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.