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The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract.
Endoscopy. 2006 Nov; 38(11):1127-32.E

Abstract

INTRODUCTION

Despite undergoing standard endoscopic diagnostic evaluation with eosophagogastroduodenoscopy and ileocolonoscopy, up to 30% of patients with iron deficiency anemia (IDA) have no definitive diagnosis. The aim of this study was to prospectively investigate the role of wireless capsule endoscopy (WCE) in detecting lesions of the small bowel in patients with unexplained IDA after a negative endoscopic work-up.

PATIENTS AND METHODS

Between 1 December 2003 and 31 December 2004, 253 consecutive patients who had been referred because of unexplained IDA underwent eosophagogastroduodenoscopy with small-bowel biopsies and ileocolonoscopy. Endoscopic and histological investigations were negative in 51 of these patients (20.2%) and WCE was performed. Air double-contrast enteroclysis was performed following WCE in all these patients.

RESULTS

Wireless capsule endoscopy revealed one or more small-bowel lesions that were considered to be a likely cause of the IDA in 29/51 patients (57%): angiodysplasias in twelve patients (23.5%), multiple jejunal and/or ileal ulcers in six patients (11.7%), multiple erosions in four patients (7.8%), a solitary ulcer in three patients (5.9%), polyps in two patients (3.9%), and tumors in two patients (3.9%). Enteroclysis revealed abnormal findings likely to cause IDA in only 6/51 patients (11.8%): multiple ileal ulcers in three patients (5.9%), tumors in two patients (3.9%), and polyps in one patient (1.9%) (enteroclysis VS. WCE, P < 0.0001). WCE revealed all of the radiographic findings and no adverse events were observed.

CONCLUSIONS

This study demonstrates the importance of investigating the small bowel with WCE in patients with unexplained IDA after negative standard endoscopic evaluation. Wireless capsule endoscopy is superior to enteroclysis for detecting lesions of the small bowel in patients with unexplained IDA and should be the next diagnostic test of choice after unremarkable standard endoscopic evaluation.

Authors+Show Affiliations

Department of Gastroenterology, Army Share Fund (NIMTS) Hospital, Athens, Greece. periklisapo@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17111335

Citation

Apostolopoulos, P, et al. "The Role of Wireless Capsule Endoscopy in Investigating Unexplained Iron Deficiency Anemia After Negative Endoscopic Evaluation of the Upper and Lower Gastrointestinal Tract." Endoscopy, vol. 38, no. 11, 2006, pp. 1127-32.
Apostolopoulos P, Liatsos C, Gralnek IM, et al. The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy. 2006;38(11):1127-32.
Apostolopoulos, P., Liatsos, C., Gralnek, I. M., Giannakoulopoulou, E., Alexandrakis, G., Kalantzis, C., Gabriel, P., & Kalantzis, N. (2006). The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy, 38(11), 1127-32.
Apostolopoulos P, et al. The Role of Wireless Capsule Endoscopy in Investigating Unexplained Iron Deficiency Anemia After Negative Endoscopic Evaluation of the Upper and Lower Gastrointestinal Tract. Endoscopy. 2006;38(11):1127-32. PubMed PMID: 17111335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. AU - Apostolopoulos,P, AU - Liatsos,C, AU - Gralnek,I M, AU - Giannakoulopoulou,E, AU - Alexandrakis,G, AU - Kalantzis,C, AU - Gabriel,P, AU - Kalantzis,N, PY - 2006/11/18/pubmed PY - 2007/3/23/medline PY - 2006/11/18/entrez SP - 1127 EP - 32 JF - Endoscopy JO - Endoscopy VL - 38 IS - 11 N2 - INTRODUCTION: Despite undergoing standard endoscopic diagnostic evaluation with eosophagogastroduodenoscopy and ileocolonoscopy, up to 30% of patients with iron deficiency anemia (IDA) have no definitive diagnosis. The aim of this study was to prospectively investigate the role of wireless capsule endoscopy (WCE) in detecting lesions of the small bowel in patients with unexplained IDA after a negative endoscopic work-up. PATIENTS AND METHODS: Between 1 December 2003 and 31 December 2004, 253 consecutive patients who had been referred because of unexplained IDA underwent eosophagogastroduodenoscopy with small-bowel biopsies and ileocolonoscopy. Endoscopic and histological investigations were negative in 51 of these patients (20.2%) and WCE was performed. Air double-contrast enteroclysis was performed following WCE in all these patients. RESULTS: Wireless capsule endoscopy revealed one or more small-bowel lesions that were considered to be a likely cause of the IDA in 29/51 patients (57%): angiodysplasias in twelve patients (23.5%), multiple jejunal and/or ileal ulcers in six patients (11.7%), multiple erosions in four patients (7.8%), a solitary ulcer in three patients (5.9%), polyps in two patients (3.9%), and tumors in two patients (3.9%). Enteroclysis revealed abnormal findings likely to cause IDA in only 6/51 patients (11.8%): multiple ileal ulcers in three patients (5.9%), tumors in two patients (3.9%), and polyps in one patient (1.9%) (enteroclysis VS. WCE, P < 0.0001). WCE revealed all of the radiographic findings and no adverse events were observed. CONCLUSIONS: This study demonstrates the importance of investigating the small bowel with WCE in patients with unexplained IDA after negative standard endoscopic evaluation. Wireless capsule endoscopy is superior to enteroclysis for detecting lesions of the small bowel in patients with unexplained IDA and should be the next diagnostic test of choice after unremarkable standard endoscopic evaluation. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/17111335/The_role_of_wireless_capsule_endoscopy_in_investigating_unexplained_iron_deficiency_anemia_after_negative_endoscopic_evaluation_of_the_upper_and_lower_gastrointestinal_tract_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2006-944736 DB - PRIME DP - Unbound Medicine ER -