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Su1233 Small Intestine Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding in the Elderly
Abstracts unclassified colitis during follow-up. A LS135 at SBCE had a sensitivity Z 90%, specificity Z 100%, Positive Predictive Value Z 100% and Negative Predictive Value Z 94% for the diagnosis of CD. Conclusions: SBCE proved to be very important in the reclassification of patients with unclassified colitis. In this study, absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.
Su1232 The Utility of Small Intestine Capsule Endoscopy and BalloonAssisted Enteroscopy for Diagnosis of Small Intestinal Tumor Yusuke Nagata*, Ryoichi Sawada, Takashi Nishimura, Kanae Tsutsui, Hiroki Saijo, Eri Hayashi, Jimi Mitobe, Nobuhiko Komoike, Tetsuyoshi Iwasaki, Daisuke Ide, Makoto Mitsunaga, Masayuki Saruta, Mika Matsuoka, Seiji Arihiro, Tomohiro Kato Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan Purpose: Both small intestine capsule endoscopy (SCE) and balloon-assisted enteroscopy (BAE) play an important role in the diagnosis of small intestinal tumors. However, the usefulness of both modalities is still unclear. To confirm their utility and diagnostic ability, we examined small intestinal tumor cases diagnosed using SCE and BAE at our institute, in comparison with those diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI) studies. Methods: Between April 2008 and July 2015, BAEs and SCEs were performed for 610 and 480 cases, respectively, at our institute. Of these cases, 54 (31 men and 23 women; median age, 61 years) were confirmed as small intestinal tumors and included in this study to determine the usefulness of the diagnostic modalities for small intestinal tumor. The modalities, namely CT, MRI, SCE, and BAE, were studied and retrospectively compared with each other for all the cases. Results: No adverse effects were observed in each modality. The chief complaints were unidentified anemia/obscure gastrointestinal bleeding (16 cases, 30%), suspicion of tumor based on the results from other diagnostic modalities without abdominal symptom (13 cases, 24%), and abdominal symptom (11 cases, 20%). The final diagnoses of the 54 cases were small intestinal cancer (15 cases, 29.6% [10 primary/5 metastases]), non-epithelial tumor (14 cases, 25.9%), malignant lymphoma (12 cases, 24.1%), and hereditary polyposis (10 cases, 18.5%). BAE was performed for all the cases, and SCE was performed for 28 of the 54 cases. CT/MRI was performed for 52 cases, excluding 2 cases of PeutzJeghers syndrome. In 19 (35.2%) of the 52 cases, the tumor was not detected during the CT/MRI examinations. They were non-epithelial tumor (7 cases, 36.8%), hereditary polyposis (6 cases, 31.6%), small intestinal cancer (3 cases, 15.8% [2 primary/1 metastasis]), and malignant lymphoma (3 cases, 15.8%). BAE detected the tumor in 19 cases. Meanwhile, SCE was performed on 13 of the 19 cases. Four (30.8%) of the 13 cases were not detected as small intestinal tumors, but as malignant lymphoma in 1 case and non-epithelial tumor in 3 cases. By using SCE and/or BAE, even cases that were not detected on CT/MRI as small intestinal tumors, because of their small size and slight mucosal changes, were detected. Conclusion: For patients who are suspected of having small intestinal tumors, modalities for the small intestine are useful for their detection. However, in some cases, small intestinal tumors are difficult to detect by using CT/MRI studies because of their size and mucosal change. For cases that are strongly suspected to be small intestinal tumors, even though no lesions are detected during the CT/MRI examinations, we should pay attention to perform SCE and/or BAE.
Su1233 Small Intestine Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding in the Elderly Maiko Ogawa*, Ryoichi Sawada, Takashi Nishimura, Daisuke Ide, Kanae Tsutsui, Shunsuke Kamba, Tetsuyoshi Iwasaki, Yoshinori Arai, Nobuhiko Komoike, Jimi Mitobe, Makoto Mitsunaga, Masayuki Saruta, Seiji Arihiro, Mika Matsuoka, Tomohiro Kato Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan Purpose: Obscure gastrointestinal bleeding (OGIB) in the elderly is often caused by angioectasia and/or mucosal injury. We previously examined elderly patients (65 years old or older) with OGIB, according to the WHO criteria and reported our findings (Gastrointest Endosc 2015, 81:AB479). Cases of OGIB significantly increased with the intake of oral antithrombotic agents among the elderly due to prolonged small intestine transit time. These findings also suggest the involvement of chemical mucosal disorders. In this study, we classified patients according to 10year increments in order to clarify the effects of age on the occurrence of OGIB. Method: We used small intestine capsule endoscopy (CE) to examine 470 patients in this hospital, between April 2004 and August 2015. We classified the patients according to age (Group A, <55 years old; Group B, 55 years old 65 years old; Group C, 65 years old 75 years old; Group D >75 years old) and compared symptoms, oral medication use, and small intestine transit times between the groups. Results: Among the 470 patients who were enrolled in the study, there were 161, 93, 117, and 99 patients in groups A, B, C, and D, respectively. Antithrombotic
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drugs were administered in 5% (8), 15.1% (14), 18% (21), and 26.3% (26) of patients in groups A, B, C, and D, respectively. The use of antithrombotic drugs significantly increased with age (P < 0.01). Angioectasia and/or mucosal injury were demonstrated in 37.5% (3), 21.4% (3), 42.9% (9), and 57.7% (15) of patients in groups A, B, C, and D, respectively. Small intestine transit times were 250.4, 280.2, 304.2, and 318.9 min in groups A, B, C, and D, respectively. Although the small intestine transit time was significantly shorter in group A compared to the other groups (P < 0.05, P < 0.01, P < 0.01), no significant differences were observed among the other three groups. Conclusions: The oral use of the antithrombotic drugs increased with age, along with the concomitant findings of angioectasia and/or mucosal injury. The small intestine transit time was significantly longer in elderly people who were at least 55 years old. These findings suggest the development of OGIB in the elderly. Therefore, in cases of OGIB in the elderly, we should consider utilizing CE to monitor for mucosal disorders related to the intake of antithrombotic drugs, particularly in patients older than 55 years old.
