Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy

Yung, Diana E; Rondonotti, Emanuele; Giannakou, Andry; Avni, Tomer; Rosa, Bruno; Tóth, Ervin; Lucendo, Alfredo J.; Sidhu, Reena; Beaumont, Hanneke; Ellul, Pierre; Negreanu, Lucian; Jiménez-García, Victoria Alejandra; McNamara, Deirdre; Kopylov, Uri; Elli, Luca; Triantafyllou, Konstantinos; Shibli, Fahmi; Riccioni, Maria Elena; Bruno, Mauro; Dray, Xavier; Plevris, John; Koulaouzidis, Anastasios; Argüelles-Arias, Federico; Becq, Aymeric; Branchi, Federica; Tejero-Bustos, María Ángeles; Cotter, José; Eliakim, Rami; Ferretti, Francesca; Gralnek, Ian M.; Herrerías‐Gutiérrez, Juan Manuel; Hussey, Mary; Jacobs, Maarten; Johansson, Gabriele Wurm; McAlindon, Mark E.; Montiero, Sara; Németh, Artúr; Pennazio, Marco; Rattehalli, Deepa; Stemate, Ana; Tortora, Annalisa; Tziatzios, Georgios

doi:10.1177/2050640617692501

Cited by 38 publications

(37 citation statements)

References 26 publications

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“…The certainty of evidence was very low due to high risk of bias (selection bias due to inclusion of symptomatic patients and patients referred to specialty centers for CE). [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123] Additionally, in a recent study that followed 93 patients with IDA for more than 5 years, no small bowel malignancies were identified. 124 However, the comparative efficacy of CE in IDA remains undefined.…”

Section: After Negative Bidirectional Endoscopy In Patients With Iromentioning

confidence: 99%

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

et al. 2020

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Section: After Negative Bidirectional Endoscopy In Patients With Iromentioning

confidence: 99%

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

et al. 2020

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“…In clinical practice, the performance of SBCE is formulated in terms of diagnostic yield (DY), understood as the detection rate for what are thought to be clinically significant findings [ 2 ]. Studies showed an overall DY of SBCE for OGIB of around 60%, with higher DYs in patients with active bleeding compared to those with occult bleeding, and in cases explored sooner (until 14 days) after the bleeding episode [ 6 , 7 ]. Occult bleeding is either defined by a positive fecal test or implied by IDA.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Small Bowel Capsule Endoscopy in Obscure Gastrointestinal Bleeding

et al. 2020

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Background and objectives: The most frequent indications for small bowel capsule endoscopy (SBCE) are obscure gastrointestinal bleeding (OGIB) and iron deficiency anemia (IDA). The aim of this study was to evaluate the diagnostic yield (DY) of SBCE in overt and occult OGIB, as well as its impact on the clinical outcome. Materials and Methods: This study retrospectively included all cases of OGIB investigated by SBCE in a tertiary care referral center, between 1st January 2016 and 31st December 2018. OGIB was defined by overt or occult gastrointestinal bleeding, with negative upper and lower endoscopy. Occult gastrointestinal bleeding was either proved by a fecal test or presumptively incriminated as a cause for IDA. DY was defined as the detection rate for what were thought to be clinically significant findings. DYs for overt and occult bleeding were assessed and compared. Gender, age, hemoglobin levels, NSAID consumption and the use of anticoagulants were recorded. Following SBCE results, individual therapeutic decisions were made, and follow-up data were recorded. Results: 224 SBCE examinations were performed for OGIB, of which 148 were for overt OGIB, and 76 for unexplained IDA. Positive findings were found in 139 patients, resulting in an overall DY for OGIB of 62%, higher in overt OGIB (75%) compared to IDA (37%). The most frequent findings were small bowel angioectasias (62.2% in overt OGIB and 78.5% in IDA). On multivariate logistic regression analysis, only hemoglobin level <10 g/dL and anticoagulants were the variables independently associated with positive findings. All patients received medical, endoscopic or surgical treatment and had good clinical outcome during follow-up. Conclusion: SBCE has a high diagnostic yield and a positive impact on management of patients with OGIB.

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“…Imaging modalities such as magnetic resonance enterography (MRE), intestinal ultrasound (IUS) and capsule endoscopy (CE) may provide an accurate assessment of postoperative recurrence at the anastomotic site. 7 …”

Section: Introductionmentioning

confidence: 99%

Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

Tham

Yung

Fay

et al. 2018

Therap Adv Gastroenterol

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Background:Anastomotic recurrence is frequent in patients with Crohn’s disease (CD) following ileocecal resection. The degree of endoscopic recurrence, quantified by the Rutgeerts score (RS), correlates with risk of clinical and surgical recurrence. Several studies demonstrate the accuracy of fecal calprotectin (FC) for detection of endoscopic recurrence, however the optimal threshold FC value remains to be established. The aim of our meta-analysis was to evaluate the accuracy of common FC cut-offs for detection of endoscopic recurrence.Methods:We performed a systematic literature search for studies evaluating postoperative recurrence in CD which reported RS and FC levels. Endoscopic recurrence was defined as RS = 2–4 (or RS ⩾ 2). We calculated pooled diagnostic sensitivity, specificity, diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic (SROC) curves for each available FC cut-off value.Results:A total of 54 studies were retrieved; 9 studies were eligible for analysis. Diagnostic accuracy was calculated for FC values of 50, 100, 150 and 200 µg/g. A significant threshold effect was observed for all FC values. The optimal diagnostic accuracy was obtained for FC value of 150 µg/g, with a pooled sensitivity of 70% [95% confidence interval (CI) 59–81%], specificity 69% (95% CI 61–77%), and DOR 5.92 (95% CI 2.61–12.17). The area under the SROC curve was 0.73.Conclusion:FC is an accurate surrogate marker of postoperative endoscopic recurrence in CD patients. The FC cut-off 150 μg/g appears to have the best overall accuracy. Serial FC evaluations may eliminate or defer the need for colonoscopic evaluation in up to 70% of postoperative CD patients.

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Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy

Abstract: In IDA patients ≤50 years with negative bidirectional GI endoscopy, overall DY of SBCE for clinically significant findings was 32.3%. Some 5% of our cohort was diagnosed with SB neoplasia; lower MCV or weight loss were associated with higher DY for SB pathology.

Cited by 38 publications

References 26 publications

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

Clinical Impact of Small Bowel Capsule Endoscopy in Obscure Gastrointestinal Bleeding

Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

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