Diagnostic Yield of Video Capsule Endoscopy for Iron Deficiency Anemia Without Overt Gastrointestinal Bleeding

Abstract

Diagnostic Yield of Video Capsule Endoscopy for Iron Deficiency Anemia Without Overt Gastrointestinal Bleeding Kirk Bernadino, Peter B. Anderson, Steve P. Bensen Background: Since it’s introduction to clinical use in 2001, video capsule endoscopy (VCE) has become an important adjunct in the evaluation of occult gastrointestinal hemorrhage and chronic GI bleeding of suspected small intestine etiology. Previous studies have reported diagnostic yield in obscure, overt gastrointestinal bleeding (OGIB) as high as 87%. To date, there have been no published studies evaluating the diagnostic yield in patients with iron deficiency anemia (IDA), but without OGIB, who have undergone a negative endoscopic work up. Aims: To determine the diagnostic yield VCE in patients with IDA, but no history of OGIB. Methods: Between 5/02 and 12/03 140 patients were referred for VCE, 46 of these for IDA. Of these, 36 patients met our inclusion criteria of: 1) IDA as defined by transferrin saturation of <15% or ferritin <29ng/ml in the previous 12 months, 2) no history of melena or hematochezia and 3) previous negative EGD and colonoscopy. 44% had a previous small bowel follow through or enteroclysis that was negative. 8% had previous enteroscopy that was negative. VCE was performed in all patients and interpreted by one of two gastroenterologists. Complications including retained capsule, obstruction and capsule failure were recorded. Results: 19 of 36 (53%) patients had abnormalities on VCE. Angiodysplasia was the most common abnormality, seen in 8/36 (22%). 5/36 (14%) had small bowel erosions or ulcerations. 1/36 (3%) had scalloped duodenal folds suspicious for celiac disease which was later confirmed by elevated serum TTG. 1/36 (3%) had gastric antral vascular ectasia unrecognized on previous EGD. 6/36 (17%) patients had active bleeding from an unclear source, 2 of whom also had non-bleeding angiodysplasia. No complications were reported. In three patients the exam ended prior to the capsule reaching the cecum. Conclusion: VCE found abnormalities in 53% of patients with IDA and previous negative endoscopic evaluation. Small bowel angiodysplasia is themost common abnormal finding. The yield of VCE for IDA without overt bleeding is less than the previously reported yield for overt gastrointestinal bleeding of suspected small bowel source. Further studies are needed to determine the impact of VCE on management strategy of chronic IDA. *M1779 Prospective Controlled Multicentric Trial Comparing Capsule Endoscopy with Intraoperative Enteroscopy: Long Term Results in Patients with Chronic Gastrointestinal Bleeding Harald Schmidt, Dirk Hartmann, Frank Kinzel, Dieter Schilling, Georg Bolz, Peter Reitzig, Henning E. Adamek, Hartmut Hollerbuhl, Klaus Guenther, Klaus Schoenleben, Juergen F. Riemann, Hans J. Schulz Background: Capsule Endoscopy (CE) is a very precise and efficant non-invasive diagnostic procedure in patients with chronic gastrointestinal bleeding. Long term clinical outcome data of patients undergoing CE and intraoperative enteroscopy (IOE) for investigation of obscure gastrointestinal bleeding are lacking. The aimof this porspective trial was to evaluate the diagnostic and therapeutic value of CE in long term follow up. Methods: 33 patients with obscure gastrointestinal bleeding (23 men, 10 women, mean age 61.6617.7 years) underwent CE and IOE between 02/2002-07/2003. Complete data of 29 patients were available (4 patients lost in follow up). Clinical outcome was assessed with a standartised patient questionnaire and personal communication with reffering doctors. Results: A defintive bleeding source was detected and effective traeted with argon plasma coagulation or surgical resection in 25 patients (18 angiodysplasia, 2 erosive-ulcerous lesions, 1 hemangioma, 1 Meckel’’s diverticulum, 1 ileum diverticulosis, 1 jejunal polyp, 1 lymphoma). Mean follow up was 310.3 days (range 32-553 days). Clinical signs of recurrent gastrointestinal bleeding occurred in 9 of 29 patients (1 positiv faecal occult blood test, 2 anemia, 2 red blood on stool, 2melena, 2 hematochezia). In 5 of these patients (17.2%) no further therapywas necessary, 4 patients (13.8%) needed blood transfusions (range 2-62 units). In 2 of these patients (6.9%) further endoscopic interventions (argon plasma coagulation) were necessary to controll rebleeding caused by recurrent angiodysplasias. The 4 patients without bleeding source in CE showed no signs of gastrointestinal rebleeding during follow up. Conclusion: Confirmed by our long term results Capsule Endoscopy (CE) followed by therapeutic intraoperative enteroscopy or surgical intervention is a very precise and efficiant non-invasive diagnostic procedure in patients with severe chronic gastrointestinal bleeding.