SMALL BOWEL EXPLORATION WITH CAPSULE ENDOSCOPY, DOES THE INDICATION FIT THE CLINICAL PRACTICE GUIDELINES?

Aims To assess if the indications of the capsule endoscopy made in our center adjust to the recommendations of the clinical practice guidelines (ESGE, 2015).

Methods A retrospective descriptive study of the last 50 procedures with capsule endoscopy carried out in our hospital.

Results The indication for capsule endoscopy was anemia in 35 patients (74%), obscure gastrointestinal bleeding (OGIB) 10 (20%), suspicion of Crohn’s disease 4 (8%), and polyposis syndromes 1 (2%).

Of the explorations requested for anemia, 6 of 35 patients (17%) did not have a complete previous evaluation (medical history including hematological and gynecological evaluation in premenopausal women, response to empirical iron trial, oesophagogastroduodenoscopy, and ileocolonoscopy). Of the patients who had undergone oesophagogastroduodenoscopy, 5 (15%) had gastric and duodenal biopsies.

Of the procedures requested for OGIB, all were performed during the bleeding episode, finding the cause of bleeding in 80%.

Conclusions

1. It is important a full evaluation before indicating a capsule endoscopy due to iron-deficiency anemia. In our series, gastric and duodenal biopsies were only taken in 15% of patients.

2. The capsule performed during the bleeding episode increases its diagnostic usefulness. In our series, lesions that justify the bleeding were found in 80% of patients.

3. In our center, the capsule endoscopy is underused in patients with Crohn’s disease and it is a fundamental procedure for the complete evaluation of these patients.

4. It is important that the indications for capsule endoscopy fit the clinical practice guidelines to increase its benefit, reduce costs and prevent unnecessary examinations with potential risk of complications.

Publication History

Article published online:
14 April 2022