Sa1759 Prep, No Prep or More Prep? A Prospective Randomised Blinded Study Comparing Two Bowel Preparation Regimes With No Preparation on Quality of Capsule Endoscopy

Abstracts

Sa1759 Prep, No Prep or More Prep? A Prospective Randomised Blinded Study Comparing Two Bowel Preparation Regimes With No Preparation on Quality of Capsule Endoscopy Nadia Maqboul*, Aravinth U. Murugananthan, Thai P. Hong, Janine French, Ben Allen, Ken Tan, Marion H. Croft, Robert Chen Gastroenterology and Hepatology, Western Hospital, Melbourne, VIC, Australia Introduction and Study Aims: Capsule endoscopy (CE) is a widely used method for evaluation of the small bowel. However it does have limitations; visualisation of the small bowel mucosa is often impaired due to the presence of food residue, air bubbles and bile pigments (1). The effect of bowel preparation on improving visualisation of the small bowel varies (2,3 4) and is inconvenient for patients. (5) We aimed to prospectively evaluate the effects of 2 different bowel preparations on visualisation of the small bowel and on overall diagnostic yield compared with standard dietary changes. Methods: Fifty-one patients (26 male/ 25 female; mean age 60.7 years) were randomised into three groups using the sealed envelope technique. Indications for CE were iron deficiency anaemia, obscure GI bleeding (occult and overt) and anaemia. The three groups are highlighted in table 1.CE were viewed by a single blinded examiner and adequacy of bowel preparation according to three categories (⬎80% visualisation; 50-80% visualisation; ⬍50% visualisation) recorded. The diagnostic yield, gastric and small bowel transit times were also measured. Results: The results are summarised in table 2. Conclusion: Our findings are in keeping with a recent meta-analysis which has shown no difference in CE completion rates, GTT and SBTT with purgative preparation (6). Our study shows a trend towards better caecal completion rates with bowel preparation involving PEG and Picoprep, but these results did not reach statistical significance. Overall diagnostic yield was similar in all three groups. Liquid diet, in combination with fasting, prior to CE is generally better tolerated by patients (5) and our findings would support this as adequate preparation for CE. References: 1. Park SC et al. Effect of Bowel Preparation with Polyethylene Glycol on Quality of Capsule Endoscopy. Dig Dis Sci. (2011). 56: 1769-17752. Viazis N et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: A prospective, randomised controlled study. Gastrointest Endosc (2004). 60: 534-5383. Dai N et al. Improved Capsule Endoscopy after Bowel Preparation. Gastrointest Endosc. (2005). 61: 28-314. Fireman Z et al. Capsule Endoscopy: Improving transit time and image view. World J Gastroenterol. (2005). 11: 5863-58665. Beltran VP et al. Evaluation of Different Bowel Preparations for Small Bowel Capsule Endoscopy: A Prospective, Randomised, Controlled Study. Dig Dis Sci. (2011). 56: 290029056. Rokkas T et al. Does Purgative Preparation influence the Diagnostic Yield of Small Bowel Video Capsule Endoscopy? : A Meta-analysis. Am J Gastroenterol. (2009). 104: 219-227. Allocation of patients GROUP

BOWEL PREPARATION

1 (n⫽19) 2 (n⫽12)

Clear fluid day before procedure. Overnight fast Clear fluid day before procedure; 2L PEG in afternoon of the day prior to procedure. Overnight fast Clear fluid day before procedure; 1L PEG and 1 sachet Picoprep in afternoon of the day prior to procedure. Overnight fast.

3 (n⫽20)

Table 1. Overall findings

Gp 1 Gp 2 Gp 3 p-value

Mean Age

Completion Rate (%)

Yield (%)

63.6 57 60

79 83.3 90 NS

42.1 41.6 35 NS

Good SB views (%) 100 81.2 79

Mean GTT ⴞ SEM (mins)

Mean SBTT ⴞ SEM (mins)

35.9 ⫾ 11.19 87.5 ⫾ 47.79 74.8 ⫾ 27.06 NS

254.8 ⫾ 24.83 239.3 ⫾ 45.7 211.5 ⫾ 24.14 NS

Table 2

Sa1760 The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors Manuele Furnari*1, Giovanni Ballardini2, Edoardo Savarino1, Lorenzo Gemignani1, Vincenzo Savarino1, Emanuele Meroni2 1 Gastroenterology Unit, University of Genoa, Departme, Genoa, Italy; 2 Diagnostic Endoscopy and Endoscopic Surgery Unit, IRCCS Istituto Nazionale dei Tumori foundation, Milan, Italy Introduction: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear aetiology, usually classified into non-functioning and functioning. Unfortunately, a large number of patients already have liver metastases at the time of the diagnosis, poorly impacting their survival. Integrated imaging (CT, MRI, somatostatin receptor scintigraphy, endoscopy) is

