Introduction: VCE is now first line therapy for OGIB, but it is unclear whether the type of obscure bleeding (overt vs.occult) alters the clinical findings. We aimed to investigate the differences in demographics, clinical workup, and capsule findings between overt and occult bleeders undergoing VCE for the evaluation of OGIB
Methods: Retrospective analysis of all patients undergoing VCE for the evaluation of OGIB at a single university center between 2008 and 2012. We excluded all studies with technical errors and/or retention. Relevant data was obtained through chart review and examined with chi-square, t-test, and univariate analysis.
Results: 370 VCE studies were performed in the time period. 302 (82%) were performed for the indication of OGIB. 17 studies were excluded, leaving 285 for analysis. The average age of the population was 62.8 ± 13.6 years; 54% were female, 76% were Caucasian, and 38% were performed in the hospital. The diagnostic yield was 62% with angioectasias the predominant finding (43%). 143 (50%) patients underwent VCE for overt bleeding, compared to 137 (48%) for occult bleeding (Table 1 ). Compared to patients undergoing VCE for occult GIB, overt bleeders were more often male (p=0.015), inpatient (p < 0.0001), taking aspirin (p=0.004) or coumadin (p=0.006), and have history of GIB (p < 0.0001). Overt bleeders received more pRBC transfusions (p < 0.0001) and had more diagnostic studies prior to the VCE (p < 0.0001). Similarly, overt bleeders were more likely to undergo further diagnostic workup after the VCE compared to occult bleeders (p < 0.0001). There was no difference in diagnostic yield or presence of angioectasias; but overt bleeders were more likely to have intraluminal blood (p=0.0008). Small bowel transit times (SBTT) were longer (p=0.05) and completion rates lower (p=0.04) for overt bleeders as compared to occult bleeders.
Table 1: Results by VCE Indication (Overt vs. Occult) for OGIB
Conclusion: Overt bleeders are more often male, inpatient, taking aspirin or coumadin, and have history of GIB. They also require more PRBC transfusions and undergo more endoscopic and radiologic investigations prior to the VCE. SBTT is longer and VCE completion rates are lower in overt bleeders. Although the diagnostic yield for occult and overt bleeders is similar (57% and 70%, respectively), the pre-VCE diagnostic workup is significantly more extensive in the latter. We suggest earlier implementation of VCE in overt OGIB to reduce unnecessary studies performed in this population.
