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• W2806796025 abstract "We read with interest the letter by Sidhu et al, and we thank them for sharing their findings. In our analysis,1Koulaouzidis A. Rondonotti E. Giannakou A. et al.Diagnostic yield of small-bowel capsule endoscopy in patients with iron-deficiency anemia: a systematic review.Gastrointest Endosc. 2012; 76: 983-992Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar we found that the pooled diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) in 1960 patients who underwent SBCE for iron deficiency anemia (IDA) was 47%. Interestingly, the pooled DY of SBCE in studies that focused solely on patients with IDA (n = 264) was 66.6%. Recently, we showed that IDA alone remains one of the main indications for referral to SBCE and that the majority of patients are older than 40 years.2Koulaouzidis A. Yung D.E. Lam J.H. et al.The use of small-bowel capsule endoscopy in iron-deficiency anemia alone: be aware of the young anemic patient.Scand J Gastroenterol. 2012; 47: 1094-1100Crossref PubMed Scopus (37) Google Scholar In smaller cohorts (n = 93), investigators reported a DY as high as 53%.3Holleran G.E. Barry S.A. Thornton O.J. et al.The use of small bowel capsule endoscopy in iron deficiency anaemia: low impact on outcome in the medium term despite high diagnostic yield.Eur J Gastroenterol Hepatol. 2013; 25: 327-332Crossref PubMed Scopus (25) Google Scholar The Edinburgh experience is that the DY of SBCE for IDA (n = 221) is 30.7% and that the commonest finding was angioectasias—findings similar to those of Sidhu et al. Furthermore, in our experience, the detection rate of sinister small-bowel pathology for those older than 40 is low, decreasing to zero in those over 80. Angioectasias were found in none of the 20 patients 40 years old and younger, and in only 5 of 65 (7.7%) patients 50 years old and younger. By contrast, 25% of those 40 years old and younger had a sinister diagnosis.2Koulaouzidis A. Yung D.E. Lam J.H. et al.The use of small-bowel capsule endoscopy in iron-deficiency anemia alone: be aware of the young anemic patient.Scand J Gastroenterol. 2012; 47: 1094-1100Crossref PubMed Scopus (37) Google Scholar Recently, the Sheffield group have also reported their experience in the utility of SBCE for patients with IDA and those under 50 years of age.4Sidhu P.S. McAlindon M.E. Drew K. et al.The utility of capsule endoscopy in patients with iron deficiency anaemia under 50 years: is the juice worth the squeeze?.Gut. 2013; 62: A287Crossref Google Scholar In their cohort, the mean age was 40 years (range, 17 - 49 years). Angioectasias were detected in 10% (n = 27) of this patient group. Furthermore, significant diagnoses were found in this age group, including erosions and ulcers in 71 patients (26%), small-bowel (SB) angioectasias in 27 (10%), SB tumors in 7, Crohn's disease in 7, SB bowel strictures in 3, and SB varices in 2. Therefore, we strongly agree with the Sheffield group that CE should be considered in the management pathway of patients under 50 years and that further consideration should be given to amend relevant guidelines accordingly.5Goddard A.F. James M.W. McIntyre A.S. et al.Guidelines for the management of iron deficiency anaemia.Gut. 2011; 60 (1309e-16)Crossref PubMed Scopus (496) Google Scholar Diagnostic yield of small-bowel capsule endoscopy in patients with iron deficiency anemia: does it affect management?Gastrointestinal EndoscopyVol. 78Issue 5PreviewWe read with interest the systematic review by Koulaouzidis et al,1 who alluded that the validity of small-bowel capsule endoscopy in patients with iron deficiency anemia (IDA) alone remains limited. They found that studies focusing solely on IDA had a diagnostic yield of 66%, and significant findings included vascular (31%), inflammatory (17.8%), and mass and/or tumor (7.95%) lesions. We would like to share our findings. From a cohort of 1324 patients with obscure GI bleeding who underwent small-bowel capsule endoscopy, we identified 971 patients (73%) with IDA. Full-Text PDF" @default.
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