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Background and Aim: Video capsule endoscopy (VCE) is a first‐line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Methods: A total of 997 patients that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, to December 28, 2016, were included in this study. We matched patients that underwent early VCE within 14 days of bleeding (early group, n = 678) to patients that did not (late group, n = 319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post‐VCE rebleeding in patients with initial negative VCE findings within 1 year between these groups before and after PSM. Results: Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs 45.5%, P = 0.001) and with a significantly lower incidence of rebleeding within 1 year following treatment (24.7% vs 36.7%, P = 0.041). In univariate and multivariate analyses, VCE timing (odds ratio 0.648; 95% confidence interval 0.496–0.847, P = 0.001 and odds ratio 0.666; 95% confidence interval 0.496–0.894, P = 0.007, respectively) was found to be linked with a higher rate of positive findings. Conclusion: Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post‐VCE rebleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis. [ABSTRACT FROM AUTHOR]

Background and Aim: Clear visualization of the small bowel is a requirement for satisfactory video capsule endoscopy (VCE). The aim of this study was to identify the optimal dose and timing of polyethylene glycol (PEG) for small bowel preparation before VCE. Methods: A total of 410 patients were enrolled in this prospective randomized trial. All patients fasted for 12 h and ingested 320 mg simethicone 30 min before swallowing the capsule. Patients were randomized into five groups: Group A (no PEG), Group B (1‐L PEG, 12 h before VCE), Group C (2‐L PEG, 12 h before VCE), Group D (1‐L PEG, 4 h before VCE), and Group E (2‐L PEG, 4 h before VCE). The primary endpoint was small bowel visualization quality (SBVQ), and the secondary endpoints were patient acceptability and diagnosis rate of VCE. Results: Excellent SBVQ was achieved in 27 (32.5%) of Group A, 38 (46.3%) of Group B, 40 (48.2%) of Group C, 55 (66.3%) of Group D, and 43 (54.4%) of Group E. The percentage of excellent SBVQ in Group D was significantly more than in Group A (66.3% vs 32.5%, P < 0.001), and diagnostic rate in the distal segment was higher (28.9% vs 10.8%, P = 0.0035). Patient acceptance of 1‐L PEG was better than of 2‐L PEG (P < 0.005). Conclusion: Small bowel cleansing with 1‐L PEG given 4 h before VCE was the optimal preparation for visualization of the bowel and patient acceptance (ClinicalTrials.gov, ID: NCT02486536). [ABSTRACT FROM AUTHOR]

Background and Study Aims Small bowel Crohn's disease ( SBCD) patients are frequently assessed by capsule endoscopy ( CE), which enables direct visualization of small bowel mucosal abnormalities; however, the correlations between CE scoring index ( CESI), C-reactive protein ( CRP), and disease activity indices remain undefined. We aimed to determine correlations between the CESI, clinical disease activity indices, and CRP in SBCD patients. Patients and Methods A prospective study was conducted between October 2008 and February 2011 on 58 established SBCD patients and suspected patients who received a definitive SBCD diagnosis during study. Patients underwent complete CE and were scored according to the CESI and Harvey- Bradshaw index ( HBI). Statistical correlation among CESI, HBI, and CRP was assessed. Results Weak, but significant, correlations were found between CESI and HBI (r = 0.4, P < 0.01). The correlation between CESI and CRP was moderate (r = 0.58, P < 0.01). The median CRP value was significantly higher in patients with moderate to severe CESI compared with the mild group (22.60 ± 16.79 mg/ L vs 11.88 ± 8.39 mg/ L, P < 0.01). Changes between baseline and follow-up CESI failed to correlate with the delta- HBI or delta- CRP (both, P > 0.05). Conclusions In this cohort of SBCD patients, clinical disease activity index was not reliable predictors of mucosal inflammation. CRP, however, might be a useful inflammatory marker for evaluating the moderate to severe CE activity in SBCD patients. Furthermore, therapy-induced clinical and biological improvement was not associated with repair of SBCD mucosal lesions. [ABSTRACT FROM AUTHOR]