Introduction Guidelines suggest that repeat gastroscopy (OGD) and small bowel capsule endoscopy (CE) should be considered in recurrent and refractory iron deficiency anaemia (1). Upper and mid gut CE might satisfy both requirements with a single procedure. We compare the diagnostic ability of MSCE in the upper and mid gut to OGD.
Method After ingestion of 1L water with simethicone, the Mirocam Navi (Intromedic Ltd., Korea) was steered around the stomach using a handheld magnet before allowing it to pass through the small bowel. Diagnoses were compared with subsequent OGD performed within 14 days. Visibility of MSCE and patient comfort was assessed.
Results 33 patients (mean age 64±14 years, 45.5% male) underwent MSCE gastric examination for a mean of 26±11 mins before the capsule left the stomach. 39.4% of patients received sedation for OGD. MSCE visibility scores (worst-best:1–5) for greater and lesser curves, anterior and posterior body, second part of duodenum (D2) were: 4.5 (±0.8), 4.7 (±0.6), 4.5 (±0.7), 4.5 (±0.7), 4.6 (±0.8) respectively. Views of the oesophagus (2.6±2), proximal stomach (cardia, 3.2±1.7; fundus, 2.8±1.3) and the first part of the duodenum (D1, 3.4±0.9) were more challenging. 33.7% of upper GI lesions were detected by both techniques: oesophagitis (n=1), hiatus hernia (n=3), gastritis (18), pancreatic rest (n=1), active duodenal bleeding (n=1) and gastric polyps (n=3). 14% of lesions were only detected by OGD: oesophagitis (n=1), Barrett’s oesophagus (n=1), hiatus hernia (n=2), gastritis (n=1), gastric polyps (n=2) gastric angioectasia (AE, n=1), duodenitis (n=2), duodenal AE (n=2). However, MSCE identified 52.3% of all lesions that OGD missed: oesophagitis (n=1), hiatus hernia (n=3), gastritis (n=15), gastric ulcers (n=3), benign gastric polyps (n=6), gastric AE (n=4), altered blood in the stomach (n=1), gastric lymphangiectasia (n=1), suspected intestinal metaplasia (n=1), duodenitis (n=4), duodenal ulcers (n=2), duodenal AE (n=2), duodenal diverticulum (n=1). CE additionally identified normal small bowel (n=11), small bowel angioectasia (n=11), erosions (n=8), ulcers (n=2), polyps (n=2), active bleeding (n=2) and suspected small bowel varices (n=1). Pain, discomfort and distress scores for MSCE were all significantly lower than those for OGD (p<0.05).
Conclusion Both CE and OGD miss upper GI pathologies. The Mirocam Navi identifies as many upper GI pathologies as OGD in addition to small bowel pathologies as likely to contribute to IDA, without pain, discomfort or distress. This non-invasive investigative modality might reasonably be considered in patients with recurrent or refractory IDA.
. Goddard AF, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309–16.
Disclosure of Interest None Declared
- capsule endoscopy
- Iron Deficiency Anaemia