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P.175 EVALUATION OF ANGIODYSPLASIAS IN PATIENTS IN ORAL ANTICOAGULANT THERAPY BY CAPSULE ENDOSCOPY
S164
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192
P.173 COST ESTIMATION OF SMALL BOWEL CAPSULE ENDOSCOPY BASED ON “REAL WORLD” DATA: INPATIENT OR OUTPATIENT PROCEDURE? E. Rondonotti ∗ ,1 , S. Marco 2 , C. Girelli 3 , F. Villa 4 , A. Russo 5 , R. de Franchis 6 , on behalf of SIGE-AIGO-SIED 1 Ospedale
Valduce; U.O.C. Gastroenterologia, Como; 2 Ospedale S. Carlo Borromeo; U.O. Gastroenterologia, Milano; 3 A.O. Ospedale di Circolo di Busto Arsizio; U.O. Gastroenterologia, Busto Arsizio; 4 IRCCS Fondazione Policlinico Mangiagalli Regina Elena; U.O. Gastroenterologia 3, Milano; 5 Ospedale S. Carlo Borromeo; U.O. Epidemiologia e Statistica Medica, Milano; 6 Università degli Studi di Milano; IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena; U.O. Gastroenterologia 3, Milano Background and aim: Although capsule endoscopy (CE) is the cornerstone for the evaluation of the small bowel in patients with Obscure GI Bleeding (OGIB) data about costs are lacking. Aim: to evaluate, from a third party payer point of view, whether performing capsule endoscopy as an outpatient instead of an inpatient procedure can reduce costs. Material and methods: The data source is a multicentre survey collecting 2921 patients; 1486 of them underwent CE for OGIB or chronic unexplained iron-deficiency anemia as inpatients (814 with positive, 211 with inconclusive and 461 with negative result). We estimated costs of inpatient procedures based on the Diagnosis Related Groups (DRG) system, while those of outpatient procedures on reimbursement provided in 5 Italian Regions. Results: We estimated that each inpatient undergoing CE costs about €1,775.90. Assuming that all these patients had undergone the same procedure as outpatients, €175.00-741.00 per patient (depending on the reimbursement and/or on DRG codes applied) would have been saved. Conclusions: Our estimate suggests that, from the third party payer’s perspective and using the DRG reimbursement system, shifting CE from inpatient to outpatient procedure, would be potentially cost saving at least for patients referred for obscure GI bleeding or chronic unexplained anemia. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.174 DIAGNOSTIC ROLE OF CAPSULE ENDOSCOPY IN PATIENTS WITH SYMPTOMS HIGHLY COMPATIBLE WITH CROHN’S DISEASE C. Petruzziello ∗ , S. Onali, E. Calabrese, E. Lolli, F. Zorzi, M. Ascolani, G. Condino, F. Pallone, L. Biancone G.I. Unit “Università Tor Vergata”, Roma Background and aim: The role of Wireless Capsule Endoscopy (WCE) in patients (pts) with clinically suspected CD remains to be established. To assess, in a prospective longitudinal study, the diagnostic role of WCE in pts with symptoms compatible with small bowel CD and undefined diagnosis after conventional techniques. Material and methods: From Sept 2005 to May 2009, pts with suspected CD and not conclusive ileocolonoscopy (IC), Small Bowel Follow Through (SBFT) and/or Small Bowel Contrast Ultrasonography (SICUS) findings were enrolled. Symptoms compatible with CD included: chronic diarrhoea, abdominal pain, weight loss, fever, IDA and/or perianal disease. Findings compatible with CD included a bowel wall thickness >3 mm at SICUS and >3 aphtoid ulcers, deep ulcers and/or strictures at WCE. Results: Conventional techniques did not lead to a conclusive diagnosis in 53 pts with clinically suspected CD (33 F, median age 35 yrs, range 17-64), showing chronic diarrhoea in 42/53 (79%), abdominal pain in 38/53 (72%), weight loss in 15/53 (28%), fever in 10/53 (19%), IDA in 8/53 (15%) and/or perianal disease in 5/53 (9%). Among risk factors, 17/53 (32%) pts. were smokers, 13/53 (25%) had appendectomy, 10/53 (19%) familial history of IBD, 9/53 (17%) were NSAIDs users. All these 53 pts. were studied by both WCE and IC, 49/53 (92%) were also studied by SICUS and 40/53 (75%) by SBFT. Findings compatible but not diagnostic for small bowel CD were detected by IC in 17/53 (32%) pts. (aphtoid ulcers in 14/17; deep ulcers in 3/17), by SICUS in 17/49 (35%), by SBFT in 11/40 (27%) pts. WCE showed
