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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Randomized controlled trial comparing outcomes of video capsule endoscopy with push enteroscopy in obscure gastrointestinal bleeding</title><author><name sortKey="Segarajasingam, Dev S" sort="Segarajasingam, Dev S" uniqKey="Segarajasingam D" first="Dev S" last="Segarajasingam">Dev S. Segarajasingam</name><affiliation><nlm:aff id="af1-cjgh-29-85">Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital and School of Population Health, The University of Western Australia, Crawley, Australia;</nlm:aff></affiliation></author><author><name sortKey="Hanley, Stephen C" sort="Hanley, Stephen C" uniqKey="Hanley S" first="Stephen C" last="Hanley">Stephen C. Hanley</name><affiliation><nlm:aff id="af2-cjgh-29-85">Division of General Surgery, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Barkun, Alan N" sort="Barkun, Alan N" uniqKey="Barkun A" first="Alan N" last="Barkun">Alan N. Barkun</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cjgh-29-85">Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Waschke, Kevin A" sort="Waschke, Kevin A" uniqKey="Waschke K" first="Kevin A" last="Waschke">Kevin A. Waschke</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Burtin, Pascal" sort="Burtin, Pascal" uniqKey="Burtin P" first="Pascal" last="Burtin">Pascal Burtin</name><affiliation><nlm:aff id="af5-cjgh-29-85">Endoscopy Unit, Gustave Roussy Institute of Oncology, Villejuif, Greater Paris, France;</nlm:aff></affiliation></author><author><name sortKey="Parent, Josee" sort="Parent, Josee" uniqKey="Parent J" first="Josée" last="Parent">Josée Parent</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Mayrand, Serge" sort="Mayrand, Serge" uniqKey="Mayrand S" first="Serge" last="Mayrand">Serge Mayrand</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Fallone, Carlo A" sort="Fallone, Carlo A" uniqKey="Fallone C" first="Carlo A" last="Fallone">Carlo A. Fallone</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Jobin, Gilles" sort="Jobin, Gilles" uniqKey="Jobin G" first="Gilles" last="Jobin">Gilles Jobin</name><affiliation><nlm:aff id="af6-cjgh-29-85">Division of Gastroenterology, Montreal University, Montreal, Quebec</nlm:aff></affiliation></author><author><name sortKey="Seidman, Ernest G" sort="Seidman, Ernest G" uniqKey="Seidman E" first="Ernest G" last="Seidman">Ernest G. Seidman</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Martel, Myriam" sort="Martel, Myriam" uniqKey="Martel M" first="Myriam" last="Martel">Myriam Martel</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25803018</idno><idno type="pmc">4373566</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373566</idno><idno type="RBID">PMC:4373566</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">001820</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001820</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Randomized controlled trial comparing outcomes of video capsule endoscopy with push enteroscopy in obscure gastrointestinal bleeding</title><author><name sortKey="Segarajasingam, Dev S" sort="Segarajasingam, Dev S" uniqKey="Segarajasingam D" first="Dev S" last="Segarajasingam">Dev S. Segarajasingam</name><affiliation><nlm:aff id="af1-cjgh-29-85">Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital and School of Population Health, The University of Western Australia, Crawley, Australia;</nlm:aff></affiliation></author><author><name sortKey="Hanley, Stephen C" sort="Hanley, Stephen C" uniqKey="Hanley S" first="Stephen C" last="Hanley">Stephen C. Hanley</name><affiliation><nlm:aff id="af2-cjgh-29-85">Division of General Surgery, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Barkun, Alan N" sort="Barkun, Alan N" uniqKey="Barkun A" first="Alan N" last="Barkun">Alan N. Barkun</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cjgh-29-85">Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Waschke, Kevin A" sort="Waschke, Kevin A" uniqKey="Waschke K" first="Kevin A" last="Waschke">Kevin A. Waschke</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Burtin, Pascal" sort="Burtin, Pascal" uniqKey="Burtin P" first="Pascal" last="Burtin">Pascal Burtin</name><affiliation><nlm:aff id="af5-cjgh-29-85">Endoscopy Unit, Gustave Roussy Institute of Oncology, Villejuif, Greater Paris, France;</nlm:aff></affiliation></author><author><name sortKey="Parent, Josee" sort="Parent, Josee" uniqKey="Parent J" first="Josée" last="Parent">Josée Parent</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Mayrand, Serge" sort="Mayrand, Serge" uniqKey="Mayrand S" first="Serge" last="Mayrand">Serge Mayrand</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Fallone, Carlo A" sort="Fallone, Carlo A" uniqKey="Fallone C" first="Carlo A" last="Fallone">Carlo