Iron deficiency anemia (IDA) is a common problem worldwide. The initial workup usually involves performing a bidirectional endoscopy. When negative, the small bowel could be the source of obscure gastrointestinal bleeding presenting as IDA. The next best diagnostic test is uncertain. Wireless capsule endoscopy (WCE) is a non-invasive new technology that allows examination of the entire small bowel. Methods: We designed a randomized controlled pilot study to outline the challenges for conducting a full randomized controlled trial (RCT) to determine if WCE should be first-line investigation in such cases. 109 patients were enrolled; 55 intervention (WCE) & 54 controls (standard of care) (SC). Results: Two-years post-randomization there was no difference in anemia between the two groups. Conclusion: Few methodological hurdles for conducting a full RCT were identified.