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Small bowel and nutrition
Original research
Clinical outcomes in frail elderly patients undergoing small-bowel capsule endoscopy
  1. Rebecca K Grant1,
  2. Alexander R Robertson2,
  3. Kirsty A Lennon1,
  4. Eksha Gupta1,
  5. Ursula E Walton1,
  6. Ross J Porter1,
  7. Niall T Burke1,
  8. Solomon Ong1,
  9. Atul Anand3,
  10. Sarah Douglas1,
  11. Alice Corbett1,
  12. William M Brindle4,
  13. Rahul Kalla1,
  14. John N Plevris1
  15. on behalf of Edinburgh GI Audit and Research (EGAR) Collaborative
  1. 1The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Department of Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
  4. 4Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  1. Correspondence to Dr Rebecca K Grant; rebecca.grant9{at}nhs.scot

Abstract

Objective Small-bowel capsule endoscopy (SBCE) is being used with increasing frequency. It is important, however, to ensure that the frail elderly in particular are undergoing investigations which have a positive impact on their ongoing management. We aimed to determine the SBCE rate in the elderly, the clinical outcomes, and if clinical frailty may be used to tailor SBCE.

Design/methods Patients aged ≥65 who had a SBCE performed at the Royal Infirmary of Edinburgh from 1 January 2016 to 1 December 2021 were identified. Demographic, clinical and SBCE results were collected and statistical analysis was performed.

Results In total, 189 patients aged ≥65 years underwent SBCE. Median age at SBCE was 72 years (IQR 68–76); 63.0% (n=119) were women. The most common indication for SBCE was iron-deficiency anaemia (n=174, 92.1%).

A total of 15.9% (n=30) patients were clinically frail (Clinical Frailty Scale ≥5). Frail patients had reduced survival at 1 (p=0.003), 3 (p<0.001) and 5 (p<0.0001) years post-SBCE. The most common pathology in this group was angioectasia (33.3%, n=10). Double balloon enteroscopy was performed in 1 frail patient, compared with 11 non-frail patients (p=0.488).

Conclusions Our results indicate that small bowel bleeding in the frail elderly is most likely to be associated with angioectasia. Given the high mortality at follow-up and risks of subsequent investigations in this group, conservative treatment with oral or parenteral iron may be more appropriate. Investigating these patients with SBCE is unlikely to alter management and clinical outcome.

  • SMALL BOWEL ENTEROSCOPY
  • SMALL BOWEL DISEASE
  • ENDOSCOPY
  • ANGIODYSPLASIA

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/flgastro-2024-102746

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @rebeccakg6, @@Alexoscopy, @@kirsty_lennon, @@Porterrj0, @@rahul_kalla, @@john_plevris

    • Contributors RKG contributed to data collection and drafted the manuscript. JP, RK and ARR conceived the work. KAL, EG, UEW, RJP, NTB and SO contributed to data collection and critically reviewed the manuscript. ARR, AA, SD, AC, WMB and RK critically reviewed the manuscript. JP was the senior author and critically reviewed the manuscript for important intellectual content. RKG is the guarantor of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RJP has received support from Edinburgh and Lothian’s Health Care Trust and The Pathological Society, in addition to travel grants from Dr Falk and Janssen. RKG, ARR, KAL, EG, UEW, NTB, SO, AA, SD, AC, WMB, RK and JP have no competing interests to declare.

    • Provenance and peer review Not commissioned; externally peer-reviewed.