Abstract
Small bowel malignancies are rare and usually asymptomatic or symptoms are nonspecific. Therefore, small bowel tumors are difficult to diagnose. In patients with iron deficiency anemia (IDA) who have negative bidirectional endoscopy results, the small bowel may be considered the source of bleeding. However, in asymptomatic IDA patients with negative bidirectional endoscopy results, evidence supporting the routine use of capsule endoscopy (CE) is insufficient. CE can be considered in selected patients with recurrent or persistent IDA. The frequency of small bowel malignancies is low in patients undergoing CE for IDA, but the usefulness of CE for the diagnosis of small bowel malignancies in younger age groups with IDA has been reported. For patients with risk factors for small bowel malignancy, investigation of the small bowel should be considered. Efforts should be made to prevent adverse events, such as capsule retention or capsule aspiration, through meticulous history taking and endoscopic capsule delivery as necessary.
Highlights
Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal (GI) tract without an obvious etiology after negative bidirectional endoscopy [1,2]
We reviewed the role and diagnostic yield of capsule endoscopy in patients with iron deficiency anemia (IDA)
We investigated the frequency of small bowel malignancies detected through capsule endoscopy (CE) in patients with IDA, and briefly reviewed the adverse events associated with CE
Summary
Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal (GI) tract without an obvious etiology after negative bidirectional endoscopy In patients presenting with overt OGIB, capsule endoscopy (CE) should be performed to evaluate the small bowel [4]. In patients with occult blood in the stool but without anemia, advanced examination beyond bidirectional endoscopy is not recommended [5]. In the 2015 ESGE guidelines, the fecal occult blood test was not recommended as a screening tool to decide whether to perform small bowel CE [6]. In patients with IDA, bidirectional endoscopy to evaluate the GI tract should generally be the first examination [7]. If the bidirectional endoscopy results are negative, the small bowel can be considered the source of bleeding. In such cases, the use of CE is common in clinical practice [8]. We investigated the frequency of small bowel malignancies detected through CE in patients with IDA, and briefly reviewed the adverse events associated with CE
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