A. Fallone</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Jobin, Gilles" sort="Jobin, Gilles" uniqKey="Jobin G" first="Gilles" last="Jobin">Gilles Jobin</name><affiliation><nlm:aff id="af6-cjgh-29-85">Division of Gastroenterology, Montreal University, Montreal, Quebec</nlm:aff></affiliation></author><author><name sortKey="Seidman, Ernest G" sort="Seidman, Ernest G" uniqKey="Seidman E" first="Ernest G" last="Seidman">Ernest G. Seidman</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author><author><name sortKey="Martel, Myriam" sort="Martel, Myriam" uniqKey="Martel M" first="Myriam" last="Martel">Myriam Martel</name><affiliation><nlm:aff id="af3-cjgh-29-85">Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</nlm:aff></affiliation></author></analytic><series><title level="j">Canadian Journal of Gastroenterology & Hepatology</title><idno type="ISSN">2291-2789</idno><idno type="eISSN">2291-2797</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Although currently available techniques can provide a diagnosis in a highly significant proportion of cases of gastrointestinal (GI) bleeding, a small percentage of patients experience obscure GI bleeding, which, despite its rarity, is associated with significant expense and health care resource use. Several societies have endorsed video capsule endoscopy as a reliable imaging modality for patients who present with obscure GI bleeding. This study compared video capsule endoscopy with push enteroscopy with regard to a series of clinically meaningful outcomes.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can J Gastroenterol Hepatol</journal-id><journal-id journal-id-type="iso-abbrev">Can J Gastroenterol Hepatol</journal-id><journal-id journal-id-type="publisher-id">PGI</journal-id><journal-title-group><journal-title>Canadian Journal of Gastroenterology & Hepatology</journal-title></journal-title-group><issn pub-type="ppub">2291-2789</issn><issn pub-type="epub">2291-2797</issn><publisher><publisher-name>Pulsus Group Inc</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25803018</article-id><article-id pub-id-type="pmc">4373566</article-id><article-id pub-id-type="publisher-id">cjgh-29-85</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Randomized controlled trial comparing outcomes of video capsule endoscopy with push enteroscopy in obscure gastrointestinal bleeding</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Segarajasingam</surname><given-names>Dev S</given-names></name><degrees>MBBS FRACP</degrees><xref ref-type="aff" rid="af1-cjgh-29-85"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hanley</surname><given-names>Stephen C</given-names></name><degrees>MD PhD</degrees><xref ref-type="aff" rid="af2-cjgh-29-85"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Barkun</surname><given-names>Alan N</given-names></name><degrees>MDCM FRCPC MSc</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref><xref ref-type="aff" rid="af4-cjgh-29-85"><sup>4</sup></xref><xref rid="c1-cjgh-29-85" ref-type="corresp"></xref></contrib><contrib contrib-type="author"><name><surname>Waschke</surname><given-names>Kevin A</given-names></name><degrees>MDCM FRCPC</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Burtin</surname><given-names>Pascal</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af5-cjgh-29-85"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Parent</surname><given-names>Josée</given-names></name><degrees>MDCM FRCPC</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mayrand</surname><given-names>Serge</given-names></name><degrees>MDCM FRCPC</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fallone</surname><given-names>Carlo A</given-names></name><degrees>MDCM FRCPC</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jobin</surname><given-names>Gilles</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af6-cjgh-29-85"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seidman</surname><given-names>Ernest G</given-names></name><degrees>MDCM FRCPC</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Martel</surname><given-names>Myriam</given-names></name><degrees>BSc</degrees><xref ref-type="aff" rid="af3-cjgh-29-85"><sup>3</sup></xref></contrib></contrib-group><aff id="af1-cjgh-29-85"><label>1</label>Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital and School of Population Health, The University of Western Australia, Crawley, Australia;</aff><aff id="af2-cjgh-29-85"><label>2</label>Division of General Surgery, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</aff><aff id="af3-cjgh-29-85"><label>3</label>Division of Gastroenterology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</aff><aff id="af4-cjgh-29-85"><label>4</label>Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, Quebec;</aff><aff id="af5-cjgh-29-85"><label>5</label>Endoscopy Unit, Gustave Roussy Institute of