Pan-enteric video capsule endoscopy in hereditary haemorrhagic telangiectasia: gastrointestinal manifestations and feasibility

Background and aims Gastrointestinal telangiectasias are a recognised manifestation of hereditary haemorrhagic telangiectasia (HHT), but data on their nature and distribution throughout the entire gastrointestinal tract are limited. We aimed to evaluate gastrointestinal disease manifestations using pan-enteric video capsule endoscopy (VCE) and to assess its applicability in patients with HHT. Methods In this cross-sectional study, patients aged ≥50 years with confirmed HHT residing in the Region of Southern Denmark were invited to undergo pan-enteric VCE. Telangiectatic lesions were recorded according to anatomical location and lesion burden. Feasibility outcomes included patient acceptance, completion rate, mucosal visibility, and transit times. Associations between active gastrointestinal bleeding and haemoglobin concentration were analysed using multivariable linear regression. Results Of 52 eligible patients, 28 underwent VCE. One examination was lost due to technical failure, leaving 27 recordings available for analysis. Telangiectatic lesions were identified in 96.3% of evaluable examinations and were predominantly located in the stomach (74%) and proximal small bowel (81.5%). Active bleeding was observed in 14.8% of patients, only in the upper gastrointestinal tract, and was independently associated with lower haemoglobin concentrations (β −2.84 g/dL, 95% CI −4.69 to −1.00; p = 0.004). Seven examinations (25.9%) were incomplete, and colonic mucosal visibility was frequently suboptimal. No capsule retention or procedure-related complications occurred. Conclusion Pan-enteric VCE demonstrated widespread gastrointestinal involvement in HHT, predominantly in the proximal gastrointestinal tract. Although active bleeding was infrequent, it was associated with lower haemoglobin levels. Practical limitations suggest that the role of pan-enteric VCE in routine evaluation of HHT requires further clarification.