Pranav S. Nair, BS1, Muhammad Saad Faisal, MD2, Suraj Suresh, MD2, Syed Ahmad Adil, MD3, Renieh M. Nabaty, MD2 1Wayne State School of Medicine, Detroit, MI; 2Henry Ford Health, Detroit, MI; 3Henry Ford Health, Shelby Township, MI Introduction: Iron deficiency anemia (IDA) is a common nutritional deficiency and a significant cause of morbidity. When initial evaluation with esophagogastroduodenoscopy (EGD) and colonoscopy fails to identify a gastrointestinal (GI) bleeding source, video capsule endoscopy (VCE) offers a non-invasive method to visualize the small intestine, a region inaccessible by standard endoscopy. VCE is effective in detecting lesions such as angiodysplasias, ulcers, and tumors. This study examines the diagnostic yield, lesion characteristics, and subsequent management in patients with IDA who underwent VCE after negative EGD and colonoscopy. Methods: A retrospective case-control study was conducted on 157 patients with IDA who underwent VCE between January 2020 and December 2024 following negative bidirectional endoscopy. Clinical data included demographics, comorbidities, medications, labs, transfusion history, and VCE findings. Patients were stratified by VCE result (positive vs. negative), and downstream management was assessed. Results: Of 157 patients, 95 (60.5%) had positive VCE findings. The mean age was 69.4 years; 58% were female. Common comorbidities included hypertension (80%), cardiovascular disease (73%), and diabetes (46%). Mean hemoglobin was 8.2 g/dL; ferritin 22.2 ng/mL; iron 30.7 µg/dL. Patients were frequently on NSAIDs (55%), PPIs (76%), and antithrombotic agents (52%). Most patients (81%) had prior blood transfusions (mean 6.7 units), and 43% received iron infusions. VCE most frequently revealed arteriovenous malformations (41%), active bleeding (23%), and inflammatory lesions (15%), often in the proximal small bowel (41%). Follow-up endoscopy, typically push enteroscopy, was performed in 54% of patients. Comparing positive and negative VCE groups, there were no significant differences in baseline demographics, comorbidities, medication use, or labs (Table 1). However, positive cases were associated with higher rates of follow-up endoscopy (54% vs. 11%, p < 0.001) and less observation-only management (15% vs. 56%, p < 0.001). Positive cases also trended toward greater transfusion needs (mean 6.7 vs. 3.6 units, p = 0.06). No adverse events were reported. Discussion: VCE demonstrates a meaningful diagnostic yield in patients with iron deficiency anemia and non-diagnostic EGD/colonoscopy. Findings often reveal actionable lesions and guide management. These results support integrating VCE into diagnostic algorithms for unexplained IDA.
Figure: Figure 1. Distribution of Lesion Types and Anatomical Locations Identified on Video Capsule Endoscopy (VCE) in Patients with Iron Deficiency Anemia. Figure 1A illustrates the types of findings detected on VCE among patients with iron deficiency anemia and prior negative EGD/colonoscopy. Arteriovenous malformations (41%), active bleeding (23%), and inflammatory lesions (15%) were the most common. Figure 1B shows the anatomical locations of these findings, with the majority located in the proximal small bowel (41%), followed by the mid-to-distal small bowel (20%) and stomach (13%).
Figure: Table 1. Baseline Characteristics, VCE Findings, and Management in Patients with Iron Deficiency Anemia Undergoing Video Capsule Endoscopy. This table summarizes clinical characteristics, laboratory values, medication use, transfusion history, VCE findings, and subsequent management strategies for study subjects. Data is presented as number (percentage) for categorical variables and mean ± standard deviation for continuous variables.
Disclosures: Pranav Nair indicated no relevant financial relationships. Muhammad Saad Faisal indicated no relevant financial relationships. Suraj Suresh indicated no relevant financial relationships. Syed Ahmad Adil indicated no relevant financial relationships. Renieh Nabaty indicated no relevant financial relationships.
Pranav S. Nair, BS1, Muhammad Saad Faisal, MD2, Suraj Suresh, MD2, Syed Ahmad Adil, MD3, Renieh M. Nabaty, MD2. P0837 - A Swallow Away from the Source: Diagnostic Insights From Capsule Endoscopy in Iron Deficiency Anemia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
