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Mo1561 Clinical Impact of Longer Battery Life in Small Bowel Capsule Endoscopy: a Single-Center Experience
Abstracts
Mo1559 Diagnostic Yield and Clinical Impact of Video Capsule Endoscopy in Patients With Chronic Diarrhea: a Korean Multicenter Study Hyun Joo Song*1, Jeong Seop Moon2, Seong Ran Jeon3, Jin OH Kim3, Jin Su Kim4, Dae Young Cheung4, Myung-Gyu Choi4, Yun Jeong Lim5, Ki-Nam Shim6, Byong Duk Ye7, Jae Hee Cheon8, Cheol Hee Park9, Hyun-Soo Kim10, Ji Hyun Kim11, Dong Kyung Chang12, Jae Hyuk Do13, Kyeong Ok Kim14, Byung IK Jang14, Sung Jae Shin15 1 Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea; 2Inje University College of Medicine, Seoul, Republic of Korea; 3Soonchunhyang University College of Medicine, Seoul, Republic of Korea; 4The Catholic University of College of Medicine, Seoul, Republic of Korea; 5Dongguk University College of Medicine, Goyang, Republic of Korea; 6Ewha Womans University School of Medicine, Seoul, Republic of Korea; 7University of Ulsan College of Medicine, Seoul, Republic of Korea; 8Yonsei University College of Medicine, Seoul, Republic of Korea; 9Hallym University College of Medicine, Anayng-si, Republic of Korea; 10Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; 11Inje University College of Medicine, Pusan, Republic of Korea; 12Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 13Chung-Ang University College of Medicine, Seoul, Republic of Korea; 14Yeungnam University College of Medicine, Daegu, Republic of Korea; 15Ajou University College of Medicine, Suwon, Republic of Korea Backgrounds/Aims: Most of studies about video capsule endoscopy (VCE) have been focused on the evaluation of obscure gastrointestinal bleeding. However, it is increasingly used in other indications associated with small bowel disease. Chronic diarrhea is sometimes unexplained, and small bowel disorders can be one of the causes. The aim of this study was to evaluate the diagnostic yield and clinical impact of VCE in patients with chronic diarrhea. Methods: We retrospectively analyzed records in the VCE nationwide database registry from October 2002 to August 2013. From data base of VCE registry (nZ2,964), total 91 patients of 15 medical centers (60 male to 31 female, mean age, 47 19 year) were evaluated for VCE due to chronic diarrhea. Results: The duration of chronic diarrhea was 13.7 42.4 months (range 1-360 months). Prior to VCE, 75 patients (82.4%) underwent colonoscopy and 53 patients (58.2%) underwent abdominal pelvic computed tomography. The positive diagnostic yield of VCE was 45.1% (41/91). However, 16.5% (15/91) showed inconsistent result, and 38.5% (35/91) was negative. Abnormal findings consistent with chronic diarrhea include erosions (19.8%), ulcers (17.6%), mucosal erythema (3.3%), edema (1.1%) and luminal narrowing (1.1%). Although nonneoplastic polyp (6.6%), angiodysplasia (5.5%), submucosal tumor (4.4%), and diverticulum (1.1%) were found, they were inconsistent with chronic diarrhea. Most common diagnoses were functional diarrhea associated with irritable bowel syndrome in 30 (33.3%) and Crohn’s disease in 18 (19.8%) patients. Eosinophilic enteritis in 5 (5.5%), small bowel tumor in 4 (4%), intestinal tuberculosis in 1 (1.1%), Celiac disease in 1 (1.1%) and HIV enteropathy in 1 patient (1.1%) were also found. After VCE examination, 41.8% (38/91) of previously diagnosed patients were changed and 70.3% (64/91) patients underwent medical treatment. Conclusions: These results suggest that VCE can be helpful in patients suffering from chronic diarrhea that cannot be explained by established examinations. VCE had favorable diagnostic yield and clinical impact in patients with chronic diarrhea.