ileal lesions in 27/53 (51%) pts, including erosions in 8/53 (15%), aphtoid ulcers in 19/53 (36%), deep ulcers in 3/53 (6%), 1 ulcerated stenosis in 1 (2%) pts. Among these 27 pts. showing ileal lesions at WCE, findings compatible with CD were observed in 18/22 (67%) pts. Overall, 18 out of the 53 (34%) pts studied showed WCE findings compatible with small bowel CD. WCE impact was observed in 1 pt. with a small bowel stenosis not detected by SBFT, requiring surgery, leading to a histological diagnosis of CD. Conclusions: The use of WCE in pts with clinically suspected CD and undefined diagnosis after conventional techniques, may detect lesions compatible with small bowel CD in almost 35% of pts. The unexpected WCE retention related to a previously unknown stenosis further supports the need of a careful selection of patients before WCE. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.175 EVALUATION OF ANGIODYSPLASIAS IN PATIENTS IN ORAL ANTICOAGULANT THERAPY BY CAPSULE ENDOSCOPY M. Riccioni ∗ ,1 , R. Cianci 2 , R. Urgesi 1 , C. Spada 1 , G. Costamagna 1 1 Digestive Endoscopy Unit, Catholic University of Rome, Gemelli Hospital, Roma; 2 Departement of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Roma
Background and aim: Gastro-Intestinal (GI) bleeding is one of the main concerns in patients undergoing oral anticoagulation therapy. Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in these patients. Their cause is unknown. Capsule endoscopy (CE) is the first-line method for evaluation of bleeding in patient after negative upper endoscopy and colonoscopy. To investigate, by CE the frequency and features of GI lesions causes of bleeding in patients undergoing oral anticoagulant therapy. Material and methods: Of a total of 750 CE obtained between January 2003 and November 2009, 401 were performed in patients with obscure gastrointestinal bleeding. Of these 401, 43 (10.72%) were obtained in patients undergoing oral anticoagulant therapy for different cardiovascular diseases. Results: In our series, 21/43 (48.8%) patients had small-bowel angiodysplasias. Ten (23.25%) patients had negative examinations; the others had evidence of erosive gastritis (4 pts), jejunal erosions (3 pts), NSAIDs’ related lesions (1 patient), one diagnosis of coeliac disease, 1 small bowel inflammation, 1 Dieulafoy’s ulcer and 1 Meckel diverticulum. Conclusions: Even if it is well established that the sensitivity of capsule endoscopy (CE) performed during active bleeding is higher, small bowel angiodysplasias remain the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high prevalence of small bowel angiodysplasias. Angiodysplasias in these patients represent the 20.83% of total angiodysplasias found in 750 CE examinations. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.176 FEASIBILITY, SAFETY AND DIAGNOSTIC YIELD OF OMOM CE, A NEW CAPSULE ENDOSCOPY SYSTEM F. Cavallaro ∗ ,1 , R. Bozzi 2 , D. Cattaneo 2 , F. Villa 3 , S. Cadoni 4 , P. Gallittu 4 , L. Spina 1 , A. Citrino 5 , M. Vecchi 1 1 Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato & University of Milan, Milan; 2 Surgery & Digestive Endoscopy Unit, V. Monaldi Hospital, Naples; 3 Gastroenterology & Digestive Endoscopy Unit, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan; 4 Santa Barbara Hospital, Iglesias; 5 Sofar S.P.A, Milan
Background and aim: Since its approval by FDA in 2001, the clinical use of capsule endoscopy (CE) has been rapidly expanding and several systems have been developed for this purpose. One of the main limitations of its diffusion has been the relatively high cost and thus a questionable cost-effectiveness ratio. Very recently, a new videocapsule system (OMOM CE) has been
