title: The use of small bowel capsule endoscopy in iron deficiency anaemia:  low impact on outcome in the medium term despite high diagnostic yield.
abstract: BACKGROUND
  Small bowel capsule endoscopy (SBCE) is a useful diagnostic modality in small bowel disorders. Iron deficiency anaemia (IDA) is one of the most common indications for SBCE. However, there are limited data on the diagnostic yield for IDA alone, and little is known about the clinical impact and long-term outcome of patients following SBCE.
  
  
  OBJECTIVE
  To determine the diagnostic yield of SBCE in IDA and to examine outcome.
  
  
  METHODS
  A retrospective review of a tertiary referral centre's database over a 21-month time period was carried out. Information on follow-up and management was obtained through chart review.
  
  
  RESULTS
  In all, 309 SBCEs were identified, 30% (n=93) for anaemia and in 70% (n=65), follow-up data were available. The small bowel diagnostic yield for IDA was 53% (n=35), including angiodysplasia 49% (n=17), nonspecific inflammation 34% (n=12), active bleeding 11% (n=4) and Crohn's disease 6% (n=2). In addition, 16% (n=10) had abnormalities (gastritis, gastric antral vascular ectasia, duodenitis) outside the small bowel. In all, 42% (n=27) were persistently anaemic after a mean follow-up of 9.3 months. Of these, 52% (n=14) and 48% (n=13) had positive and negative SBCEs, respectively. In total, SBCE led to a change in treatment in 28 patients (44%), of whom 17 (61%) remained anaemic.
  
  
  CONCLUSIONS
  This study shows a high overall diagnostic yield for SBCE in IDA 71% (n=45). Despite the majority, 53% (n=24), of patients with positive tests receiving specific treatment, 61% (n=17) remained anaemic in the long term. SBCE results were not predictive of long-term outcome even when stratified for a change in management.
authors.affiliation: Department of Clinical Medicine, Trinity College, Dublin, Ireland. grainneholleran@gmail.com
authors.forename: Grainne E
authors.initials: GE
authors.lastname: Holleran
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Barry
authors.forename: Orla J
authors.initials: OJ
authors.lastname: Thornton
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Dobson
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: McNamara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000628:therapy; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D053705:Capsule Endoscopes / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult