Long-term impact of capsule endoscopy in patients referred for iron-deficiency anemia

Video capsule endoscopy (VCE) is recommended as the third diagnostic test for patients with iron-deficiency anemia (IDA) after a normal upper endoscopy and colonoscopy.

To study long-term outcomes after VCE in patients with IDA.

We performed a retrospective study of VCE studies performed at Stanford University Hospital or the VA Palo Alto Health Care System from 2002 to 2006. We assessed endoscopic or radiographic procedures performed post-CE and contacted patients by telephone in order to determine current medical status and potential resolution of anemia since the VCE.

We invited 153 patients to participate, and 82 (54%) patients agreed to enroll including 57 patients with IDA and 25 patients with overt gastrointestinal bleeding. The overt group received more transfusions pre-CE (P < 0.05). The mean follow-up time was 36 +/- 16 months (median 33 months, range 14-67) in the IDA referral group and 40 +/- 16 months (median 39 months, range 17-69) in the overt bleeding group (P = 0.3). Positive findings on VCE were detected in 35 (60%) and 15 (60%) patients in the IDA referral and overt groups, respectively (P= 1.0). Of the 35 patients in the IDA referral group with significant VCE findings, 15 underwent therapeutic procedures, while 20 were managed conservatively. Over the mean follow-up period, 23% of the IDA referral group and 22% of the overt group remained anemic (P = 0.30).

Most patients referred for VCE examination to evaluate IDA were no longer anemic at 36 months of follow-up, with or without therapeutic intervention.