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- W2000992074 abstract "Acute gastrointestinal bleeding occurs frequently in patients on oral anticoagulation. In a minority of these patients no cause can be found during routine upper and lower endoscopy. In these cases a small bowel lesion could be responsible. If no apparent cause has been found after routine endoscopy, video capsule endoscopy (VCE) might be helpful to elucidate the cause of the bleeding episode. Aim of our study was to assess the diagnostic yield of VCE in patients with overt gastrointestinal bleeding while on oral anticoagulation, in whom no cause was identified during upper and lower endoscopy and to identify factors associated with positive findings.We performed a retrospective analysis of all 56 VCE studies performed because of acute gastrointestinal bleeding with negative upper and lower endoscopy in patients who were on oral anticoagulation. These studies were reviewed for positive findings by an experienced gastroenterologist blinded to clinical details. Univariate and multiple logistic regression analysis were performed to identify factors associated with a positive yield.The median time between the bleeding episode and VCE was 23 days. A bleeding source was found in 28 (50.0%) of the 56 patients. Twenty-two of the 28 positive studies showed a possible cause in the small bowel, whereas two studies showed causative lesions in the stomach or duodenal bulb, and four studies showed causative lesions in the colon. Continuation of anticoagulants during VCE was the only independent factor predicting positive VCE findings (odds ratio 11.7; 95% CI 3.14 - 43.53; p<0.0001). The yield of VCE in patients who were on anticoagulation during VCE was 71.4%. In patients in who anticoagulation had been withdrawn the yield was 28.6%. Twelve of the 28 positive VCE-studies were performed in patients who had continued coumarin monotherapy, four in patients who had continued antiplatelet monotherapy and four in patients who had continued anticoagulant combination therapy. Eight of the 28 positive VCE-studies were performed in patients in whom anticoagulation therapy had been withdrawn.In conclusion, VCE might be helpful in identifying the source of overt gastrointestinal bleeding in anticoagulated patients in who no source was found during initial evaluation. Continuation or reinstitution of oral anticoagulants, especially coumarins, is associated with a positive yield of VCE." @default.
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- W2000992074 date "2010-04-01" @default.
- W2000992074 modified "2023-09-26" @default.
- W2000992074 title "W1584: Continuation of Anticoagulant Therapy in Patients With Overt Obscure Gastrointestinal Bleeding Increases the Yield of Video Capsule Endoscopy" @default.
- W2000992074 doi "https://doi.org/10.1016/j.gie.2010.03.992" @default.
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