The use of small-bowel capsule endoscopy in iron-deficiency anemia alone; be aware of the young anemic patient

Scand J Gastroenterol. 2012 Sep;47(8-9):1094-100. doi: 10.3109/00365521.2012.704938. Epub 2012 Aug 2.

Abstract

Background & aim: The role of Small-Bowel Capsule Endoscopy (SBCE) in Iron Deficiency Anemia (IDA) alone is still under validation. We aim to assess the usefulness of SBCE in patients with IDA alone.

Methods: Retrospective study; patients with IDA (no GI symptoms or known previous diagnosis), who underwent SBCE were included. SBCE findings were classified as clinically significant/sinister (small-bowel malignancy, significant/sinister inflammation and/or strictures and coeliac disease) or vascular, i.e., signifcant/angioectasias (P1/P2 lesions).

Results: A total of 221 (151F/70M) patients had SBCE for IDA as the sole indication. The diagnostic yield (DY) was 30.7% (68/221). The DY for significant/sinister pathology and significant/angioectasias was 9% and 21.7%, respectively. In those ≤ 40 years (20; 13F/7M), significant pathology was found in 25% (5/20); in the >40-year group (201; 138F/63M), significant/sinister pathology was found in 7.5% (15/201), p = 0.0231. None of the patients ≤40 years had angioectasias, such lesions were found in 48/201 (21.7%) of those >40 years, p = 0.009. Fifty percent of those >80 years (16; 12F/4M) had angioectasias, but none had significant/sinister pathology (p = 0.0126). On multiple regression analysis, only prior blood transfusion was predictive of higher DY in SBCE.

Conclusions: IDA alone is one of the main indications (27%) for referral to SBCE; the majority of patients are >40 years. In our cohort, the DY of SBCE for IDA was 30.7% and the commonest finding was angioectasias. The detection rate of sinister small-bowel pathology for those >40 years is low decreasing to zero in the >80 age group. In contrast, 25% of those ≤40 years had a sinister diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / etiology*
  • Capsule Endoscopy*
  • Celiac Disease / complications
  • Celiac Disease / diagnosis
  • Chi-Square Distribution
  • Constriction, Pathologic / complications
  • Constriction, Pathologic / diagnosis
  • Enteritis / complications
  • Enteritis / diagnosis
  • Female
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Intestinal Neoplasms / complications
  • Intestinal Neoplasms / diagnosis*
  • Intestine, Small / pathology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Statistics, Nonparametric
  • Telangiectasis / complications
  • Telangiectasis / diagnosis