Usefulness of video capsule gastrointestinal endoscopy in digestive bleeding of unknown origin

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; ALCARAZ, A.; BARDACH, A.; GARCIA MARTI, S.; GLUJOVSKY, D.; LOPEZ, A.; REGUEIRO, A.

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2005 p. 1 - 30

1668-2793

The aim of this report was to assess video capsule gastrointestinal endoscopy usefulness for digestive bleeding of unknown origin.A search was started on the main literature databases (MEDLINE, Cochrane, DARE, LILACS, NHS NICE, EMBASE), Centre for Reviews and Dissemination New York University (CRD) on the Internet's general search engines, health technology assessment agencies and health sponsors. The terms capsule endoscopy, video capsule gastrointestinal endoscopy, and their different variants and abbreviations were introduced, and when they were available, turning to the corresponding thesaurus MEDLINE terms. Data from local sources on the use of health resources and coverage in Argentina were also searched. The authorities of the Argentine Society on Digestive Endoscopy were consulted in writing.For this report 11 narrative revisions, 1 meta-analysis, 3 randomized controlled clinical trials and 6 case series were used. In addition, documents that set their view on the topic, from the American Society of Digestive Endoscopy (ASGE), the U.S. Food and Drugs Administration, 5 health technology assessments from American, Canadian, British and Australian agencies, and 7 coverage policies from north-American groups, including Medicaid, were chosen. In general the medical literature found shows poor evidence. A meta-analysis was performed incorporating evidence from observational studies available to the moment on video capsule endoscopy (VCE) vs intestinal transit. The results related to the diagnostic usefulness of both tests assesed were 58% (CI 95% 46,3-67,7) for the capsule, and 4% (CI 0,5-12,0%) conventional contrast radiology. With respect to enteroscopy, VCE is a better diagnostic tool (VCE 40-83% vs. enteroscopy 21-50%). VCE is especially useful to detect lesions beyond the enteroscope reach.