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Small bowel capsule endoscopy for obscure gastrointestinal bleeding not associated with a reduction in iron or haemoglobin support

Year: 2025
Type: article
Study design: Observational Study
Abstract: BackgroundOGIB accounts for 10-20% of cases of gastrointestinal (GI) bleeding and is traditionally defined as bleeding of unknown origin that persists or recurs after negative initial bidirectional endoscopy evaluation. 1 The small bowel is the most common site of bleeding in these patients.2 The endoscopic examination of the small bowel and investigation of OGIB was revolutionised with the advent of wireless capsule endoscopy.3 Clinically significant lesions are diagnosed in 40-60% of small bowel capsule endoscopy procedures, with small bowel angiodysplasia being the most common lesion detected.[4][5][6] Not infrequently, capsule endoscopy also identifies clinically significant lesions outside the small bowel.7 Due to the obscure nature of bleeding and the often-benign underlying pathology, patients with OGIB tend to require repeated RCC transfusion or chronic iron replacement.Despite initial optimism, studies have observed that the improved diagnostic yield with capsule endoscopy may not necessarily translate into improved clinical outcomes in patients with OGIB.One randomised trial of 136 patients showed no significant differences in rebleeding rates, subsequent transfusions, or hospitalisations between patients undergoing capsule endoscopy versus dedicated small bowel contrast radiography after a 12-month observation period.8 A retrospective study of capsule endoscopy in patients with iron deficiency showed a high rate of persisting anaemia in the long term in both positive and negative capsule patients, despite the former receiving a change in management.9 Despite the availability of capsule endoscopy in South Africa for many years, there is no published data on the yield or outcomes of this investigation.This retrospective study aimed to determine the impact of capsule endoscopy on RCC transfusions and IV iron prescriptions in patients with OGIB. MethodsThe study was conducted within the GI unit of a university teaching hospital in South Africa.Most capsule endoscopy referrals originate from medical and surgical departments within the hospital, with a smaller number referred from secondarylevel health facilities in the province.We identified patients who Background: In obscure gastrointestinal bleeding (OGIB), capsule endoscopy has a high diagnostic yield, but its impact on clinically important outcomes such as rebleeding rates and transfusion requirements remains uncertain.This study aimed to investigate the effect of capsule endoscopy on red cell concentrate (RCC) transfusion and intravenous (IV) iron prescriptions in patients with OGIB. Methods:We conducted a retrospective study and identified patients undergoing capsule endoscopy for OGIB from an endoscopy database at a tertiary teaching hospital.Data were collected on patient demographics, capsule findings, post-capsule invasive interventions, number of RCC units issued, IV iron prescriptions, and survival two years post-capsule.Data on RCC and IV iron were collected for a period of two years before and two years after capsule endoscopy for each patient.The primary outcome was comparison of RCC and IV iron quantities before and after capsule endoscopy.Secondary outcomes included the comparison of RCC and IV iron quantities based on the capsule result and the application of invasive interventions.Results: Between January 2011 and December 2018, 96 patients who underwent capsule endoscopy for OGIB were enrolled, with a median age of 64.5 years (interquartile range [IQR] 35-80) and 57% (55/96) being female.Of the patients, 71 received RCC, with 337 units issued before the capsule (mean 4.7 units/patient) and 167 units issued post-capsule (mean 2.4 units/patient), representing a 49% decrease.Sixty-four patients received IV iron with 100 scripts before the capsule (mean 1.6/patient) and 140 scripts postcapsule (mean 2.2/patient), representing a 38% increase.During the post-capsule period, patients with a positive capsule received more RCC (2.7 vs. 1.9 units/patient) and more IV iron (2.3 vs. 1.9 scripts/patient) than those with a negative capsule; however, the differences were not statistically significant.Double balloon enteroscopy (DBE) was performed in 34% of patients (18/53) with a positive capsule, and the quantities of RCC and IV iron did not differ based on the application of this intervention.Patient survival at two years post-capsule was 92% (88/96). Conclusion:In the two years after capsule endoscopy, RCC transfusions decreased by 49%, and IV iron scripts increased by 38%, suggesting an ongoing requirement for haemoglobin or iron level support.
DOI: 10.36303/sajgh.2894
Language: English
Field: Medicine
Open Access status: hybrid
OpenAlex ID: W4413995161
FWCI:
Cites: 14
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Related to: 10