Video-capsule Endoscopy in the Etiological Diagnosis of Occult Gastrointestinal Bleeding

Introduction: The advent of Video-capsule Endoscopy (VCE) has revolutionized the exploration of the small bowel, which was previously inaccessible to conventional endoscopic procedures, and the management of unexplained anemia without gastrointestinal bleeding (GIB). The aim of this work is to evaluate the contribution of VCE in the etiological diagnosis of unexplained iron deficiency anemia.

Materials and Methods: This is a monocentric, descriptive retrospective study from June 2018 to May 2024, including patients referred for unexplained anemia without exteriorized gastrointestinal bleeding and explored by VCE type PillCam® SB3 and Capsocam SV-1.

Results: Out of 161 patients who underwent VCE, 48 (29.81%) were referred for evaluation of unexplained iron-deficiency anemia without exteriorized GIB, with a mean hemoglobin level of 6.9g/dl, the average age was 56.21 years, with a female predominance (sex ratio: 1.4). 43,75% of patients were hypertensive, 33,3% were diabetic, 20.8% were taking non-steroidal anti-inflammatory drugs, 4,16% had celiac disease, 2,08% had Crohn's disease. 16.6% had capsule retention factor. VCE found vascular lesions in 58% of cases, dominated by angiodysplasias (47.8%), followed by inflammatory and ulcerative lesions in 23% of cases, tumoral lesions in 12% dominated by submucosal tumors. There was one case of a small bowel diverticulum with mucosal ulceration. The distribution of the lesions was jejunal in 51% of cases, ileal in 30% and duodenal in 19% of cases. Gastric angiodysplasia were diagnosed in 16% of cases and cecal angiodysplasia in 4,16% of cases. the diagnostic yield of VCE in the etiological diagnosis of occult gastrointestinal bleeding was 83%.

Conclusion: Occult digestive bleeding with a normal endoscopic evaluation represents a formal indication for VCE. In our study, small bowel angiodysplasia was the most common cause, followed by inflammatory and ulcerative lesions, as well as tumoral lesions.