Pan-intestinal Capsule Endoscopy Versus Colonoscopy in Iron Deficiency Anemia or Overt GI Bleeding
Pan-intestinal Capsule Endoscopy Versus Colonoscopy in Iron Deficiency Anemia or Overt GI Bleeding
The authors hypothesize that in patients with iron deficiency anemia or gastrointestinal
 bleeding, pan-intestinal capsule endoscopy is a safe and well tolerated procedure that may
 improve diagnostic yield comparatively to the current standard invasive colonoscopy.
Patients presenting with iron deficiency anemia (IDA) or overt GI bleeding are often
 submitted to conventional upper GI endoscopy and colonoscopy, followed by small bowel capsule
 endoscopy if diagnosis remains elusive. Recently, however, the possibility of performing
 pan-intestinal endoscopy using a video capsule that evaluates both the small bowel and the
 colon in a single non-invasive examination, opens new perspectives for the management of
 those conditions, particularly when the initial upper GI endoscopy has been non-diagnostic.
 The authors hypothesize that performing early pan-intestinal capsule endoscopy strategy may
 allow, in a safe and well tolerated manner, to identify which patients would benefit of
 further interventions, such as colonoscopy or invasive enteroscopy, guided by findings
 pre-identified at capsule examination. The study aims to evaluate whether pan-intestinal
 capsule endoscopy is superior to the current standard strategy of conventional colonoscopy
 after non-diagnostic upper endoscopy in patients with IDA or overt GI bleeding, regarding
 diagnostic yield, safety and tolerability.
Inclusion Criteria:

 -  Patients from external consultation, hospital ward or urgency department, with
 suspected GI bleeding presenting in the occult form as IDA (Hb <12.0 g/dL in female
 gender or <13.0 g/dL in male gender) and/or overt GI bleeding presenting as melaena
 and/or haematochezia, and with prior non-diagnostic upper GI endoscopy
 (esophagogastroduodenoscopy, EGD)

 Exclusion Criteria:

 1. Lack of informed consent

 2. Suspected lesions at index EGD that could justify the anemia or digestive bleeding

 3. Known history of gastroparesis or bowel dysmotility

 4. Known or suspected intestinal stricture

 5. Female patients with potential gynaecological source of bleeding causative of the
 clinical condition

 6. Patients with severe malnutrition

 7. Patients unable to walk at least for short periods and/or with neurological and/or
 psychiatric condition potentially favouring protocol deviations

 8. Allergy or contra-indications to any of the drugs or products used in the study

 9. Pregnancy or breastfeeding