Introduction Video capsule endoscopy (VCE) is appropriate for patients with iron deficiency anaemia (IDA) who do not respond to oral iron replacement following normal upper and lower gastrointestinal endoscopy.1Terminal ileal (TI) intubation at the time of colonoscopy has a significant diagnostic yield in patients with IDA.2 Bidirectional endoscopy without ileoscopy may miss significant lesions later noted by VCE.
Method This study aimed to identify what proportion of patients had TI pathology within the reach of the colonoscope and to assess whether ileo-colonoscopy would have prevented the need for VCE.
Patients with VCEs for IDA at a single site between Jan 2009 – Dec 2014 were identified. Data were collected retrospectively, including previous colonoscopy findings and extent, VCE findings and subsequent colonoscopy findings.
Results 120 patients were identified, of which only 28 (23.3%) had TI intubation at colonoscopy. 5/28 (17.9%) demonstrated TI pathology at colonoscopy (4 ulceration, 1 inflammation). 23/28 (82.1%) had normal TI at initial colonoscopy, but 3 of these patients had ulceration in TI on VCE.
11 (9%) patients had TI pathology on VCE (6 normal TI, 4 TI ulceration, 1 TI inflammation), possibly within reach of ileo-colonoscopy. All 11 patients had undergone colonoscopy prior to VCE- 8/11 to TI, 5 of which were abnormal. Of those who had positive ileo-colonoscopy findings, VCE changed management in 2 additional cases (40%).
3 patients with TI pathology on VCE had not undergone ileo-colonoscopy. 1/3 (33.3%) of these patients was found to have a definite TI abnormality at subsequent ileo-colonoscopy and was treated for Crohn’s.
A cause for IDA was found at VCE in 37/120 patients overall (30.8%). 29/109 (26.6%) VCEs with no TI pathology revealed a cause for IDA, compared with 8/11 (72.7%) where TI pathology was found.
Conclusion In this cohort, only 5/37 (13.5%) of cases of IDA would have been diagnosed by ileo-colonoscopy and only one capsule endoscopy avoided by ileoscopy being performed. These data suggest that ileo-colonoscopy should be performed in cases of IDA but should not alter plans for VCE. A further prospective study is planned.
Disclosure of interest None Declared.
Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60:1309-16
Neilson LJ, Bevan R, Panter S, et al. Terminal ileal intubation and biopsy in routine colonoscopy practice. Expert Rev Gastroenterol Hepatol. 2015 Jan 12:1-8. (accessed online 18/02/2015)