa and tagged red blood cell scans. Angiography is another option, although more invasive and rarely used in the pediatric population.[1] Each of these modalities is limited by variable sensitivities and false-negative rates. Direct visualization of the GI tract through upper and lower endoscopy requires sedation or general anesthesia but offers a high rate of success in identifying abnormalities of the colon, terminal ileum, esophagus, stomach, and duodenum.[2] However, this standard evaluation fails to reveal the source of bleeding in up to 10% of patients.[3] Surgical exploration in the setting of negative upper endoscopy, colonoscopy, and negative technitium-99m scan has its role in diagnosing and treating obscure GI bleed.[4] However, negative explorations are not uncommon.[4]

Video capsule endoscopy (VCE) has been used in the adult population since 2001 and more recently used in the pediatric populations. It provides a noninvasive method for the direct visualization of the entire small bowel mucosa and has an improved diagnostic yield for small bowel pathology in comparison to typical radiologic and endoscopic examinations.[5] [6] In this report, we describe the use of VCE leading to source localization for an obscure GI bleed allowing directed surgical intervention and avoiding blind surgical exploration.

• References

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