DDW 2018: 12-Hour Video Capsule Endoscopy Improves Small Bowel Evaluation Over the 8-Hour Device in Hospitalized Patients With Obscure Gastrointestinal Bleed
June 5, 2018—Washington, DC—In the evaluation of obscure gastrointestinal bleed, 12-h video capsule endoscopy has been associated with more frequent successful visualization of the entirety of hospitalized patients' small intestine than the 8-h device.
This outcome of a retrospective chart review was presented at Digestive Disease Week (DDW) 2018, from June 2 – 5.
Christopher Kasia, MS, of Loyola University Medical Center, Maywood, Illinois, explained that video capsule endoscopy is used to evaluate obscure gastrointestinal bleeding in hospitalized patients. Incomplete study, however, resulting in inadequate evaluation of the small bowel and treatment delay, limits its use.
Video capsule endoscopy with an extended recording time of 12 h was introduced recently at the same cost of the 8-h device.
Mr. Kasia and colleagues set out to determine whether a prolonged recording duration improved the success rate. They also identified risk factors for incomplete studies.
In a single tertiary care medical center, the records of hospitalized patients who underwent 8- or 12-h video capsule endoscopy to evaluate obscure gastrointestinal bleeding between 2014 and 2017 were studied.
Patient age, gender, history of diabetes, inpatient opiate use, history of bowel obstruction, history of abdominal surgery, method of capsule delivery, adequacy of bowel preparation after 1 gallon of polyethylene glycol 3350 and electrolytes, and indication for video capsule endoscopy were assessed for these patients.
Of a total of 191 video capsule endoscopies, 151 were with 8- and 40 were with 12-hour video capsule endoscopy. A statistically significantly higher completion rate was observed with 12- vs 8-hour video capsule endoscopy (92% vs 78%, P = .04, odds ratio 3.45).
Patients who received 12-h video capsule endoscopy underwent abdominal surgery and suffered from iron deficiency anemia significantly less frequently than those who underwent 8-h video capsule endoscopy (28% vs 13%, P = .03, and 70% vs 39%, P < .001, respectively).
No statistically significant differences in other patient characteristics were observed.
Factors that increased risk of an incomplete study included a history of bowel obstruction (P = .02), inpatient opiate use (P = .05), older age (P = .03), and abdominal surgery (P < .01) in both groups.
In the 12-h video capsule endoscopy group, only inpatient opiate use (P = .05) and history of abdominal surgery (P = .02) were statistically significant risk factors vs the 8-h video capsule endoscopy group.
Method of delivery (swallowed or deployed endoscopically) did not improve the rate of completion of video capsule endoscopy in either group.
Mr. Kasia concluded that in the evaluation of obscure gastrointestinal bleeding, 12-h video capsule endoscopy was associated with more frequent successful visualization of the entirety of hospitalized patients' small intestine than the 8-h device. No unique risk factors for incomplete studies were observed in 12-h video capsule endoscopy.
Further studies in patients with abdominal operations may be beneficial.
These data suggest that 12-hour video capsule endoscopy can lead to efficient treatment and should be considered standard practice.
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