Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;7(11):E1379-E1385.
doi: 10.1055/a-0990-9225. Epub 2019 Oct 22.

Predicting Pathology on Small Bowel Capsule Endoscopy: A Good FIT

Affiliations
Free PMC article

Predicting Pathology on Small Bowel Capsule Endoscopy: A Good FIT

Ciaran Judge et al. Endosc Int Open. .
Free PMC article

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.

Conflict of interest statement

Competing interests None

Figures

Fig. 1
Fig. 1
Findings on small bowel capsule endoscopy. Findings considered to be potential causes for suspected small bowel bleeding are shown.
Fig. 2
Fig. 2
Mean ± SEM FIT values. Mean FIT Values: Positive SBCE = 1300.8 (± 439.8 uh Hb/g); Negative SBCE = 168.6 (± 129.9 ug Hb/g). *** P  = 0.0001.
Fig. 3
Fig. 3
ROC of varying FIT values in prediction of pathology on SBCE.
Fig. 4
Fig. 4
Findings on SBCE (including outside of SB).
Fig. 5
Fig. 5
Suggested algorithm for SBCE referral based on FIT use.

Similar articles

See all similar articles

References

    1. Gerson L B, Fidler J L, Cave D R et al. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding Am J Gastroenterol 20151101265–1287.; quiz 1288 - PubMed
    1. Szold A, Katz L B, Lewis B S. Surgical approach to occult gastrointestinal bleeding. Am J Surg. 1992;163:90–93. - PubMed
    1. Tee H-P, Kaffes A J. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding. World J Gastroenterol. 2010;16:1885–1889. - PMC - PubMed
    1. Pennazio M, Arrigoni A, Risio M et al. Clinical evaluation of push-type enteroscopy. Endoscopy. 1995;27:164–170. - PubMed
    1. de Leusse A, Vahedi K, Edery J et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? Gastroenterology. 2007;132:855–862. - PubMed
Feedback