PAN-ENTERIC CAPSULE IN PATIENTS WITH MELENA AND A NEGATIVE UPPER ENDOSCOPY: A PILOT STUDY

Aims: Melena can be caused both by bleeding from upper sources and from mid/lower gastrointestinal bleeding. Colonoscopy is frequently used to investigate melena after a non-diagnostic EGD but retrospective studies showed that its diagnostic and therapeutic yield is low. Aim of our study was to perform a pan-enteric capsule endoscopy (PCE) with PillCam Colon2 capsule and evaluate its ability to avoid unnecessary colonoscopies when performed on patients with melena after an initial negative upper endoscopy. Methods: Between January and September 2018 patients with melena, negative gastroscopy and the need to be hospitalized for drop of haemoglobin level, were prospectively included. After a negative upper endoscopy examination, a PCE was performed after a split, high-volume preparation. After the passage through the stomach, the capsule was “forced” to acquire images of the small bowel at a rate similar to that of current-generation small-bowel capsules. Results: 12 patients (8 female, mean age 76 years) met the criteria. Capsule was egested “on” in 11 out of 12 patients. PCE found small bowel findings in 6/12 patients (blood in lumen in 2 patients, angiodysplasias in 2 patients, ileal ulcer in one patient and jejunitis with substenosis in one patient); colon findings were revealed in 4 patients (polyps in 1 patient, diverticulosis with haemorrhagic stigmata in 1 patient, blood in caecum in 1 patient and right colon cancer in another patient) and both small bowel and colon findings in 2 patients. One patient had a negative, incomplete study. The pan-enteric study led to a double ballon enteroscopy in six cases and a colonoscopy in 5 patients. Conclusions: In this small, prospective, study, the PCE was useful to identify the site of bleeding in 92% of patients with melena and a negative gastroscopy and was able to guide the subsequent endoscopic treatments. In particular, PCE resulted in less unnecessary colon investigations.