Introduction Anaemia is a common complication of chronic renal failure (CRF). The cause of the anaemia is often multifactorial including erythropoietin deficiency, uraemic platelet dysfunction, absolute iron deficiency anaemia (IDA) and overt bleeding (OB). Capsule endoscopy (CE) has developed an important role in the investigative pathway of obscure gastrointestinal bleeding (OGB). We conducted a study to evaluate the utility of CE in such patients after negative bidirectional endoscopies and their subsequent management consequences.
Methods We retrospectively reviewed our data set and isolated patients with OGB and CRF. This data set was scrutinised to elucidate demographics, factors that increase yield and their subsequent management.
Results Of the 1324 patients investigated, 4.1%(n = 54) had CRF. The mean age was 68 years (range = 37–86) and males consisted of 56% of the new cohort (n = 33). The indications for CE was IDA in 61%(n = 33) of patients and OB in the remaining 39%. The majority 89%(n = 48) of patients had significant other co-morbidity which included cardiovascular (13), diabetes (10), haematological (8), cancers (7), respiratory disease (7) and chronic liver disease (3). 3 patients were on warfarin and 4 patients were transfusion dependent. The diagnostic yield (as defined by lesions responsible for OGB) identified on CE was 48%(n = 26). Angioectasia was the commonest diagnosis identified in 33% of patients (n = 18). Other findings were ulcers and erosions 22%(n = 12), fresh blood without a definite bleeding site 17%(n = 9), strictures in 7%(n = 4), whilst crohns and polyps were seen in 2%(n = 1) each respectively. CE identified significant lesions within the upper gastrointestinal tract in 19%(n = 10) of patients. There was no significant difference in the diagnostic yield between those with IDA and OB (p = 0.53) and between the sexes (p = 0.76). Management was altered in 44%(n = 24) of those with a positive yield, in the form of further procedures (48%, n = 12). These procedures included push-enteroscopies 58%(n = 7), double balloon enteroscopies 25%(n = 3) and 3 OGDs. In the same group, argon photocoagulation therapy was applied to 83%(n = 10) of patients.
Conclusion CE has a high diagnostic yield in patients with CRF with a positive outcome on subsequent management. Small bowel angioectasia is the commonest finding. CE should be considered in the work up of patients with CRF and OGB.
Disclosure of Interest None Declared.
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