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often necessary for detecting the primary tumor. Although guidelines for the management of NETs have been updated recently, indication for using WCE in NETs detection is still debated. Aim: Our study aims at evaluating WCE as potential examination for the detection of primary tumor in patients showing liver NET metastases when first-line investigations are negative or dubious. Patients and Methods: From Jan 2004 thru Oct 2011, 24 individuals (mean age, 53 years; M/F:13/10; BMI 23) with histologic diagnosis of NET obtained by biopsy of liver or lymphnode metastases and no evidence of a primary lesion were studied at the IRCCS Istituto Nazionale dei Tumori Foundation. Sixteen of them (69.5%) were symptomatic for carcinoid syndrome. All patients had negative or inconclusive total body-CT, MRI, SSRS, double-contrast barium enema, upper- and lower-GI endoscopy. WCE was therefore requested before laparotomy exploration and intra-operative ultrasound. Nine subjects refused laparotomy (drop out) after WCE. Results: WCE provided good visualization of the small bowel in 21/24 subjects. Intestinal preparation was judged optimal in 74% of cases. Among subjects who agreed to undergo surgery, 10/15 had positive WCE identifying a total of 15 bulging lesions (2 jejunum, 8 ileum, 1 ileocecal valve, 4 undetermined jejunum/ileum). Laparotomy found 9 NETs of the small bowel in 7/15 subjects (3 jejunum, 1 jejunum/ileum, 4 ileum, 1 ileocecal valve). Three pancreatic NETs and 1 biliary NET were found in the remaining 8 subjects. Agreement between WCE and laparotomy was recorded in 8 cases (both WCE and laparotomy positive in 5 subjects, negative in 3 subjects). Two had negative WCE and positive laparoscopy, 5 had positive WCE and negative laparotopy (Sens 71%, IC95% 0.37-1.05; Spec 37.5%, IC95% 0.04-0.71). When correspondence between the two investigations was referred to bulging lesions, results were the following: 6 tumors were identified by both WCE and laparoscopy, 9 found by WCE were not confirmed by laparoscopy, and 3 found by laparoscopy were not visualized by WCE (Sens 66%, IC95% 0.36-0.96; Spec 33%, IC95% 0.07-0.61; PPV 40%, IC95% 0.15-0.25; NPV 50%, IC95% 0.1-0.9). Conclusions: In patients with NET metastases from occult primary lesions, the usefulness of WCE seems to be poor. More specifically, general diagnostic value of this method is limited by the high number of false positive cases, probably due to extrinsic compression of intestinal lumen and lymph stasis within the bowel wall.

Sa1761 A Retrospective Analysis of Wireless Capsule Endoscopy Performance at a Large Academic Referral Center Jason Korenblit*1, Karthik Gournani2, Yaa Oppong2, Laura Setlur2, Stephanie M. Moleski1, David M. Kastenberg1, Leo Katz1, Anthony Infantolino1, Michael Dimarino1, Mitchell Conn1 1 Divison of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA; 2Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA Background: Wireless capsule endoscopy (CE) has become the standard for noninvasive evaluation of the stomach, small intestine, and colon. Since 2001, our center has performed over 4200 wireless capsule endoscopies with excellent diagnostic yield and safety record. Methods: 1906 CE exams were examined retrospectively from Jan 2002 to Sept 2011 at an academic referral center. Exams were performed on both inpatients and outpatients. Demographics and results were collected from the endoscopy computer reporting system and outpatient charts. CE exams were interpreted by one of six expert endoscopists and correlated to primary and secondary indication (see Table 1). Gastric transit time (GTT) was defined as first gastric images until time of first duodenal image and small bowel transit time (SBTT) as time to first cecal image, ostomy, or pouch. Results: 1077 (57%) of capsule exams were in female subjects. The mean age of subjects was 57.7 years (7.7-92.9 years). 65 capsules (3.4%) were placed endoscopically either due to subjects’ inability to swallow or altered gastric anatomy. These studies were excluded from calculations for GTT. Mean GTT was 44.6 minutes (0-570 minutes). Mean SBTT was 234.9 minutes (6-767 minutes). 1682 (88.3%) capsules completed a full small bowel exam, confirmed by either reaching the colon or an end ostomy during the battery life of the capsule device. Overall, 1058 (55.5%) of capsule exams demonstrated a significant finding over the course of the exam, and of these positive exams, 835/1058 (78.9%) demonstrated findings that explained the primary or secondary pre-test indication for the study. Taking into account all studies, 43.8% demonstrated a finding that satisfied the primary or secondary indication. Studies done for overt or occult gastrointestinal bleeding had significantly higher yield than the average study (Odds Ratio 1.29 [1.12-1.49 95% Confidence Interval]). Studies done for abdominal pain, diarrhea, constipation, and weight loss had significantly lower yield than the average study to explain primary or secondary indication (see Table 1). Capsule studies done for inflammatory bowel disease also had a significantly lower yield. However, it is not possible to ascertain if patients had active symptoms at the time of the exam or if it was for screening purposes only and thus it is difficult to interpret this result.Two patients had complications in this series. One patient had abdominal pain during the procedure that was self-limited. A second patient had the capsule impact in a luminal stricture during the exam. However, the capsule device passed spontaneously soon after the exam. Conclusions: The diagnostic yield of CE varies based on the pre-test indication. Capsule endoscopy is a safe diagnostic

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