Endoscopy 2019; 51(05): 409-418
DOI: 10.1055/a-0750-5682
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic yield of magnetically assisted capsule endoscopy versus gastroscopy in recurrent and refractory iron deficiency anemia

Hey-Long Ching
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Melissa F. Hale
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Matthew Kurien
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Jennifer A. Campbell
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Stefania Chetcuti Zammit
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Ailish Healy
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Victoria Thurston
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
John M. Hebden
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Reena Sidhu
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
,
Mark E. McAlindon
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
› Author Affiliations
TRIAL REGISTRATION: Single-center, non-randomized, prospective cohort study. NCT02282553 at clinicaltrials.gov
Further Information

Publication History

submitted 21 May 2018

accepted after revision 31 August 2018

Publication Date:
25 October 2018 (online)

Abstract

Background Small-bowel capsule endoscopy is advocated and repeat upper gastrointestinal (GI) endoscopy should be considered for evaluation of recurrent or refractory iron deficiency anemia (IDA). A new device that allows magnetic steering of the capsule around the stomach (magnetically assisted capsule endoscopy [MACE]), followed by passive small-bowel examination might satisfy both requirements in a single procedure.

Methods In this prospective cohort study, MACE and esophagogastroduodenoscopy (EGD) were performed in patients with recurrent or refractory IDA. Comparisons of total (upper GI and small bowel) and upper GI diagnostic yields, gastric mucosal visibility, and patient comfort scores were the primary end points.

Results 49 patients were recruited (median age 64 years; 39 % male). Combined upper and small-bowel examination using the new capsule yielded more pathology than EGD alone (113 vs. 52; P < 0.001). In upper GI examination (proximal to the second part of the duodenum, D2), MACE identified more total lesions than EGD (88 vs. 52; P < 0.001). There was also a difference if only IDA-associated lesions (esophagitis, altered/fresh blood, angioectasia, ulcers, and villous atrophy) were included (20 vs. 10; P = 0.04). Pathology distal to D2 was identified in 17 patients (34.7 %). Median scores (0 – 10 for none – extreme) for pain (0 vs. 2), discomfort (0 vs. 3), and distress (0 vs. 4) were lower for MACE than for EGD (P < 0.001).

Conclusion Combined examination of the upper GI tract and small bowel using the MACE capsule detected more pathology than EGD alone in patients with recurrent or refractory IDA. MACE also had a higher diagnostic yield than EGD in the upper GI tract and was better tolerated by patients.