title: Improved diagnostic yield with severity of bleeding.
abstract: OBJECTIVE
  Video capsule endoscopy (VCE) is an important tool for non-invasive imaging of the small bowel. Whether there is a dose-related effect of anemia severity on the diagnostic yield of VCE is unknown. The aim of this study was to determine the influence of anemia severity on VCE outcome measures.
  
  
  METHODS
  VCE studies from the Sacramento Veterans Affairs Medical Center for 300 consecutive patients were retrospectively screened. Those with anemia were selected. Patients were grouped as mildly, moderately or severely bleeding. Outcomes data including completion of study, diagnostic yield and further intervention were compared.
  
  
  RESULTS
  Of the 300 patients, 210 (70%) were found to have anemia. Overall 32 (15.24%) patients were mildly, 145 (69.05%) were moderately and 33 (15.71%) were severely bleeding. The diagnostic yield was significantly higher in severe (72.73%) relative to moderate (32.41%) and mild bleeding (12.50%); P = 0.0001. Significantly more angioectasias were detected in severely bleeding patients (42.42%) than in those bleeding moderately (14.48%) and mildly (0.00%), P = 0.0001. The ability of VCE to guide further intervention was significantly higher in patients bleeding severely (69.70%, P = 0.006).
  
  
  CONCLUSIONS
  Our data showed a significant increase in diagnostic yield with the increasing degree of anemia. Relative difference in hemoglobin rather than absolute values may be a better predictor. The ability of VCE to guide further intervention reached significance in severely bleeding patients. The hypothesis that use of VCE prior to esophagogastroduodenoscopy or colonoscopy in the severely bleeding group deserves to be evaluated.
authors.affiliation: Department of Gastroenterology, UC Davis Medical Center, Sacramento, California 95817-1460, USA. dhavan15@gmail.com
authors.forename: Dhavan A
authors.initials: DA
authors.lastname: Parikh
authors.forename: Mohit
authors.initials: M
authors.lastname: Mittal
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
authors.forename: Surinder K
authors.initials: SK
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000175:diagnosis; D053704:Capsule Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies