Indications for and diagnostic yield of capsule endoscopy in the elderly. / Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano.

INTRODUCTION AND AIMS: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.

Push-enteroscopy series: diagnostic and therapeutic efficacy.

OBJECTIVE: To analyse the diagnostic efficacy of oral push-type enteroscopy (PE) according to indications. To assess evolution in patients with occult gastrointestinal bleeding (OGIB) according to findings and endoscopic therapy. METHODS: 204 PE performed in 167 patients: OGIB: 117, Crohn's disease: 34, radiological abnormalities: 21; chronic diarrhoea: 12; intestinal sub-occlusion: 11; polyposis: 7; other: 2. We followed clinical outcome in 72 patients after PE for OGIB. They were separated according to findings and endoscopic therapy: no findings: 32; no treated angiodysplasia: 10; treated angiodysplasia: 20; other lesions: 10. We evaluated the number of admissions and transfusional requirements before and after PE, re-bleeding and surgical treatment. Statistics were performed using Student's t test and Chi-square test (statistical significance p < 0.05). RESULTS: We diagnosed lesions in 65.8% PE for OGIB, angiodysplasia being the more frequent finding (33.3%). We found lesions before Treitz in 15.4% A higher diagnostic efficacy was seen in active bleeding (83.4%) versus anaemia (52.2%), p < 0.05. After PE both admissions and transfusional requirements decreased in all subgroups specially in treated angiodysplasias and other lesions, nearly reaching statistical significance (p = 0.07). Re-bleeding occurred in 50% of non-treated lesions versus 20-25% in treated lesions. We found lesions in 47% of PE for Crohn's disease, in 52.4% for radiological abnormalities, in 41.6% for chronic diarrhoea and in 0% for intestinal sub-occlusion. CONCLUSIONS: PE is efficient in the diagnosis and therapy of patients with OGIB, Crohn's disease and radiological abnormalities. Its usefulness is controversial in the study of chronic diarrhoea and intestinal sub-occlusion.