Introduction Iron deficiency anaemia (IDA) is a common problem seen by gastroenterologists and a key aim in its investigation is the diagnosis or exclusion of malignancy. Currently the BSG guidelines (under review) only suggest small bowel imaging if there is an inadequate response to iron therapy post non-diagnostic upper and lower gastrointestinal endoscopy1 .The aim of this study was to review the role of capsule endoscopy (CE) in the investigation of IDA, with a focus on the detection of neoplasms.
Method All CEs done over a 4 year period at a medium sized district general hospital for recurrent IDA or obscure GI bleeding (158 of a total of 372) were reviewed. The results were divided into neoplastic findings, clinically significant but non neoplastic findings and insignificant or normal findings. For those cases that detected a potential neoplasm, electronic records were reviewed to ascertain the final diagnosis.
Results 158 CEs were reviewed. The patients had an age range of 13 to 91 with a median age of 68. 88 of the patients were women and 70 men. Of these 158, 8 (5.1%) were found to have a potential neoplasm, 123 (77.8%) were found to have clinically significant but non neoplastic findings, 27 (17.1%) were found to have insignificant or normal findings.
Of the 8 that were found to have a suspected neoplasm; 1 was a tumour in the third part of the duodenum, 1 was a caecal tumour, 2 were Gastro Intestinal Stromal Tumours (GIST), 1 was a neurofibroma, 2 had non-malignant findings (duplication cyst and small bowel Crohn’s disease) and 1 (ileal neuroendocrine tumour) is still undergoing investigation.
Of the other significant pathology detected;Angioectasia was the primary diagnosis in 98 (62%), small bowel Crohns in 14 (8.7%), NSAID enteropathy in 7 (4.4%) and Miscellaneous causes in 4 (2.5%).
This series has a detection rate of 2.5% (4 out of 158) for small bowel tumours. 2 tumours were found in males and 2 in females with a median age of 67.
The tumour detection rate of 2.5% is significantly higher than a series from Edinburgh that had a tumour detection rate of 0.4%2.
Conclusion In our series the diagnostic yield of CE for IDA is 82.9%. 2.5% were diagnosed with malignancy. While small bowel tumours are rare our experience suggests that they are more common than previous data suggests.
CE is a beneficial tool in the investigation of IDA with negative bi-directional endoscopies, particularly in the investigation for malignancy.
. Guidelines for the Management of Iron Deficiency Anaemia A F Goddard et al, on behalf of the British Society of Gastroenterology; Gut2011;60:1309–1316
. SMALL BOWEL MALIGNANCY IN PATIENTS UNDERGOING CAPSULE ENDOSCOPY IN A TERTIARY CARE ACADEMIC INSTITUTION; C Johnston et al; GUT; June 2016Volume 7Supplement 1; 10.1136/gutjnl-2016-312388.98
Disclosure of Interest None Declared
- capsule endoscopy
- Iron Deficiency Anaemia