Su1234 Visceral adipose tissue, NSAID intake, and PPI intake are factors affecting small bowel transit time in capsule endoscopy Yuki Otake*, Toshiyuki Sakurai, Naoyoshi Nagata, Koh Imbe, Kazuhiro Watanabe, Chizu Yokoi, Yasushi Kojima, Masao Kobayakawa, Junichi Akiyama, Mikio Yanase Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan Background and Aims: Physical factors affecting small bowel transit time (SBTT) in capsule endoscopy (CE) remain unknown, and only a few reports suggested that aging might affect SBTT. Recently, a positive association between visceral adipose tissue (VAT) and irritable bowel syndrome was reported, and it suggested that VAT might increasingly affect intestinal motility. Our aims were to 1) investigate the association between VAT and SBTT and 2) other factors affecting SBTT in CE. Subjects and Methods: Patients who underwent CE in our hospital from January 2011 to December 2014 were included. Subjects were divided into two groups: SBTT shorter than 240 min (group S) and SBTT longer than 240 min (group L). We analyzed the association between SBTT and age, sex, height, body weight, body mass index (>25 or <25), VAT ( >100 cm2 or <100 cm2), physical activity (>2 or < 2), history of abdominal surgery, and medications that patients took at that time, including PPIs, aspirin, and NSAIDs. VAT was measured at the level of the umbilicus on CT scan which had taken within 1 year before or after CE. Patients who did not undergo abdominal CT scan within 1 year after CE were excluded. Results: Of 142 patients who underwent CE, 124 (62 men) were eligible for assignment, of which 40 (21 men) were in group S and 84 (41 men) were in group L. The proportion of patients with VAT >100 cm2 (group S vs. group L; 50% vs. 22.6%, pZ0.002), BMI >25 (30% vs. 13.1%, pZ0.024), diabetes (20% vs. 7.1%, pZ0.034), NSAID intake (22.5% vs. 7.1%, pZ0.014) was significantly higher in group S. The proportion of patients taking PPI was higher in group L (32.5% vs. 51.2%, pZ0.051). Multivariate analysis of group L showed that VAT >100 cm2 (ORZ0.37, 95% CIZ0.13–0.99, pZ0.05), NSAID intake (ORZ0.27, 95% CIZ0.08–0.96, pZ0.043), and PPI intake (ORZ3.01, 95% CIZ1.22–7.42, pZ0.017) were significant factors. Conclusion: VAT >100 cm2 and NSAID intake might increase small intestinal motility, and PPI intake might weaken it.
