Introduction Capsule endoscopy (CE) is increasingly being used to investigate iron deficiency anaemia (IDA) when bi-directional endoscopy does not find a cause although current guidelines do not recommend routine small intestinal investigation unless symptoms or recurrent/refractory IDA.1 The aim of this study was to review the use of CE in the investigation of IDA over a two year period in a medium sized DGH following the creation of a new CE service.
Methods Electronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Indication for CE was recorded along with the result of the investigation. Clinic letters were reviewed to assess the impact of CE on patient management.
Results Over the study period 97 CE procedures were performed. Fifty (52%) procedures were performed to investigate IDA, 34 (35%) for investigation of possible or known Crohn’s disease; 4 (4%) for polyposis and 9 (9%) for other indications.
Of the 50 CE procedures for IDA, 18 (36%) showed abnormalities in the small bowel; these included polyps (28%), vascular lesions (33%) and ulcers (28%). No malignancy was found over the 2 year period although one large (3 cm) polyp exhibited high grade dysplasia. Thirteen procedures (26%) showed gastroduodenal pathology but no small bowel abnormality. There was no difference between the mean ages of patients with normal compared to abnormal small bowel CE findings (56.9 years old vs 57.6 years old).
In 8 of the 18 cases (44%) where small bowel abnormalities were found there was a subsequent change in patient management; this included surgery to remove polyps, endoscopic treatment of vascular lesions and medication changes. Thirty-eight patients (76%) were discharged from clinical follow up following CE with advice to continue long-term iron supplementation; this included 8 patients with abnormalities seen at CE.
Conclusion Over a third of patients undergoing CE to investigate IDA were found to have small bowel pathology. However less than half of these findings resulted in significant management changes. In total CE findings altered clinical management in only 16% of patients although it did allow 76% of patients to be discharged from further clinical follow-up. Clincal factors such as age did not appear to predict the presence of small bowel pathology. As a result, the role and timing of CE in the investigation of IDA remains uncertain.
Reference 1 Guidelines for the management of iron deficiency anaemia. Goddard, et al. on behalf of the British Society of Gastroenterology 2011.
Disclosure of Interest None Declared