A211 OUTCOME OF CAPSULE ENDOSCOPY IN THE SETTING OF IRON DEFICIENCY ANEMIA IN PATIENTS ABOVE AGE 65.

Iron deficiency anemia (IDA) is a common indication for a capsule endoscopy (CE), which is often offered after a negative bidirectional endoscopy. Since malignancy is a concern in the older population with IDA, upper and lower endoscopic exams are typically performed. If these tests are negative, a CE study may be offered to evaluate the small intestine. However, choosing the ideal candidates who will benefit from a CE study is challenging. To assess the outcomes for CE in patients with IDA over age 65 and which factors are more likely to contribute to a positive result. A retrospective review of all CE studies at St. Paul’s Hospital from 01/10-06/16 was conducted after ethics approval. Inclusion: age>65, hemoglobin<120 g/dL, serum ferritin<70 mg/L, minimum 12 month follow up and at least one high quality complete EGD/colonoscopy performed prior to CE. Variables to assess factors that are more likely to contribute to a positive capsule yield included: use of anticoagulation, NSAIDs, and cardiac disease. Chi-Square test was used to determine clinical predictive factors of a positive and negative study. 1149 CE studies were reviewed of which 106 CE studies met inclusion criteria. 43 studies (40.6%) had positive findings and from this group, 26 (60.5%) recommended active intervention (i.e. EGD n=7, colonoscopy n=9, enteroscopy n=5, small bowel resection n=3, escalation of Crohn’s therapy n=2), while 17 (39.5%) were managed supportively, typically with Fe supplementation. Most negative studies (57 of 63) recommended supportive therapy (others: hematological workup n=3, hiatal hernia repair n=1, PPI initiation n=1, stop donating blood n=1). History of cardiac disease had a significant association with positive findings (0.54 vs. 0.33, p=0.039). Conversely, a known history of hiatal hernia was associated with a negative study (0.22 vs. 0.07, p=0.036). These findings suggest that the diagnostic yield of CE in IDA in patients above age 65 is relatively low. The majority of all CE studies recommended supportive therapy and/or repeat endoscopic exams (EGD/Colonoscopy) of areas previously assessed. Clinical history of cardiac disease was associated with more positive findings on CE, whereas the presence of a hiatal hernia was associated with a negative study. Emphasis on these data may help select more appropriate patients for CE. Positive CE Findings by Location (N=43) SB=Small Bowel, ICV= Ileocecal Valve, TI= Terminal Ileum St. Paul’s Hospital GI Research Institute

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