PWE-101 capsule endoscopy in octogenarians

Abstract

Introduction In 2014, our centre reported experience showing a high diagnostic yield (DY) of capsule endoscopy (CE) in octogenarians, although sinister lesions were rare and little change in management was made2. Based on our subsequent experience, this study seeks to establish if this still holds true. Methods A prospectively-maintained CE database of patients who underwent CE from 2005–2017 was interrogated for patients>80 years old. Data were extracted on CE indications, findings and outcomes. The capsule examination was considered to have DY if the findings accounted for the patient’s presentation. Results 164 CE procedures were performed in 150 patients≥80 years, mean age 84.1 years (range 80.0–96.2, 99F/65M). Indications for CE were iron deficiency anaemia (IDA) (82), obscure gastrointestinal bleeding (OGIB) (63), possible IBD (6), suspected malignancy/lymphoma (4) and others (10). 12 (8%) underwent more than 1 CE. 23 were excluded with incomplete data. 5 patients died of unrelated pathologies over the study period. The overall DY of CE in this cohort was 75/141 (53.2%). The findings were: angioectasias (46), small bowel masses (10, including polyps and nodular bleeding lesions), portal hypertensive/NSAID/other enteropathies (9), small bowel inflammation (3), small bowel varices (2), GAVE (2), duodenal ulcer (1) and caecal bleeding (1). 59/141 (41.8%) patients had normal CE findings; another 7/141 (4.9%) had findings of unclear clinical significance. Of the 10 (7.1%) patients with possible small bowel masses seen on CE, 5 were not followed up due to frailty and the presence of more likely causes of IDA/OGIB (e. g. significant gastritis). 2 underwent double-balloon enteroscopy with no lesion found. 1 patient was felt likely to have inflammatory bowel disease and treated. 1 patient had repeat CE with similar benign appearances and was discharged. Only 1 patient had a suspicious-looking obstructive and bleeding lesion; he returned to Australia and underwent follow-up there. There were 7 patients≥90 years old. All underwent CE for OGIB/IDA. 3 patients had angioectasias with active bleeding; 2 were treated with APC and one managed conservatively. 1 patient had small duodenal angioectasias of unclear significance. In 2 patients, the small bowel was normal but gastric ulcers/significant gastritis were deemed the likely cause of blood loss. There was 1 oesophageal retention with no further CE. Conclusion In this age group, 90% (145/162) were referred with IDA/OGIB, with DY 53.2%. Angioectasias were the main significant findings. However, although a gastrointestinal source of blood loss was frequently found, there was rarely a change to management required, advisable or possible based on the CE result.