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192
P.173 COST ESTIMATION OF SMALL BOWEL CAPSULE ENDOSCOPY BASED ON “REAL WORLD” DATA: INPATIENT OR OUTPATIENT PROCEDURE? E. Rondonotti ∗ ,1 , S. Marco 2 , C. Girelli 3 , F. Villa 4 , A. Russo 5 , R. de Franchis 6 , on behalf of SIGE-AIGO-SIED 1 Ospedale
Valduce; U.O.C. Gastroenterologia, Como; 2 Ospedale S. Carlo Borromeo; U.O. Gastroenterologia, Milano; 3 A.O. Ospedale di Circolo di Busto Arsizio; U.O. Gastroenterologia, Busto Arsizio; 4 IRCCS Fondazione Policlinico Mangiagalli Regina Elena; U.O. Gastroenterologia 3, Milano; 5 Ospedale S. Carlo Borromeo; U.O. Epidemiologia e Statistica Medica, Milano; 6 Università degli Studi di Milano; IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena; U.O. Gastroenterologia 3, Milano Background and aim: Although capsule endoscopy (CE) is the cornerstone for the evaluation of the small bowel in patients with Obscure GI Bleeding (OGIB) data about costs are lacking. Aim: to evaluate, from a third party payer point of view, whether performing capsule endoscopy as an outpatient instead of an inpatient procedure can reduce costs. Material and methods: The data source is a multicentre survey collecting 2921 patients; 1486 of them underwent CE for OGIB or chronic unexplained iron-deficiency anemia as inpatients (814 with positive, 211 with inconclusive and 461 with negative result). We estimated costs of inpatient procedures based on the Diagnosis Related Groups (DRG) system, while those of outpatient procedures on reimbursement provided in 5 Italian Regions. Results: We estimated that each inpatient undergoing CE costs about €1,775.90. Assuming that all these patients had undergone the same procedure as outpatients, €175.00-741.00 per patient (depending on the reimbursement and/or on DRG codes applied) would have been saved. Conclusions: Our estimate suggests that, from the third party payer’s perspective and using the DRG reimbursement system, shifting CE from inpatient to outpatient procedure, would be potentially cost saving at least for patients referred for obscure GI bleeding or chronic unexplained anemia. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.174 DIAGNOSTIC ROLE OF CAPSULE ENDOSCOPY IN PATIENTS WITH SYMPTOMS HIGHLY COMPATIBLE WITH CROHN’S DISEASE C. Petruzziello ∗ , S. Onali, E. Calabrese, E. Lolli, F. Zorzi, M. Ascolani, G. Condino, F. Pallone, L. Biancone G.I. Unit “Università Tor Vergata”, Roma Background and aim: The role of Wireless Capsule Endoscopy (WCE) in patients (pts) with clinically suspected CD remains to be established. To assess, in a prospective longitudinal study, the diagnostic role of WCE in pts with symptoms compatible with small bowel CD and undefined diagnosis after conventional techniques. Material and methods: From Sept 2005 to May 2009, pts with suspected CD and not conclusive ileocolonoscopy (IC), Small Bowel Follow Through (SBFT) and/or Small Bowel Contrast Ultrasonography (SICUS) findings were enrolled. Symptoms compatible with CD included: chronic diarrhoea, abdominal pain, weight loss, fever, IDA and/or perianal disease. Findings compatible with CD included a bowel wall thickness >3 mm at SICUS and >3 aphtoid ulcers, deep ulcers and/or strictures at WCE. Results: Conventional techniques did not lead to a conclusive diagnosis in 53 pts with clinically suspected CD (33 F, median age 35 yrs, range 17-64), showing chronic diarrhoea in 42/53 (79%), abdominal pain in 38/53 (72%), weight loss in 15/53 (28%), fever in 10/53 (19%), IDA in 8/53 (15%) and/or perianal disease in 5/53 (9%). Among risk factors, 17/53 (32%) pts. were smokers, 13/53 (25%) had appendectomy, 10/53 (19%) familial history of IBD, 9/53 (17%) were NSAIDs users. All these 53 pts. were studied by both WCE and IC, 49/53 (92%) were also studied by SICUS and 40/53 (75%) by SBFT. Findings compatible but not diagnostic for small bowel CD were detected by IC in 17/53 (32%) pts. (aphtoid ulcers in 14/17; deep ulcers in 3/17), by SICUS in 17/49 (35%), by SBFT in 11/40 (27%) pts. WCE showed
