Small Bowel Malignancies in Patients Undergoing Capsule Endoscopy for Iron Deficiency Anemia

Abstract

Small bowel malignancies are rare and usually asymptomatic or symptoms are nonspecific. Therefore, small bowel tumors are difficult to diagnose. In patients with iron deficiency anemia (IDA) who have negative bidirectional endoscopy results, the small bowel may be considered the source of bleeding. However, in asymptomatic IDA patients with negative bidirectional endoscopy results, evidence supporting the routine use of capsule endoscopy (CE) is insufficient. CE can be considered in selected patients with recurrent or persistent IDA. The frequency of small bowel malignancies is low in patients undergoing CE for IDA, but the usefulness of CE for the diagnosis of small bowel malignancies in younger age groups with IDA has been reported. For patients with risk factors for small bowel malignancy, investigation of the small bowel should be considered. Efforts should be made to prevent adverse events, such as capsule retention or capsule aspiration, through meticulous history taking and endoscopic capsule delivery as necessary.

A systematic review of capsule aspiration in capsule endoscopy

“…If specific precaution plans should be made for at-risk patients, the real time viewer would be a great attribute. It shows images during ongoing examination ( 63 ) and has been used more frequently in recent years. In this review, a total of 16 capsule aspirations was identified using the real time viewer, which allowed the clinicians to investigate whether the capsule was swallowed correctly.…”

Intraoperative push enteroscopy for treatment of occult small bowel bleed due to hemorrhagic bleed and tumor: a report of two cases

“…On the other hand, CE is a noninvasive method of inspecting the entirety of the small and large intestines. The diagnostic yield of CE in adults with persistent iron deficiency anemia, as seen in Patient 2, has been reported at 66.6% [ 5 ]. Among the limitations of CE are the commonly reported poorly visualized portions of the small intestine (duodenum and proximal jejunum) and its use solely as a diagnostic tool, with the inability to sample lesions or perform therapeutic interventions [ 5 , 6 ].…”

“…Studies evaluated in Kim et al . refer to malignancies initially missed on CE, which were later identified on further imaging studies such as CT or MR enterography (CTE or MRE) [ 5 , 7 ]. With consideration for the limitations of both CE and spiral endoscopy, IOE may be a viable therapeutic intervention, particularly in a rural setting, for a patient presenting with an ongoing deep small bleed.…”

“…The diagnostic yield of IOE in small bowel bleeding is reported to be between 56 to 88%, compared with that of VCE and simple PE, 56–66.6% and 25–56%, respectively [ 5 , 8 ]. The recent retrospective single-center study by Pal et al .…”