Mo1560 What Is the Optimal Timing of Capsule Endoscopy in Obscure GI Bleeding Patients? Jong Soo Lee, Bora Keum*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Yoon Tae Jeen, Hongsik Lee, Hoon Jai Chun, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Capsule endoscopy is essential examination for diagnosis of small bowel bleeding. But diagnostic yield of capsule endoscopy is 38% to 83% in obscure overt GI bleeding. For an accurate diagnosis of cause of obscure GI bleeding, the time to perform capsule endoscopy is the most important factor. This study is to investigate the diagnostic yield, rate of therapeutic intervention and prognosis according to timing of capsule endoscopy in the obscure overt GI bleeding patients. Methods: We conducted a single center, retrospective study at Korea University Medical Center Anam Hospital from April 2008 to April 2013. Patients who were negative result of initial upper endoscopy and colonoscopy were enrolled. We divided the patients into two groups: those who had performed capsule endoscopy within 2 days of last overt GI bleeding (%2-day group) and after 2 days of last overt GI bleeding(O2-day group). We compared the diagnostic yield, rate of therapeutic intervention, hospital day and rate of re-bleeding between the two groups. We defined positive finding as active bleeding or any cause of small bowel bleeding. Results: 102 capsule endoscopies were performed to evaluate obscure overt GI bleeding during the period. Among them, 81 patients were included and 21 patients who lacked of medical records were excluded. Diagnostic
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yield was 75% in %2-day group and 45% in O2-day group (pZ0.022). Therapeutic intervention was done in 45% of the%2-day group and 14% of O2-day group (pZ0.006). The average day of hospital stay was 5.7 days in %2-day group and 7.9 days in O2-day group (pZ0.021). Re-bleeding rate between the %2-day group and O2-day group was not significantly different. Conclusions: Early capsule endoscopic examination within 2 days of last overt GI bleeding may improve the diagnostic yield and rate of therapeutic intervention and length of hospital day.
Mo1561 Clinical Impact of Longer Battery Life in Small Bowel Capsule Endoscopy: a Single-Center Experience George Ou*, Oliver Takach, Cherry E. Galorport, Neal Shahidi, Robert a. Enns Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada Background: Capsule endoscopy (CE) is a non-invasive means of visualizing the small bowel mucosa with high sensitivity and specificity. However, a significant limitation of CE is the finite battery life, ranging from 8 to 12 hours depending on the system used. Previous studies have shown that the small bowel is completely visualized approximately 83.5% of the time. In the incomplete cases, additional investigations may be required to assess the distal portion of the small bowel that was not visualized, especially if the results were negative or inconclusive. Objective: To determine if longer CE battery life improves study completion rate. Methods: This is a retrospective analysis of patients who underwent CE at a University-affiliated tertiary care center (St. Paul’s Hospital, Vancouver, BC) between October 2010 and September 2013. Inclusion criteria: Patients who underwent outpatient CE using either Given Imaging PillCamÔ SB2 (eight-hour battery) or SB2U (longer battery), which are identical in terms of dimensions and image quality. Exclusion criteria: History of gastric or small bowel surgery, or inpatient status. Data collected included demographics, type of capsule endoscope used, small bowel transit time (SBTT), and gastric transit time (GTT). GTT is defined as the time between first gastric image and first duodenal image. Similarly, SBTT is defined as the time between the first duodenal image and the first cecal image. In cases of incomplete small bowel examination, the SBTT is censored at the time of last recorded image. Capsule completion rates, rates of positive findings, SBTT and GGT were compared between the two groups. Results: 324 patients were identified (114 SB2 and 210 SB2U). Mean age was 55.4 (SD Z 19.7, range 9 - 90) years, and 51.5% were female. There was no statistically significant difference in capsule completion rates (89.5% vs 93.3%, p Z 0.29 ), rates of positive findings (34.2% vs 31.4%, pZ0.5310), SBTT (median 234.5 min vs 232.0 min, pZ0.76), or GTT (median 20.3 vs 19.5, p Z 0.73); however, 9 (4.3%) CE’s in the SB2U group were completed after eight hours, which means they would have been incomplete had the SB2 CE been used. Conclusion: The total completion rates and diagnostic yields were not statistically different between the two groups when used in outpatients without history of altered gastrointestinal anatomy. However, the number of CE’s that required more than eight hours to complete (4.3%) in the SB2U group suggests an advantage over the SB2, given their similar costs.