Oncology, Villejuif, Greater Paris, France;</aff><aff id="af6-cjgh-29-85"><label>6</label>Division of Gastroenterology, Montreal University, Montreal, Quebec</aff><author-notes><corresp id="c1-cjgh-29-85">Correspondence: Dr Alan N Barkun, Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital site, 1650 Cedar Avenue, room D16.125, Montréal, Quebec H3G 1A4. Telephone 514-934-8309, fax 514-834-8531, e-mail <email>alan.barkun@muhc.mcgill.ca</email></corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2015</year></pub-date><volume>29</volume><issue>2</issue><fpage>85</fpage><lpage>90</lpage><history><date date-type="received"><day>11</day><month>9</month><year>2014</year></date><date date-type="accepted"><day>14</day><month>1</month><year>2015</year></date></history><permissions><copyright-statement>©2015, Pulsus Group Inc. All rights reserved</copyright-statement><copyright-year>2015</copyright-year></permissions><abstract abstract-type="toc"><p>Although currently available techniques can provide a diagnosis in a highly significant proportion of cases of gastrointestinal (GI) bleeding, a small percentage of patients experience obscure GI bleeding, which, despite its rarity, is associated with significant expense and health care resource use. Several societies have endorsed video capsule endoscopy as a reliable imaging modality for patients who present with obscure GI bleeding. This study compared video capsule endoscopy with push enteroscopy with regard to a series of clinically meaningful outcomes.</p></abstract><abstract><sec><title>BACKGROUND:</title><p>Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear.</p></sec><sec><title>OBJECTIVE:</title><p>To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE).</p></sec><sec><title>METHODS:</title><p>Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers.</p></sec><sec><title>RESULTS:</title><p>Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05).</p></sec><sec><title>CONCLUSIONS:</title><p>A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.</p></sec></abstract><trans-abstract xml:lang="fr"><sec><title>HISTORIQUE :</title><p>On ne connaît pas encore la prise en charge optimale du saignement gastro-intestinal occulte (SGIO).</p></sec><sec><title>OBJECTIF :</title><p>Évaluer le rendement diagnostique et les résultats cliniques en aval de l’endoscopie par vidéocapsule (EVC) par rapport à l’entéroscopie poussée (EP).</p></sec><sec><title>MÉTHODOLOGIE :</title><p>Les patients ayant un SGIO et dont les œsophagogastroduodénoscopies et les coloscopies étaient négatives ont été répartis au hasard entre une EVC ou une EP et suivis pendant 12 mois. Les critères d’évaluation incluaient le rendement diagnostique, le saignement aigu ou chronique, l’utilisation des ressources de santé et les permutations.</p></sec><sec><title>RÉSULTATS :</title><p>Les chercheurs ont analysé les données de 79 patients (EVC n=40; EP n=39; 82,3 % de SGIO manifeste). L’EVC s’associait au meilleur rendement diagnostique (72,5 % par rapport à 48,7 %; P<0,05), notamment dans l’intestin grêle distal (58 % par rapport à 13 %; P<0,01). Plus de lésions déterminées par l’EVC étaient classées comme les causes possibles ou établies du saignement (79,3 % par rapport à 35,0 %; P<0,05). Pendant le suivi, il n’y avait pas de différences dans le taux de saignement continu (aigu [40,0 % par rapport à 38,5 %; P non significatif], chronique [32,5 % par rapport à 45,6 %; P non significatif]) ni dans l’utilisation des ressources de santé. Moins de patients ayant d’abord subi une EVC ont été permutés en raison d’un saignement continu (22,5 % par rapport à 48,7 %; P<0,05).</p></sec><sec><title>CONCLUSIONS :</title><p>La décision de commencer par l’EVC comportait un avantage diagnostique important par rapport à l’EP chez les patients ayant un SGIO, notamment pour ce qui est de la détection de lésions de l’intestin grêle, et influait sur la certitude clinique et les examens subséquents de l’intestin grêle, sans différences subséquentes sur les résultats des saignements ou l’utilisation des ressources lors du suivi. Ces observations remettent en question la pertinence clinique de déceler de nombreuses lésions endoscopiques ou d’en traiter la plupart avec efficacité au fil du temps. Il faut désormais poser un meilleur pronostic des caractéristiques des patients et de l’apparence des lésions endoscopiques en regard du comportement du saignement, et tenir compte des effets de l’entéroscopie thérapeutique profonde à l’aide de méthodologies adaptées d’études de haute qualité.</p></sec></trans-abstract><kwd-group><kwd>Anemia</kwd><kwd>Enteroscopy</kwd><kwd>Obscure GI bleeding</kwd><kwd>Obscure GI hemorrhage</kwd><kwd>Small bowel bleeding</kwd><kwd>Videocapsule</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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