Wireless capsule endoscopy in patients with obscure small-intestinal bleeding.

Wireless capsule endoscopy is proposed in the management of patients with obscure gastrointestinal (GI) bleeding, defined as persistent or recurrent GI bleeding without a cause identified on routine endoscopy. Obscure GI bleeding often originates from a small-intestinal abnormality, which presents diagnostic and therapeutic challenges because the small intestine is not easily visualized on conventional workup. This is a synopsis of a systematic review by the Blue Cross Blue Shield Association Technology Evaluation Center. Limited evidence shows that capsule endoscopy identified small-bowel lesions generally beyond the reach of push enteroscopy in 25% to 50% of patients and revealed additional diagnostic findings in 25% of patients compared with small-bowel barium radiographic studies. The authors conclude that in some cases, the information provided by capsule endoscopy in this specific patient population with obscure GI bleeding not diagnosed via conventional workup can lead to changes in management that would improve net health outcome.