Mo1562 Evaluation of Gastro-Intestinal Lesions in Patients Undergoing Oral Anticoagulant Therapy by Capsule Endoscopy Clelia Marmo1, Maria Elena Riccioni*1, Rossella Cianci2, Alessandra Bizzotto1, Guido Costamagna1 1 Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; 2 Institute of Internal Medicine, Catholic University of Rome, Rome, Italy Aim: In this retrospective study, we had investigated the types and frequency of small bowel GI bleeding lesions in patients undergoing oral anticoagulant therapy, by CE. Patients and Methods: Of a total of 1085 CE obtained between January 2003 and June 2013, 679 were performed in patients with obscure gastrointestinal bleeding. Of these 96 were obtained in patients undergoing oral anticoagulant therapy, 55 males and 41 females, mean age 70.6 years (range 23-87 years). At the time of evaluation by capsule endoscopy, the mean level of haemoglobin was 8.3 g/ dl for males (normal values 14-18 g/dl) and 6.7 g/dl for females (normal values 12-16 g/dl). The mean number of blood units used for transfusions was 5.7 per patient (range 2-20). All patients underwent to upper and lower gastro-intestinal endoscopy, prior to perform capsule endoscopy (CE). If upper and lower examinations were negative, CE was performed. The following data were recorded in the data base: patient age, gender, indication for the examination, medical and surgical history, bleeding history (including type of bleeding, total number of transfusions, hospitalizations), number and type of prior diagnostic testing, and details of the capsule examination. Result: In the series of patients undergoing oral anticoagulant therapy: 35/96 (36.4%) patients had negative examination; 22/96 (22.9%) had small-bowel angiodysplasias, small bowel erosions 21/96 (21.8%), small bowel ulcerations 5/96 pts (5.2%), neoplasia 4/96 (4.1%). In the series of patients with OGIB without anticoagulant therapy: 102/583 (17.4%) had angiodysplasias, small bowel erosions 48/583 (8.2%), small bowel ulcerations 25/583 (4.2%), neoplasia 44/583 (7.5%) Conclusion: Small bowel angiodysplasias remains the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB377
Mo1559 Diagnostic Yield and Clinical Impact of Video Capsule Endoscopy in Patients With Chronic Diarrhea: a Korean Multicenter Study Hyun Joo Song*1, Jeong Seop Moon2, Seong Ran Jeon3, Jin OH Kim3, Jin Su Kim4, Dae Young Cheung4, Myung-Gyu Choi4, Yun Jeong Lim5, Ki-Nam Shim6, Byong Duk Ye7, Jae Hee Cheon8, Cheol Hee Park9, Hyun-Soo Kim10, Ji Hyun Kim11, Dong Kyung Chang12, Jae Hyuk Do13, Kyeong Ok Kim14, Byung IK Jang14, Sung Jae Shin15 1 Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea; 2Inje University College of Medicine, Seoul, Republic of Korea; 3Soonchunhyang University College of Medicine, Seoul, Republic of Korea; 4The Catholic University of College of Medicine, Seoul, Republic of Korea; 5Dongguk University College of Medicine, Goyang, Republic of Korea; 6Ewha Womans University School of Medicine, Seoul, Republic of Korea; 7University of Ulsan College of Medicine, Seoul, Republic of Korea; 8Yonsei University College of Medicine, Seoul, Republic of Korea; 9Hallym University College of Medicine, Anayng-si, Republic of Korea; 10Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; 11Inje University College of Medicine, Pusan, Republic of Korea; 12Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 13Chung-Ang University College of Medicine, Seoul, Republic of Korea; 14Yeungnam University College of Medicine, Daegu, Republic of Korea; 15Ajou University College of Medicine, Suwon, Republic of Korea Backgrounds/Aims: Most of studies about video capsule endoscopy (VCE) have been focused on the evaluation of obscure gastrointestinal bleeding. However, it is increasingly used in other indications associated with small bowel disease. Chronic diarrhea is sometimes unexplained, and small bowel disorders can be one of the causes. The aim of this study