Pan-intestinal capsule endoscopy (PCE) is increasingly recognized as a valuable diagnostic tool for patients with suspected mid-lower gastrointestinal bleeding (MLGIB). This study aimed to identify clinical predictors of significant vascular findings on PCE thatmay warrant its early application.

The study included 100 consecutive patients who underwent PCE for suspected MLGIB. The primary indications were iron deficiencyanemia (81%) and overt bleeding (19%). Clinical data collected included laboratory results, comorbidities and regular medication.

The median age was 70 years (IQR 60–78), with 65% female, and a median Charlson Comorbidity Index 4.0 (IQR 2.0-5.0). CompletePCE was achieved in 76% of cases and 72% had adequate bowel preparation. Vascular lesions were detected in 32% of patients,primarily angioectasias, 43.7% in the colon, 34,4% in small bowel and 21.9% in both. In univariate analysis, older age, highercreatinine levels, atrial fibrillation (AF) were significantly associated with the presence of vascular lesions (p < 0.05). A multivariablelogistic regression model was constructed including variables identified as significant in univariate analysis. In the adjusted model,elevated creatinine showed a trend toward independent association (OR 4.49; 95% CI: 0.99–20.23; p = 0.051), while age (OR 1.04; p =0.164) and AF (OR 0.62; p = 0.530) were not statistically significant. The final model demonstrated an overall accuracy of 78.1%,sensitivity of 52.4%, specificity of 90.7%, positive predictive value of 73.3%, and an area under the ROC curve (AUC) of 0.79.

Since the accuracy of predicting models based on clinical features is below 80%, PCE should be used for the diagnosis of small boweland/or colonic vascular lesions in patients with suspected MLGIB, regardless of age, medication or comorbidities.