LOS ANGELES — The rate of small-bowel findings on capsule endoscopy was the same whether or not patients were on anticoagulation or antiplatelet therapy, results from a single-center study showed.
The findings are important because many patients who undergo capsule endoscopy are on anticoagulation and/or antiplatelet agents, and “the findings and yield in these patients compared to others is not well documented,” a team of researchers from the University of Illinois Medical Center at Chicago wrote in a poster presented at the annual Digestive Disease Week.
They studied 196 patients referred to the medical center for capsule endoscopy between April 2004 and March 2006. They collected data on patients' use of aspirin, Plavix, or Coumadin, and both evidence of bleeding and types of lesions as shown in both gastric and small-bowel images.
Of the 196 patients, 26 (13%) had gastric bleeding as shown on capsule endoscopy. Of these 26 patients, 17 had the following gastric lesions: 8 had gastropathy, 7 had erosions, 1 had an ulcer, and 1 had an arteriovenous malformation (AVM). In addition, 18 patients (69%) had either no small-bowel lesion or a single, small, nonbleeding AVM. This suggests that the gastric site was the primary cause of the bleeding.
“We're noticing that lesions missed on the initial EGD [esophagogastroduodenoscopy] are found on capsule endoscopy,” one of the study authors, Dr. Apurv Varia, said in an interview at the meeting. “If you see blood, then you should look for a lesion, because that might be the source of the bleeding if it was not found on the initial EGD.”
No significant difference was seen in the prevalence of gastric blood in patients using antiplatelet or anticoagulation agents, compared with those who were not (11% vs. 15%, respectively). The prevalence of small-bowel lesions was similar in these two groups, regardless of the combination of agents used.
The researchers did note a significantly higher frequency of gastric bleeding in patients who underwent capsule endoscopy between April 2004 and March 2006, compared with those who underwent the procedure between April 2002 and March 2004 (20% vs. 5%, respectively).
“We anticipate that as capsule endoscopy is used earlier in the evaluation of obscure bleeding, gastric bleeding sources overlooked on routine endoscopy will be detected more frequently,” they concluded in their poster.
'We're noticing that lesions missed on the initial EGD are found on capsule endoscopy.' DR. VARIA