was to evaluate the diagnostic yield and clinical impact of VCE in patients with chronic diarrhea. Methods: We retrospectively analyzed records in the VCE nationwide database registry from October 2002 to August 2013. From data base of VCE registry (nZ2,964), total 91 patients of 15 medical centers (60 male to 31 female, mean age, 47 19 year) were evaluated for VCE due to chronic diarrhea. Results: The duration of chronic diarrhea was 13.7 42.4 months (range 1-360 months). Prior to VCE, 75 patients (82.4%) underwent colonoscopy and 53 patients (58.2%) underwent abdominal pelvic computed tomography. The positive diagnostic yield of VCE was 45.1% (41/91). However, 16.5% (15/91) showed inconsistent result, and 38.5% (35/91) was negative. Abnormal findings consistent with chronic diarrhea include erosions (19.8%), ulcers (17.6%), mucosal erythema (3.3%), edema (1.1%) and luminal narrowing (1.1%). Although nonneoplastic polyp (6.6%), angiodysplasia (5.5%), submucosal tumor (4.4%), and diverticulum (1.1%) were found, they were inconsistent with chronic diarrhea. Most common diagnoses were functional diarrhea associated with irritable bowel syndrome in 30 (33.3%) and Crohn’s disease in 18 (19.8%) patients. Eosinophilic enteritis in 5 (5.5%), small bowel tumor in 4 (4%), intestinal tuberculosis in 1 (1.1%), Celiac disease in 1 (1.1%) and HIV enteropathy in 1 patient (1.1%) were also found. After VCE examination, 41.8% (38/91) of previously diagnosed patients were changed and 70.3% (64/91) patients underwent medical treatment. Conclusions: These results suggest that VCE can be helpful in patients suffering from chronic diarrhea that cannot be explained by established examinations. VCE had favorable diagnostic yield and clinical impact in patients with chronic diarrhea.
Mo1560 What Is the Optimal Timing of Capsule Endoscopy in Obscure GI Bleeding Patients? Jong Soo Lee, Bora Keum*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Yoon Tae Jeen, Hongsik Lee, Hoon Jai Chun, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Capsule endoscopy is essential examination for diagnosis of small bowel bleeding. But diagnostic yield of capsule endoscopy is 38% to 83% in obscure overt GI bleeding. For an accurate diagnosis of cause of obscure GI bleeding, the time to perform capsule endoscopy is the most important factor. This study is to investigate the diagnostic yield, rate of therapeutic intervention and prognosis according to timing of capsule endoscopy in the obscure overt GI bleeding patients. Methods: We conducted a single center, retrospective study at Korea University Medical Center Anam Hospital from April 2008 to April 2013. Patients who were negative result of initial upper endoscopy and colonoscopy were enrolled. We divided the patients into two groups: those who had performed capsule endoscopy within 2 days of last overt GI bleeding (%2-day group) and after 2 days of last overt GI bleeding(O2-day group). We compared the diagnostic yield, rate of therapeutic intervention, hospital day and rate of re-bleeding between the two groups. We defined positive finding as active bleeding or any cause of small bowel bleeding. Results: 102 capsule endoscopies were performed to evaluate obscure overt GI bleeding during the period. Among them, 81 patients were included and 21 patients who lacked of medical records were excluded. Diagnostic
www.giejournal.org
yield was 75% in %2-day group and 45% in O2-day group (pZ0.022). Therapeutic intervention was done in 45% of the%2-day group and 14% of O2-day group (pZ0.006). The average day of hospital stay was 5.7 days in %2-day group and 7.9 days in O2-day group (pZ0.021). Re-bleeding rate between the %2-day group and O2-day group was not significantly different. Conclusions: Early capsule endoscopic examination within 2 days of last overt GI bleeding may improve the diagnostic yield and rate of therapeutic intervention and length of hospital day.
