Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding?

J Gastroenterol Hepatol. 2008 Dec;23(12):1806-9. doi: 10.1111/j.1440-1746.2008.05643.x.


Background and aim: Medicare reimbursement for capsule endoscopy for the investigation of obscure gastrointestinal bleeding in Australia requires endoscopy and colonoscopy to have been performed within 6 months. This study aims to determine the diagnostic yield of repeating these procedures when they had been non-diagnostic more than 6 months earlier.

Methods: Of 198 consecutive patients who were referred for the investigation of obscure gastrointestinal bleeding, 50 underwent repeat endoscopy and colonoscopy solely to enable reimbursement (35 females and 15 males; mean age 59.4 [range: 21-82] years). The average duration of obscure bleeding was 50.16 (range: 9-214) months. The mean number of prior endoscopies was 3 (median: 2) and 2.8 colonoscopies (median: 2). The most recent endoscopy had been performed 18.9 (median: 14; range: 7-56) months, and for colonoscopy, 19.1 (median 14; range 8-51) months earlier.

Results: A probable cause of bleeding was found at endoscopy in two patients: gastric antral vascular ectasia (1) and benign gastric ulcer (1). Colonoscopy did not reveal a source of bleeding in any patient. Capsule endoscopy was performed in 47 patients. Twenty four (51%) had a probable bleeding source identified, and another five (11%) a possible source. These included angioectasia (17 patients), mass lesion (2), non-steroidal anti-inflammatory drug enteropathy (2), Cameron's erosions (2), and Crohn's disease (1). Four patients undergoing repeat capsule endoscopy had a probable bleeding source detected.

Conclusion: The yield of repeat endoscopy and colonoscopy immediately prior to capsule endoscopy is low when these procedures have previously been non-diagnostic. Such an approach is also not cost-effective.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Capsule Endoscopy / economics*
  • Colonoscopy / economics*
  • Cost-Benefit Analysis
  • Endoscopy, Gastrointestinal / economics*
  • Female
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Insurance, Health, Reimbursement*
  • Male
  • Middle Aged
  • National Health Programs / economics*
  • New South Wales
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Risk Factors
  • Time Factors
  • Young Adult