James E. Huprich MD, Presenter: Nothing to Disclose

Joel Garland Fletcher MD, Abstract Co-Author: Research grant, Siemens AG Grant, E-Z-EM, Inc License agreement, General Electric Company

Jeff Lynn Fidler MD, Abstract Co-Author: Grant, E-Z-EM, Inc, Lake Success, NY

Jeffrey A. Alexander MD, Abstract Co-Author: Nothing to Disclose

Hassan Siddiki MD, Abstract Co-Author: Nothing to Disclose

Cynthia H. McCollough PhD, Abstract Co-Author: Research grant, Siemens AG Research grant, RTI Electronics AB

Capsule endoscopy (CE) is accepted as the preferred examination for the evaluation of obscure GI bleeding (OGIB). The purpose of this prospective, double-blind study is to compare the clinical impact of multiphase CT enterography (MpCTE) with wireless CE in patients with OGIB.

33 patients with OGIB (32/33 outpatients) consented to undergo both MpCTE and CE within 2 weeks of each other. All patients underwent successful MpCTE utilizing a 64-slice CT scanner and 2000 cc of oral VoLumen® (E-Z-EM, Lake Success, NY). Scanning was performed during each of three phases: peak aortic enhancement (arterial) and 45 (enteric) and 90 sec (delayed) after IV contrast injection. Studies were interpreted by a radiologist and gastroenterologist, blinded to all other results. Findings were categorized as negative, unrelated (findings present, equivocally related to bleeding source), or significant (findings present, likely identifying source or evidence of active bleeding). Surgical, endoscopic, and pathological findings along with clinical follow-up were reviewed by a gastroenterologist to determine whether the results of MpCTE or CE caused a change in clinical management.

CE was not performed in 4 patients (2 with MpCTE identifying a small bowel tumor who proceeded directly to surgery; 1 with prolonged capsule retention; 1 with coagulopathy). Significant findings were seen in 8 MpCTE and 5 CE studies. Changes in clinical management occurred as a result of MpCTE and/or CE findings in 6 patients—3 as a result of MpCTE findings alone (sb carcinoid, metastatic melanoma, and vascular mass), and one as a result of CE alone (sb ulcers). Two patients had clinical management changed as a result of concordant findings on both exams (Crohn’s and Brunner’s gland hamartoma).

1) Multiphase CT enterography and capsule endoscopy are complimentary tests in the evaluation of OGIB, and both were needed to discover all patients with bleeding sources. 2) Multiphase CT enterography may have a greater impact on clinical management than capsule endoscopy.

Multiphase CT enterography plays a complementary role along with capsule endoscopy in the management of patients with OGIB.

Huprich, J, Fletcher, J, Fidler, J, Alexander, J, Siddiki, H, McCollough, C, A Prospective Comparison of Multiphase CT Enterography with Wireless Capsule Endoscopy in the Management of Obscure GI Bleeding.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5012916.html