Obscure GI Bleeding: Capsule Endoscopy or Push Enteroscopy First?

Obscure gastrointestinal bleeding, in which both upper endoscopy and colonoscopy yield negative findings, is an indication for small-bowel evaluation. Which approach is best for this evaluation is controversial, with some experts favoring capsule endoscopy (CE) first (because studies generally show a higher diagnostic yield compared with enteroscopy) and others favoring push enteroscopy (PE) first (because PE allows therapeutic intervention). In this randomized trial from France, investigators compared CE and PE among 78 patients with obscure GI bleeding. The alternative procedure was performed if the study procedure failed to provide certain diagnosis of the bleeding cause or if another definite clinical indication occurred during follow-u…