Introduction Background Video capsule endoscopy (VCE) is one of the main investigations of the small bowel, especially in areas that cannot be examined by conventional endoscopy. VCE is considered gold standard for investigating obscure gastrointestinal bleeding and iron deficiency anaemia (IDA).
Methods Patients who had VCE at our hospital over two separate periods of time were included. Case notes and VCE results were reviewed. In between the two time periods patency capsule became available at the hospital and new BSG guidelines for management of IDA were published. We compared the two time periods for indication with particular reference to adherence to the IDA guidelines, and capsule retention.
Results 233 patients were identified, 48% (n = 111) male and 52% (n = 122) female. Median age (range) was 51 years (7- 94) with majority 30- 80 years.
Indications IDA was the commonest indication for VCE (52.3%), followed by exclusion of inflammatory bowel disease (IBD) (21%). No difference was seen in referral patterns for IDA despite the IDA guidelines.
Findings The most common finding overall was angioectasia (39.4%), of which 71% had IDA as indication. IBD was diagnosed in 4.2%. In cases of IDA, angioectasia was the most common finding (56%). There were no significant differences in findings between the two years studied. Non-steroidal anti-inflammatory drugs (NSAIDs) were more commonly used by patients referred with IDA (p = 0.009) but did not have an effect on the VCE result.
Patency capsule was available only for the second period. It was performed in 22 (18.6% of referrals) cases. More than half of them were referred to investigate IBD; 11 VCEs were excluded on the basis of patency capsule result. The other 11 went on to have VCE. Capsule retention was documented in three cases overall (1.3%), one of them had prior patency capsule. Two of them passed the capsule without surgical intervention, and the third case was lost to follow up.
Conclusion VCE is most commonly used to investigate obscure gastrointestinal bleeding and IDA. It is increasingly utilised for other indications such as diagnosis and assessment of IBD and coeliac disease. BSG guidelines for management of IDA recommend VCE only in certain groups of patients. We could significantly reduce VCE workload and resource requirements by adhering more closely to these guidelines.
Patency capsule has opened the door to patients with potential strictures and probably increases opportunity to visualise the small bowel in Crohns disease particularly. However passage of the patency capsule does not 100% rule out VCE retention.
Disclosure of Interest None Declared.