Obscure GI Bleeding Investigation With SB-CE Beneficial for SAGA, Nonoperated Patients

3d rendering x-ray capsule endoscopy isolated on black
Researchers assessed the safety, use, and diagnostic yield of using small bowel capsule endoscopy for examining obscure GI bleeding among patients with SAGA vs native gastric anatomy.

Orally ingested small bowel capsule endoscopy (SB-CE) to investigate obscure gastrointestinal bleeding (OGIB) in patients with surgically altered gastric anatomy (SAGA) is impaired by a longer small bowel transit time (SBTT) and lower completion rate compared with SB-CE in nonoperated patients, according to a study published in Clinics and Research in Hepatology and Gastroenterology.

In this multicenter, randomized controlled trial (RCT), a subset of participants with obscure gastrointestinal (GI) bleeding (OGIB) from the Surgically Altered Gastric Anatomy (SAGA) trial and a subset of patients (control individuals) from the PREPINTEST trial were matched on the basis of age (±2 years), sex, and type of bleeding (overt vs occult). The groups were compared in terms of SB completion rate, gastric transit time (GTT) and SBTT, rates of adverse events (AEs), and diagnosis made by SBCE. The primary outcome was the diagnostic yield (DY) of SB-CE, which was defined as the proportion of patients with intermediate (P1) or highly relevant (P2) findings.

There were 244 patients with occult OGIB (122 in each group) and 170 with overt OGIB (85 in each group). The DY was significantly higher in overt OGIB compared with occult OGIB among patients with normal gastrointestinal anatomy (51.8% vs 36.1%; P <.01), but not among patients with SAGA (51.8% with overt OGIB vs 40.1% with occult OGIB; P =.12). SBTT and completion rates were lower in patients with SAGA than in patients with normal anatomy.

Study limitations included using a retrospective design. Some data may also have been biased, while other data were not available. Patients were possibly selected in both groups from the PREPINTEST and the SAGA studies. The comparison between groups was indirect.

“Overall, this comparative study suggests that the feasibility of orally ingested SB-CE is impaired by a longer SBTT and a lower completion rate in patients with a history of major gastric surgery, compared [with] nonoperated patients,” the study authors concluded. “Despite these limitations, the procedure remains safe in patients with SAGA, and it comes with a diagnostic yield for OGIB similar to what [was] observed in matched pair controls. Although further studies may be considered for evaluating different preparation modalities (possibly with the use of boosters), patients with SAGA should benefit from SB-CE investigation for OGIB as much as nonoperated patients.”


Dray X, Rahmi G, Riccioni ME, et al. Small bowel capsule endoscopy in obscure gastrointestinal bleeding: A matched cohort comparison of patients with normal vs surgically altered gastric anatomy. Clin Res Hepatol Gastroenterol. Published online April 4, 2022. doi:10.1016/j.clinre.2022.101921