The yield of the video capsule endoscopy in the diagnosis and management of occult gastrointestinal bleeding

Aims Since the launch of the video capsule endoscopy (VCE) 20 years ago, it became the first line procedure for exploring the small bowel as it was previously inaccessible to conventional endoscopic procedures. Therefore, it has revolutionized the management of patients with unexplained iron deficiency anemia and without gastrointestinal bleeding (GIB).

This study aims to assess the diagnostic contribution of VCE in determining the causes of unexplained iron deficiency anemia.

Methods This is a monocentric, descriptive retrospective study over a period of 6 years, from June 2018 to May 2024, including patients referred for unexplained anemia without exteriorized gastrointestinal bleeding and explored by VCE type PillCam SB3 and Capsocam SV-1. All our patients underwent a clinical and biological examination, upper and lower endoscopy with biopsy. The preparation used was PEG (2 L the day before and 0.5 L after ingestion of the capsule) with clear broth the day before the examination. Patients needed 10 days discontinuation of oral iron if taken.

Results Out of 161 patients who underwent VCE, 48 (29.81%) were referred for evaluation of unexplained iron-deficiency anemia without exteriorized GIB, the average age was 56.21 years, with a female predominance (sex ratio: 1.4). 43,75% of patients were hypertensive, 33,3% were diabetic, 20.8% were taking non-steroidal anti-inflammatory drugs, 4,16% had celiac disease, 2,08% had Crohn's disease. 16.6% had capsule retention factor. The mean hemoglobin level was 6.9 g/dl (range 3 – 10 g/dL). VCE found vascular lesions of the small intestine in 58% of cases, dominated by angiodysplasias in 47.8% of cases, red spots were noted in 4 cases (8.3%) and phlebectasis was noted in 3 cases (6.25%). Inflammatory and ulcerative lesions of the small intestine were observed in 23% of cases, including 3 cases of ulcerative lesions caused by NSAIDs, 2 cases of Crohn's disease. In addition, non-typical inflammatory and ulcerative lesions were observed in 5 cases (10.41%). Tumoral lesions were noted in 12% of cases, of which 6.25% were submucosal tumors. There was one case of a small intestine diverticulum with mucosal ulceration and one case of celiac disease The distribution of the lesions was jejunal in 51% of cases, ileal in 30% and duodenal in 19% of cases. Gastric angiodysplasia were diagnosed in 16% of cases and cecal angiodysplasia in 4,16% of cases.

Conclusions VCE is at the forefront for the diagnosis of occult digestive bleeding with a normal endoscopic findings. In our study, small bowel angiodysplasia was the most common cause, followed by inflammatory and ulcerative lesions, as well as tumoral lesions

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025