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Interventional gastroenterology

By Mardi Chapman

28 Jan 2023

The diagnostic performance of video capsule endoscopy (VCE) in patients presenting with iron deficiency anaemia (IDA) is acceptable in an Australian regional setting and comparable to internationally reported data, Queensland figures show.

The retrospective review comprised 123 VCE procedures performed at a private regional gastroenterology practice in Toowoomba from March 2017 to April 2020. The adult patients had laboratory-proven IDA and a negative bidirectional endoscopy in the 12-months prior to VCE.

VCE was performed using the Pillcam SB3 and analysed using the Medtronic rapid reader software by an experienced gastroenterologist.

The study, published in BMC Research Notes, found the diagnostic yield of VCE was 54.5% – 67 of 123 procedures delivering 116 positive findings considered clinically significant and the likely cause of IDA.

The most common finding within the small bowel was angiodysplasia (53.7%) followed by ulceration/significant erosion (26.8%), fresh blood (20.8%) and tumour/polyp (16.4%).

Of the 35 lesions detected outside the small bowel, 28 (80.0%) were detected within reach of standard upper endoscopy.

The study authors, from Logan Hospital and Griffith University, said the high rate of missed lesions highlights the importance of the initial endoscopic assessment.

“This is particularly relevant for rural patients who encounter increased logistical and financial barriers to pursuing specialist services such as VCE,” they wrote.

“The results of this study may support the claim for second look endoscopy prior to VCE suggested by others.”

The researchers found a statistically significant association between mean haemoglobin and positive findings on VCE but not between ferritin levels and positive findings.

“Low haemoglobin is thought to indicate greater or more persistent blood loss over time and thus lesions detectable on VCE,” they said.

Previously reported findings that older age and male gender were factors associated with increased diagnostic yield were not supported by the study.

“Concomitant anticoagulant/antiplatelet therapy, NSAID use, increased small-bowel transit time, history of overt bleeding and various comorbidities have also been associated with diagnostic yield, however, were not found to predict yield in this study.”

“Future studies should focus on these parameters to further identify patient’s most likely to benefit from VCE.”

They concluded that patients with severe anaemia, as reflected by haemoglobin level, were more likely to have positive findings on VCE and should be referred as a priority.

“The high proportion of findings within reach of conventional endoscopy also emphasises the importance of the initial endoscopic assessment and second-look endoscopy prior to VCE in resource limited settings.”

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