Cross-sectional Small Intestinal Surveillance of Maintenance Hemodialysis Patients Using Video Capsule Endoscopy

Introduction: The number of maintenance hemodialysis (HD) patients has been increasing worldwide. Small intestinal pathology in HD patients has been studied only in a limited number of retrospective case series. Video capsule endoscopy (VCE) can non-invasively survey small intestinal disorders. The primary aim of this study was to investigate the prevalence of small intestinal abnormalities among asymptomatic maintenance HD outpatients by using VCE. The secondary aim was to assess the clinical impact of these abnormalities on HD patients. Methods: This study consisted of 2 phases. In phase I, a cross-sectional observational study, a cohort who received maintenance thrice-weekly HD at outpatient hemodialysis clinic was investigated using VCE. In phase II, a prospective cohort study, this cohort was scheduled to be followed for 1 year after VCE. Results: Fifty-six patients were enrolled in this study, and 2 were excluded from analysis due to capsule retention in the stomach. The prevalence of small bowel abnormalities in HD patients was 64.8% (35/54). Of 54 patients, 21 (38.9%) had mucosal lesions, 10 (18.5%) had vascular lesions, and 4 (7.4%) had both lesion types. During a 1-year follow-up period, events occurred in 4 patients. A small bowel-associated event was observed in 1 patient, who underwent laparoscopy-assisted small intestinal partial resection 3 months after diagnosis by VCE. All event groups had small bowel abnormalities; no events were observed in the VCE-negative group. Conclusion: We observed a high prevalence of small bowel abnormalities in asymptomatic outpatients receiving maintenance HD. In contrast to the present study, in which 21 of 54 patients (38.9%) had mucosal lesions, 10 (18.5%) had vascular lesions, and 4 (7.4%) had both lesion types, previous studies using retrospective analysis among symptomatic ESRD patients reported that vascular lesions were more often detected by VCE than mucosal lesions. VCE may help to predict the outcomes of maintenance HD patients.