Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia

Abstract

Introduction Despite the widespread use of small-bowel capsule endoscopy (CE), there is still limited data on its utility and effectiveness for the diagnosis and management of patients with iron-deficiency anemia (IDA). Aim To assess the diagnostic yield of CE and the factors predicting positive findings in patients with IDA. Methods Patients with unexplained IDA and negative upper and lower endoscopy were included. A positive diagnostic yield was considered when CE diagnosed one or more lesions that could explain the IDA. Sex, age, NSAID consumption, blood transfusion requirement, and ferritin and hemoglobin levels were recorded. Results In total, 120 CE were included (mean age 58.5 years; F/M 82:38). Mean hemoglobin levels were 9 g/dL and mean ferritin levels were 15.7 ng/mL. Positive findings were present in 50 % of patients. The most frequent was angiodysplasia (45 %). Despite several baseline variables being significantly associated with positive findings, using a logistic regression model, it was verified that male sex (OR 3.93; 95 %CI 1.57 – 9.86), age (OR 1.03; 95 %CI 1.00 – 1.06), and hemoglobin levels (OR 0.73; 95 %CI 0.57 – 0.94) were the variables having an independent effect on the probability of obtaining positive findings. Age older than 50 years (OR 14.05; 95 %CI 1.69 – 116.23) and male sex (OR 3.63; 95 %CI 1.29 – 10.17) were the variables which increased the risk of diagnosing angiodysplasia. Conclusions CE is a useful technique in patients with IDA. To improve its yield, it is necessary to select patients carefully. Male sex, older age, and low hemoglobin levels were associated with a risk of positive finding in this group of patients. The risk of diagnosing angiodysplasia increased with male sex and older age.

Clinical Impact of Small Bowel Capsule Endoscopy in Obscure Gastrointestinal Bleeding

“…Some studies reported that increased age may predict a higher diagnostic yield with SBCE [ 15 ], a characteristic not confirmed by our study. Another reported factor which may predict the ability of SBCE to detect small bowel pathology in OGIB (including IDA) was the use of anticoagulants [ 4 , 16 ], which was confirmed by our study.…”

Development of a scoring system to predict a positive diagnosis on video capsule endoscopy for suspected small bowel bleeding

“…Our findings are consistent with several prior studies evaluating the risk factors predictive of identifying a culprit lesion on capsule endoscopy exams performed for the indication of suspected small bowel bleeding [14À17]. A recent retrospective study of 120 capsule exams demonstrated that age and low hemoglobin levels were major predictive factors of a positive diagnosis on capsule endoscopy [14]. Very similar to our findings, a study of 1000 patients with obscure gastrointestinal bleeding showed that age greater than 60 years old, low hemoglobin, overt bleeding, and current hospitalization were all independent predictors for identifying a bleeding source on capsule endoscopy [18].…”

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

“…The certainty of evidence was very low due to high risk of bias (selection bias due to inclusion of symptomatic patients and patients referred to specialty centers for CE). [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123] Additionally, in a recent study that followed 93 patients with IDA for more than 5 years, no small bowel malignancies were identified. 124 However, the comparative efficacy of CE in IDA remains undefined.…”