Clinical consequences of videocapsule endoscopy in GI bleeding and Crohn's disease

Background Videocapsule endoscopy (VCE) has a high diagnostic yield in the analysis of GI bleeding and Crohn's disease. Little information is available on the impact of VCE findings on clinical care. Objective Assess the impact of VCE findings on clinical management and outcome. Design Retrospective descriptive study. Setting General hospital. Patients VCE was performed in 150 patients for GI bleeding (n = 97), Crohn's disease (n = 36), and miscellaneous reasons (n = 17). Main Outcome Measurements Clinical consequences were evaluated by using a questionnaire and were divided into change of management or unchanged management. Change of medication, endoscopic procedures, surgical procedures, other consequences, and avoidance of additional investigations were considered a change of management. For all patients, an assessment of the actual clinical condition and the most recent Hb level were registered. Results A definite diagnosis was established in 34%, a probable diagnosis in 34%, and no diagnosis in 32%. Management was changed in 38% of patients, increasing to 59% if a definite diagnosis was established at VCE. No relation between change of management and clinical improvement or increased Hb level could be established. Limitations The start of ethinylestradiol/norethisterone in case of telangiectasia was considered a change of management, although controversy on the rationale of this treatment exists. A more detailed and objective evaluation of the clinical condition should be performed to assess the clinical outcome. Conclusions VCE findings have a serious impact on clinical practice. VCE in particular leads to a change of management in 59% of the patients in whom a definite diagnosis is established.