Predicting pathology on small bowel capsule endoscopy: a good FIT

Abstract

Background and study aims Small bowel capsule endoscopy [SBCE) has an established role in investigating suspected small bowel bleeding [SSBB). Identification of a biomarker to predict pathology would maximize utility of this valuable diagnostic modality. This study aimed to investigate if fecal immunochemical test [FIT) could predict likelihood of small bowel pathology on SBCE. Patients and methods Patients referred for SBCE to investigate anaemia or suspected small bowel bleeding were prospectively recruited. All patients had negative upper and lower endoscopy prior to referral. A FIT ≥ 45 ug Hb/g was considered positive. SBCE was positive if a potential source of SSBB was identified. The primary endpoint was correlation between FIT and positive SBCE. Secondary endpoints were correlation between anemia and SBCE and a combination of anemia plus FIT and SBCE. Results Fifty-one patients were included in the final study cohort. 29.4 % had a positive FIT, 33.3 % were anemic, and 25.5 % patients had significant SBCE findings. There was a statistically significant association between positive FIT and pathology on SBCE (OR 12, 95 % CI [2.8 – 51.9), P = 0.001). Sensitivity and specificity of positive FIT in predicting SBCE findings were 69 % and 84 %, respectively. A normal Hb had an NPV of 83 % (OR 0.30, P = 0.09). Combining Hb and FIT was statistically significant in predicting pathology on SBCE (OR 9.14, 67 % PPV, 82 % NPV, P = 0.025). Conclusion FIT ≥ 45 ug Hb/g is a useful tool in predicting small bowel pathology on SBCE. Use of this biomarker alone, or in combination with serum haemoglobin, has value as a screening tool and may help to better triage patients referred for SBCE.

Small-Bowel Capsule Endoscopy—Optimizing Capsule Endoscopy in Clinical Practice

“…Judge et al found a statistically significant association between positive FIT (FIT >/= 45 µg Hb/g was considered positive) and pathology on SBCE (OR 12, 95% CI [2.8-51.9], p = 0.001). The sensitivity and specificity of positive FIT in predicting SBCE findings were 69 and 89%, respectively [13]. A negative FIT has also been shown to have a high negative predictive value for small-bowel lesions in this and other studies [13,14].…”

“…The sensitivity and specificity of positive FIT in predicting SBCE findings were 69 and 89%, respectively [13]. A negative FIT has also been shown to have a high negative predictive value for small-bowel lesions in this and other studies [13,14].…”

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…In recent years, new evidence has also emerged concerning the possible role of fecal occult blood testing (FOBT), either guaiac or immunochemical, as a filter test to select IDA patients for SBCE [77][78][79]. The meta-analysis by Yung et al [80] found, for all positive FOBT, sensitivity 0.60 (95 %CI 0.50-0.69), specificity 0.72 (95 %CI 0.52-0.86), and diagnostic OR 3.96 (95 %CI 1.50-10.4) for SB findings.…”

Editorial: Traversing through the small bowel and what not to miss

“…The study by Judge et al showed promise for the expanding role of Faecal immunochemical test (FIT) in the detection of small bowel lesions [16]. In this study of 51 patients, a positive FIT (≥45 μgHb/g) had a sensitivity of 69% in the detection of small bowel pathology.…”