ileal lesions in 27/53 (51%) pts, including erosions in 8/53 (15%), aphtoid ulcers in 19/53 (36%), deep ulcers in 3/53 (6%), 1 ulcerated stenosis in 1 (2%) pts. Among these 27 pts. showing ileal lesions at WCE, findings compatible with CD were observed in 18/22 (67%) pts. Overall, 18 out of the 53 (34%) pts studied showed WCE findings compatible with small bowel CD. WCE impact was observed in 1 pt. with a small bowel stenosis not detected by SBFT, requiring surgery, leading to a histological diagnosis of CD. Conclusions: The use of WCE in pts with clinically suspected CD and undefined diagnosis after conventional techniques, may detect lesions compatible with small bowel CD in almost 35% of pts. The unexpected WCE retention related to a previously unknown stenosis further supports the need of a careful selection of patients before WCE. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.175 EVALUATION OF ANGIODYSPLASIAS IN PATIENTS IN ORAL ANTICOAGULANT THERAPY BY CAPSULE ENDOSCOPY M. Riccioni ∗ ,1 , R. Cianci 2 , R. Urgesi 1 , C. Spada 1 , G. Costamagna 1 1 Digestive Endoscopy Unit, Catholic University of Rome, Gemelli Hospital, Roma; 2 Departement of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Roma
Background and aim: Gastro-Intestinal (GI) bleeding is one of the main concerns in patients undergoing oral anticoagulation therapy. Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in these patients. Their cause is unknown. Capsule endoscopy (CE) is the first-line method for evaluation of bleeding in patient after negative upper endoscopy and colonoscopy. To investigate, by CE the frequency and features of GI lesions causes of bleeding in patients undergoing oral anticoagulant therapy. Material and methods: Of a total of 750 CE obtained between January 2003 and November 2009, 401 were performed in patients with obscure gastrointestinal bleeding. Of these 401, 43 (10.72%) were obtained in patients undergoing oral anticoagulant therapy for different cardiovascular diseases. Results: In our series, 21/43 (48.8%) patients had small-bowel angiodysplasias. Ten (23.25%) patients had negative examinations; the others had evidence of erosive gastritis (4 pts), jejunal erosions (3 pts), NSAIDs’ related lesions (1 patient), one diagnosis of coeliac disease, 1 small bowel inflammation, 1 Dieulafoy’s ulcer and 1 Meckel diverticulum. Conclusions: Even if it is well established that the sensitivity of capsule endoscopy (CE) performed during active bleeding is higher, small bowel angiodysplasias remain the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high prevalence of small bowel angiodysplasias. Angiodysplasias in these patients represent the 20.83% of total angiodysplasias found in 750 CE examinations. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.176 FEASIBILITY, SAFETY AND DIAGNOSTIC YIELD OF OMOM CE, A NEW CAPSULE ENDOSCOPY SYSTEM F. Cavallaro ∗ ,1 , R. Bozzi 2 , D. Cattaneo 2 , F. Villa 3 , S. Cadoni 4 , P. Gallittu 4 , L. Spina 1 , A. Citrino 5 , M. Vecchi 1 1 Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato & University of Milan, Milan; 2 Surgery & Digestive Endoscopy Unit, V. Monaldi Hospital, Naples; 3 Gastroenterology & Digestive Endoscopy Unit, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan; 4 Santa Barbara Hospital, Iglesias; 5 Sofar S.P.A, Milan
Background and aim: Since its approval by FDA in 2001, the clinical use of capsule endoscopy (CE) has been rapidly expanding and several systems have been developed for this purpose. One of the main limitations of its diffusion has been the relatively high cost and thus a questionable cost-effectiveness ratio. Very recently, a new videocapsule system (OMOM CE) has been