Application Of String Capsule Endoscopy In Patients With Acute Upper Gastrointestinal Bleeding

[Objective]To exlore the value, feasibility, safety and the degree of tolerability of string capsule endoscopy examination in patients with upper gastrointestinal bleeding.[Methods]In the study, we enroll40patients with suspected upper gastrointestinal bleeding, manifested as hematemesis and/or melena and other symptoms, from June of2013to December of2013.For each patient, a detail medical records were collected, including their basic information, medical history, the time string capsule endoscopy and gastroscopy proceed from last hematemesis and/or melena were recorded in detail. Gastroscopies were done when their vital sign was stable after string endoscopy. The diagnosis of gastrointestinal bleeding, bleeding lesions and adverse reactions and discomfort ratings to the two checking methods were compare, and whether willing to double-check comparison was recorded, then whether there were statistically significant differences were analyzed.[Results]There were40patients met the inclusion criteria and all were examined by string capsule endoscopy, while36cases underwent gastroscopy; including26males and14females. Average age was54.8±20.4years old. The median time between string capsule endoscopy and last hematemesis and/or melena, was31.9±21.0h. The positive rate of string capsule endoscopy is72.2%(29/40),2cases with Coffee-like bleeding,1cases with active bleeding,1cases with dried blood, and24cases with hemorrhagic lesions detected:including12cases with upper peptic ulcers,5cases with mucosal erosion bleeding,2cases with gastric cancer,2cases with esophageal varices and/or portal hypertension gastropathy; negative in11cases.36patients accepted gastroscopy examine, the median time between gasrtoscopy and last hematemesis and/or melena, was69.7±22.5h. There were30cases with positive results after gastroscope,1case with active bleeding,1cases with dried blood,28cases with bleeding lesions detected:12cases with upper peptic ulcer,3cases with mucosal erosion bleeding,2cases with gastric malignant tumor, of2cases with esophageal varices and/or portal hypertension gastropathy; and negative in6cases. The positive detection rate of upper digestive tract bleeding was72.5%by string capsule endoscopy, by gastroscope detection rate83.3%. The difference was statistically significant. The gastroscope as diagnostic criteria, the sensitivity of the string capsule endoscopy was93.3%, and the specificity was83.3%; the positive predictive value was96.6%, and the negative was83.3%. In2/40patients (5.0%) underwent string capsule endoscopy appeared the pharynx and cardia hyperaemia erosion bleeding and all improved rapidly. The median discomfort score of string capsule endoscopy was5.0±2.8(2-10, the gastroscopy discomfort score was10). The patients who were willing to repeat string capsule endoscopy was up to37(92.5%).[Conclusion]String Capsule endoscopy is efficient, safe, and well tolerated, in diagnosis acute upper gastrointestinal bleeding. It is a good complement method of emergency gastroscopy, when applied to the early diagnosis of acute upper gastrointestinal bleeding.