Small bowel capsule endoscopy for obscure gastrointestinal bleeding not associated with a reduction in iron or haemoglobin support

Abstract

Background: In obscure gastrointestinal bleeding (OGIB), capsule endoscopy has a high diagnostic yield, but its impact on clinically important outcomes such as rebleeding rates and transfusion requirements remains uncertain. This study aimed to investigate the effect of capsule endoscopy on red cell concentrate (RCC) transfusion and intravenous (IV) iron prescriptions in patients with OGIB.

Methods: We conducted a retrospective study and identified patients undergoing capsule endoscopy for OGIB from an endoscopy database at a tertiary teaching hospital. Data were collected on patient demographics, capsule findings, post-capsule invasive interventions, number of RCC units issued, IV iron prescriptions, and survival two years post-capsule. Data on RCC and IV iron were collected for a period of two years before and two years after capsule endoscopy for each patient. The primary outcome was comparison of RCC and IV iron quantities before and after capsule endoscopy. Secondary outcomes included the comparison of RCC and IV iron quantities based on the capsule result and the application of invasive interventions.

Results: Between January 2011 and December 2018, 96 patients who underwent capsule endoscopy for OGIB were enrolled, with a median age of 64.5 years (interquartile range [IQR] 35–80) and 57% (55/96) being female. Of the patients, 71 received RCC, with 337 units issued before the capsule (mean 4.7 units/patient) and 167 units issued post-capsule (mean 2.4 units/patient), representing a 49% decrease. Sixty-four patients received IV iron with 100 scripts before the capsule (mean 1.6/patient) and 140 scripts postcapsule (mean 2.2/patient), representing a 38% increase. During the post-capsule period, patients with a positive capsule received more RCC (2.7 vs. 1.9 units/patient) and more IV iron (2.3 vs. 1.9 scripts/patient) than those with a negative capsule; however, the differences were not statistically significant. Double balloon enteroscopy (DBE) was performed in 34% of patients (18/53) with a positive capsule, and the quantities of RCC and IV iron did not differ based on the application of this intervention. Patient survival at two years post-capsule was 92% (88/96).

Conclusion: In the two years after capsule endoscopy, RCC transfusions decreased by 49%, and IV iron scripts increased by 38%, suggesting an ongoing requirement for haemoglobin or iron level support.