Yield of Wireless Capsule in the Evaluation of Patients with Obscure Gastrointestinal Bleeding

Abstract

Purpose: The purpose of this study was to explore the yield of wireless capsule endoscopy (CE) in Hispanic Veterans with obscure gastrointestinal bleeding (OGIB). OGIB represents 5–10% of all gastrointestinal bleeds and the small bowel is the presumed source in many cases. CE is the latest diagnostic modality for small bowel evaluation but has never been studied in Hispanic veterans from Puerto Rico. Methods: From May 2003 to December 2004, 41 endoscopic capsules were performed for the evaluation of obscure gastrointestinal bleeding. We retrospectively reviewed the records and CE findings of these patients. Results: The medical records and endoscopic capsule findings of 38 men and 2 females veterans were reviewed. 98% of the population was Hispanic and 2% Caucasian, with a mean age of 71 years of age (range 48–88). The indications for wireless capsule endoscopy were anemia (85%), positive fecal occult blood testing (FOBT) (10%) and overt gastrointestinal bleeding (10%). Significant findings were found in 83% of the CE (34/41). Angiectasia was the most common finding and was present in 71% (29/41) of the patients. The proportion of angiectasias increased by more than 2/3 after age 58 and was significantly higher in patients above 71 years of age (p < 0.018). Distal ileum ulcerations were found in 8% of patients (3/40). Patients with anemia were more likely to have angiectasias, ulcers, polyps and mucosal changes, these associations were statistically significant (p < 0.001). The sole presence of positive FOBT did not correlate with any capsule endoscopic finding. Conclusions: CE yielded significant small bowel findings that were useful for reassurance and directing course of management. A marked increase in telangiectasias after age of 58 years of age was noted in this population. A similar population could not be found in the literature for comparison of results. Thus, CE should be considered in US Veterans from Puerto Rico with persistent OGIB particularly in the presence of anemia.