Mo1561 Clinical Impact of Longer Battery Life in Small Bowel Capsule Endoscopy: a Single-Center Experience George Ou*, Oliver Takach, Cherry E. Galorport, Neal Shahidi, Robert a. Enns Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada Background: Capsule endoscopy (CE) is a non-invasive means of visualizing the small bowel mucosa with high sensitivity and specificity. However, a significant limitation of CE is the finite battery life, ranging from 8 to 12 hours depending on the system used. Previous studies have shown that the small bowel is completely visualized approximately 83.5% of the time. In the incomplete cases, additional investigations may be required to assess the distal portion of the small bowel that was not visualized, especially if the results were negative or inconclusive. Objective: To determine if longer CE battery life improves study completion rate. Methods: This is a retrospective analysis of patients who underwent CE at a University-affiliated tertiary care center (St. Paul’s Hospital, Vancouver, BC) between October 2010 and September 2013. Inclusion criteria: Patients who underwent outpatient CE using either Given Imaging PillCamÔ SB2 (eight-hour battery) or SB2U (longer battery), which are identical in terms of dimensions and image quality. Exclusion criteria: History of gastric or small bowel surgery, or inpatient status. Data collected included demographics, type of capsule endoscope used, small bowel transit time (SBTT), and gastric transit time (GTT). GTT is defined as the time between first gastric image and first duodenal image. Similarly, SBTT is defined as the time between the first duodenal image and the first cecal image. In cases of incomplete small bowel examination, the SBTT is censored at the time of last recorded image. Capsule completion rates, rates of positive findings, SBTT and GGT were compared between the two groups. Results: 324 patients were identified (114 SB2 and 210 SB2U). Mean age was 55.4 (SD Z 19.7, range 9 - 90) years, and 51.5% were female. There was no statistically significant difference in capsule completion rates (89.5% vs 93.3%, p Z 0.29 ), rates of positive findings (34.2% vs 31.4%, pZ0.5310), SBTT (median 234.5 min vs 232.0 min, pZ0.76), or GTT (median 20.3 vs 19.5, p Z 0.73); however, 9 (4.3%) CE’s in the SB2U group were completed after eight hours, which means they would have been incomplete had the SB2 CE been used. Conclusion: The total completion rates and diagnostic yields were not statistically different between the two groups when used in outpatients without history of altered gastrointestinal anatomy. However, the number of CE’s that required more than eight hours to complete (4.3%) in the SB2U group suggests an advantage over the SB2, given their similar costs.
Mo1562 Evaluation of Gastro-Intestinal Lesions in Patients Undergoing Oral Anticoagulant Therapy by Capsule Endoscopy Clelia Marmo1, Maria Elena Riccioni*1, Rossella Cianci2, Alessandra Bizzotto1, Guido Costamagna1 1 Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; 2 Institute of Internal Medicine, Catholic University of Rome, Rome, Italy Aim: In this retrospective study, we had investigated the types and frequency of small bowel GI bleeding lesions in patients undergoing oral anticoagulant therapy, by CE. Patients and Methods: Of a total of 1085 CE obtained between January 2003 and June 2013, 679 were performed in patients with obscure gastrointestinal bleeding. Of these 96 were obtained in patients undergoing oral anticoagulant therapy, 55 males and 41 females, mean age 70.6 years (range 23-87 years). At the time of evaluation by capsule endoscopy, the mean level of haemoglobin was 8.3 g/ dl for males (normal values 14-18 g/dl) and 6.7 g/dl for females (normal values 12-16 g/dl). The mean number of blood units used for transfusions was 5.7 per patient (range 2-20). All patients underwent to upper and lower gastro-intestinal endoscopy, prior to perform capsule endoscopy (CE). If upper and lower examinations were negative, CE was performed. The following data were recorded in the data base: patient age, gender, indication for the examination, medical and surgical history, bleeding history (including type of bleeding, total number of transfusions, hospitalizations), number and type of prior diagnostic testing, and details of the capsule examination. Result: In the series of patients undergoing oral anticoagulant therapy: 35/96 (36.4%) patients had negative examination; 22/96 (22.9%) had small-bowel angiodysplasias, small bowel erosions 21/96 (21.8%), small bowel ulcerations 5/96 pts (5.2%), neoplasia 4/96 (4.1%). In the series of patients with OGIB without anticoagulant therapy: 102/583 (17.4%) had angiodysplasias, small bowel erosions 48/583 (8.2%), small bowel ulcerations 25/583 (4.2%), neoplasia 44/583 (7.5%) Conclusion: Small bowel angiodysplasias remains the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB377