Diagnostic yield of small-bowel capsule endoscopy in patients with iron deficiency anemia: Does it affect management?

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We read with interest the systematic review by Koulaouzidis et al, 1 who alluded that the validity of small-bowel capsule endoscopy in patients with iron defi-ciency anemia (IDA) alone remains limited. They found that studies focusing solely on IDA had a diagnostic yield of 66%, and significant findings included vascular (31%), in-flammatory (17.8%), and mass and/or tumor (7.95%) le-sions. We would like to share our findings. From a cohort of 1324 patients with obscure GI bleeding who underwent small-bowel capsule endoscopy, we identified 971 patients (73%) with IDA. The diagnostic yield was 35% (n Z 342) in the IDA group in which vascular lesions made up 23% (n Z 225), the combination of erosions and ulcers another 25% (n Z 245), and small-bowel tumors 2% (n Z 16) of lesions. Other findings included 42 patients with fresh blood without a definite source, 11 with small-bowel stric-tures, and 63 with miscellaneous lesions. In 135 patients (14%), lesions were identified outside the small bowel. Yield and management change between sexes revealed no statistical difference (P Z .67, P Z .37), whereas logistic regression revealed that age (P Z .001), transfusion depen-dence (P Z .037), and respiratory disease (P Z .047) were factors associated with a positive yield. In 61% (n Z 207) of cases with a diagnostic yield, subsequent management was altered. This was more likely in the patients who were transfusion dependent (P Z .004) and in patients with comorbidity (P Z .004). Small-bowel enteroscopy (either push or double-balloon enteroscopy) was performed in 19% (n Z 39) to treat vascular lesions (56%) or biopsy of abnormalities seen (44%). Patients who underwent entero-scopy also were more likely to have cardiovascular (P Z .004) or chronic liver disease (P Z .048) and transfusion dependence (P Z .04). This study supports the validity of capsule endoscopy in patients with IDA. We highlight clinical factors associated with a higher diagnostic yield, Figure 1. This figure accompanies the letter response by Chen and Hsieh, p. 799.




Sidhu, P. S., McAlindon, M. E., Drew, K., & Sidhu, R. (2013, November). Diagnostic yield of small-bowel capsule endoscopy in patients with iron deficiency anemia: Does it affect management? Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2013.06.022

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