Clin Endosc.  2020 Nov;53(6):719-726. 10.5946/ce.2019.149.

Positive Fecal Occult Blood Test is a Predictive Factor for Gastrointestinal Bleeding after Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A Korean Multicenter CAPENTRY Study

Affiliations
  • 1Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
  • 3Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
  • 4Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
  • 5Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
  • 7Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
  • 8Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
  • 9Department of Internal Medicine, Hallym University College of Medicine, Hwasung, Korea
  • 10Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Abstract

Background/Aims
Capsule endoscopy (CE) is recommended as the primary method for the evaluation of unexplained anemia. This study aimed to assess the diagnostic yield of CE in patients with unexplained iron deficiency anemia (IDA) without overt bleeding, and to evaluate their long-term outcomes and related clinical factors.
Methods
Data of patients who underwent CE for the evaluation of IDA were reviewed from a CE registry in Korea. Additional clinical data were collected by the involved investigators of each hospital through a review of medical records.
Results
Among a total of 144 patients, the diagnostic yield of CE was 34%. Gastrointestinal (GI) bleeding was found in 6.3% (n=9) of the patients (occult bleeding in four patients and overt bleeding in five patients) during a mean follow-up of 17.8 months. Patients with a positive fecal occult blood test (FOBT) result at the initial diagnosis had a higher rate of GI bleeding after CE (p=0.004). In addition, a positive FOBT result was the only independent predictive factor for GI bleeding (hazard ratio, 5.30; 95% confidence interval, 1.41–19.85; p=0.013).
Conclusions
Positive FOBT is a predictive factor for GI bleeding during follow-up after CE in patients with unexplained IDA without overt bleeding. Thus, patients with positive FOBT need to be more closely followed up.

Keyword

Capsule endoscopy; Fecal occult blood test; Gastrointestinal bleeding; Iron deficiency anemia; Predictive factors

Figure

  • Fig. 1. Flowchart of the study subjects. CE, capsule endoscopy; EGD, esophagogastroduodenoscopy; FOBT, fecal occult blood test; IDA, iron deficiency anemia.

  • Fig. 2. Kaplan–Meier curve showing the cumulative gastrointestinal (GI) bleeding rate according to fecal occult blood test (FOBT) result.


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