title: Use of small bowel capsule endoscopy in patients with chronic kidney disease: experience from a University Referral Center.
abstract: BACKGROUND
  There are only few reports on the diagnostic yield (DY) of small bowel capsule endoscopy (SBCE) in patients with chronic kidney disease (CKD). We aim to report our SBCE experience in patients with CKD.
  
  
  METHODS
  Retrospective study; case notes of patients with low estimated glomerular filtration rate (eGFR) who underwent SBCE (March 2005-August 2012) for anemia and/or obscure gastrointestinal bleeding (OGIB) were retrieved and abstracted. Severity of CKD was defined according to Renal Association recommendations as: stage 3 (eGFR: 30-59); stage 4 (eGFR: 15-29); and stage 5 (eGFR <15 or on dialysis).
  
  
  RESULTS
  In the aforementioned period, 69 patients with CKD [stage 3: 65/69 (92.8%), stage 4 or 5:4/69 (7.2%)] had SBCE. 51/65 (78.5%) patients with stage 3 CKD had SBCE due to unexplained anemia and/or OGIB [43 (66.1%) and 8 (12.3%), respectively]. In 25/51 (49%), the SBCE was normal and in 17/51 (33.3%) showed small-bowel angiectasias. Other findings were active bleeding (n=2), fold edema (n=2), ileal erosions (n=1), adenocarcinoma (n=1), and inconclusive/videos not available (n=3). All patients (n=4) with CKD grade 4 or 5 were referred due to unexplained anemia; 3/4 (75%) had angiectasias and 1 normal SBCE. Fecal calprotectin (FC) was measured in 12 patients with CKD stage 3 and unexplained anemia prior to their SBCE; no significant small-bowel inflammation was found in this subgroup.
  
  
  CONCLUSIONS
  SBCE has limited DY in CKD patients referred for unexplained anemia. Sinister SB pathology is rare, while the most common finding is angiectasias. Furthermore, FC measurement prior to SBCE -in this cohort of patients- is not associated with increased DY.
authors.affiliation: Medical School, The University of Edinburgh (Emily Docherty, John N. Plevris), Scotland, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Docherty
authors.affiliation: Endoscopy Unit, Center for Liver and Digestive Disorders, The Royal Infirmary Edinburgh (Anastasios Koulaouzidis, Sarah Douglas, John N. Plevris), Scotland, UK.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Koulaouzidis
authors.affiliation: Endoscopy Unit, Center for Liver and Digestive Disorders, The Royal Infirmary Edinburgh (Anastasios Koulaouzidis, Sarah Douglas, John N. Plevris), Scotland, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Douglas
authors.affiliation: Medical School, The University of Edinburgh (Emily Docherty, John N. Plevris), Scotland, UK ; Medical School, The University of Edinburgh (Emily Docherty, John N. Plevris), Scotland, UK.
authors.forename: John N
authors.initials: JN
authors.lastname: Plevris
keywords: Keywords Capsule endoscopy; anemia; chronic kidney disease; fecal calprotectin; obscure gastrointestinal bleeding