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• W2016331344 abstract "We read with great interest the Clinical Management section “Obscure-overt Gastrointestinal Bleeding” by Gralnek.1Gralnek I.M. Obscure-overt gastrointestinal bleeding.Gastroenterology. 2005; 128: 1424-1430Abstract Full Text Full Text PDF Scopus (59) Google Scholar The author accurately explains clinical approach and diagnosis tools to find a source of bleeding, their advantages and drawbacks. Nevertheless, when determining, in a recommended management’s algorithm, the order in which the different procedures should be performed, push enteroscopy is set before capsule endoscopy. We strongly disagree with this statement. Capsule endoscopy is a new technology whose role in small bowel study is now being established. An increasing number of reports show its superiority over push enteroscopy. The author, basing on the most disappointing studies, prefers push enteroscopy, an invasive sedation requiring procedure, rather than capsule-endoscopy a safe and well tolerated one, which has shown in every study its superiority over push enteroscopy.2Gee Z.Z. Hu Y.B. Xiao S.D. Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding.Chin Med J (Engl). 2004; 117: 1045-1049Google Scholar, 3Mata A. Bordas J.M. Feu F. Gines A. Pellise M. Fernandez-Esparrach G. et al.Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding a comparative study with push enteroscopy.Aliment Pharmacol Ther. 2004; 20: 189-194Google Scholar, 4Mylonaki M. Fritscher-Ravens A. Swain P. Wireless capsule endoscopy a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.Gut. 2003; 52: 1122-1126Google Scholar, 5Saurin J.C. Delvaux M. Gaudin J.L. Fassler I. Villarejo J. Vahedi K. et al.Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding blinded comparison with video push-enteroscopy.Endoscopy. 2003; 35: 576-584Google Scholar, 6Ell C. Remke S. May A. Helou L. Henrich R. Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.Endoscopy. 2002; 34: 685-689Google Scholar, 7Chong A.K. Taylor A. Miller A. Hennessy O. Connell W. Desmond P. Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn’s disease.Gastrointest Endosc. 2005; 61: 255-261Google Scholar As a matter of fact, in this clinical management section, the author suggests to proceed with push enteroscopy immediately after upper endoscopy, only in the case of an absence of findings in the standard upper endoscopy exam.1Gralnek I.M. Obscure-overt gastrointestinal bleeding.Gastroenterology. 2005; 128: 1424-1430Abstract Full Text Full Text PDF Scopus (59) Google Scholar This approach would determine a high number of unnecessary push enteroscopies, as it is accepted that a source of bleeding is between the ligament of Treitz and the ileocecal valve only in a 5% of patients. Current guidelines focused on obscure gastrointestinal bleeding have also established that colonoscopy should be performed before enteroscopy, and, although published before recent studies about capsule endoscopy, they recognize the absence of evidence-based data about the choice between both procedures and the order in which they should be performed.8Leighton J.A. Goldstein J. Hirota W. Jacobson B.C. Johanson J.F. Mallery J.S. Obscure gastrointestinal bleeding.Gastrointest Endosc. 2003; 58: 650-655Google Scholar Given those facts, what should we do? Should we perform the classical work-up instead of introducing capsule endoscopy, a new safe and well-tolerated technology, after the standard endoscopy (upper endoscopy and colonoscopy) study? We think that after an accurate conventional endoscopic study, with or without repeated procedures, depending on the endoscopist experience and findings, capsule endoscopy should be the best choice for the patient. Afterwards, the lesions found could be treated by means of enteroscopy, surgery, or medical therapy. Besides, in the case reported, capsule endoscopy found the bleeding source that was managed surgically. Although more studies are needed to assess scientific evidence, we think current data are enough to perform capsule endoscopy before push enteroscopy in patients with occult gastrointestinal bleeding." @default.
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• W2016331344 title "Capsule Endoscopy Vs. Push Enteroscopy: Which One Should We Perform First?" @default.
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• W2016331344 doi "https://doi.org/10.1053/j.gastro.2005.08.039" @default.
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