Indications and Outcomes of Video Capsule Endoscopy in Sub-Saharan Africa: A 5-Year Single-Center Experience in Nairobi, Kenya.

Abstract

Background: Utilization of video capsule endoscopy (VCE) for the evaluation of small bowel disease is limited in Africa. The predominant causes of gastrointestinal disease in this region are infectious, but the prevalence of inflammatory bowel disease and malignancies is rising. We sought to evaluate the indications and outcomes of VCE in sub-Saharan Africa. Methods: We conducted a retrospective study at an outpatient gastroenterology center in Nairobi, Kenya. Data collected included demographics of the study population, procedure indication, prior investigations, findings, and complications of VCE. Descriptive statistics were used to analyze the results, and statistical analysis of association was performed using Fischer's exact test; a p value of less than 0.05 was considered significant. Results: A total of 72 patients underwent VCE from January 2017 to April 2022. The mean age was 59.1 years (range: 15-91); 61.7% were males. A total of 97.2% of the patients had a preceding upper and lower endoscopy. The indications were obscure gastrointestinal bleeding (GIB) in 51.4%, anemia (15.5%), abdominal pain (25.4%), altered bowel habits (23.9%), weight loss (9.9%), and suspected Crohn's disease (7.0%). The overall diagnostic yield was 77.1% and included angiodysplasia (14%), duodenitis (10.7%), mass/polyps (8.9%), suspected intestinal tuberculosis (7.1%), and helminths (2.8%). Angiodysplasia was the most common cause of GIB, accounting for 35.3% and 35.0% of occult and overt bleeding, respectively. Capsule retention occurred in 2 patients (2.8%). Conclusions: There are similarities in indications and preceding workup in our cohort compared to existing literature from Western and Asian countries. Infectious causes of GIB were unique to our study.