Su1235 Laboratorial Markers as a Selection Tool for Capsule Endoscopy May Rule in, but Not Rule out, the Diagnosis of Crohn’s Disease Bruno Rosa*1, Margarida Marques2, Pedro Boal Carvalho1, Helder Cardoso2, J. Firmino-machado4, Guilherme Macedo2, José Cotter1,3 1 Gastroenterology, Hospital da Senhora da Oliveira - Guimarães, Portugal, Guimarães, Portugal; 2Gastroenterology, Hospital de São João, Porto, Portugal; 3Life and Health Sciences Research Institute, University of Minho, Braga/Guimarães, Portugal; 4Public Health Unit, ACES Porto Ocidental, Porto, Portugal Introduction: The diagnosis of Crohn’s disease (CD) usually requires not only a strong clinical suspicion, but also a combination of laboratorial markers and endoscopic procedures. The diagnostic workup of CD in patients with negative ileocolonoscopy often includes expensive and time-consuming procedures, such as small bowel capsule endoscopy (SBCE) or cross-sectional imaging. A pre-selection for patients who would benefit of additional diagnostic procedures, as well as those in whom further investigation is unwarranted, would reduce diagnostic delay and allow for better allocation of resources. We aimed to identify analytical variables with discriminative power for the need of additional diagnostic procedures in patients with suspected CD and negative ileocolonoscopy. Methods: Multicentric retrospective study including patients with suspected CD and negative or inconclusive ileocolonoscopy. At enrollment, patients’ clinical and demographic characteristics were assessed, and a blood panel was obtained, including hemoglobin, leukocyte and platelet cell count, ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin and total serum protein levels. Patients were followed during 12 months, and the primary outcome was the confirmation of the diagnosis of CD,
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB321
Su1232 The Utility of Small Intestine Capsule Endoscopy and BalloonAssisted Enteroscopy for Diagnosis of Small Intestinal Tumor Yusuke Nagata*, Ryoichi Sawada, Takashi Nishimura, Kanae Tsutsui, Hiroki Saijo, Eri Hayashi, Jimi Mitobe, Nobuhiko Komoike, Tetsuyoshi Iwasaki, Daisuke Ide, Makoto Mitsunaga, Masayuki Saruta, Mika Matsuoka, Seiji Arihiro, Tomohiro Kato Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan Purpose: Both small intestine capsule endoscopy (SCE) and balloon-assisted enteroscopy (BAE) play an important role in the diagnosis of small intestinal tumors. However, the usefulness of both modalities is still unclear. To confirm their utility and diagnostic ability, we examined small intestinal tumor cases diagnosed using SCE and BAE at our institute, in comparison with those diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI) studies. Methods: Between April 2008 and July 2015, BAEs and SCEs were performed for 610 and 480 cases, respectively, at our institute. Of these cases, 54 (31 men and 23 women; median age, 61 years) were confirmed as small intestinal tumors and included in this study to determine the usefulness of the diagnostic modalities for small intestinal tumor. The modalities, namely CT, MRI, SCE, and BAE, were studied and retrospectively compared with each other for all the cases. Results: No adverse effects were observed in each modality. The chief complaints were unidentified anemia/obscure gastrointestinal bleeding (16 cases, 30%), suspicion of tumor based on the results from other diagnostic modalities without abdominal symptom (13 cases, 24%), and abdominal symptom (11 cases, 20%). The final diagnoses of the 54 cases were small intestinal cancer (15 cases, 29.6% [10 primary/5 metastases]), non-epithelial tumor (14 cases, 25.9%), malignant lymphoma (12 cases, 24.1%), and hereditary polyposis (10 cases, 18.5%). BAE was performed for all the cases, and SCE was performed for 28 of the 54 cases. CT/MRI was performed for 52 cases, excluding 2 cases of PeutzJeghers syndrome. In 19 (35.2%) of the 52 cases, the tumor was not detected during the CT/MRI examinations. They were non-epithelial tumor (7 cases, 36.8%), hereditary polyposis (6 cases, 31.6%), small intestinal cancer (3 cases, 15.8% [2 primary/1 metastasis]), and malignant lymphoma (3 cases, 15.8%). BAE detected the tumor in 19 cases. Meanwhile, SCE was performed on 13 of the 19 cases. Four (30.8%) of the 13 cases were not detected as small intestinal tumors, but as malignant lymphoma in 1 case and non-epithelial tumor in 3 cases. By using SCE and/or BAE, even cases that were not detected on CT/MRI as small intestinal tumors, because of their small size and slight mucosal changes, were detected. Conclusion: For patients who are suspected of having small intestinal tumors, modalities for the small intestine are useful for their detection. However, in some cases, small intestinal tumors are difficult to detect by using CT/MRI studies because of their size and mucosal change. For cases that are strongly suspected to be small intestinal tumors, even though no lesions are detected during the CT/MRI examinations, we should pay attention to perform SCE and/or BAE.
Su1233 Small Intestine Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding in the Elderly Maiko Ogawa*, Ryoichi Sawada, Takashi Nishimura, Daisuke Ide, Kanae Tsutsui, Shunsuke Kamba, Tetsuyoshi Iwasaki, Yoshinori Arai, Nobuhiko Komoike, Jimi Mitobe, Makoto Mitsunaga, Masayuki Saruta, Seiji Arihiro, Mika Matsuoka, Tomohiro Kato Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan Purpose: Obscure gastrointestinal bleeding (OGIB) in the elderly is often caused by angioectasia and/or mucosal injury. We previously examined elderly patients (65 years old or older) with OGIB, according to the WHO criteria and reported our findings (Gastrointest Endosc 2015, 81:AB479). Cases of OGIB significantly increased with the intake of oral antithrombotic agents among the elderly due to prolonged small intestine transit time. These findings also suggest the involvement of chemical mucosal disorders. In this study, we classified patients according to 10year increments in order to clarify the effects of age on the occurrence of OGIB. Method: We used small intestine capsule endoscopy (CE) to examine 470 patients in this hospital, between April 2004 and August 2015. We classified the patients according to age (Group A, <55 years old; Group B, 55 years old 65 years old; Group C, 65 years old 75 years old; Group D >75 years old) and compared symptoms, oral medication use, and small intestine transit times between the groups. Results: Among the 470 patients who were enrolled in the study, there were 161, 93, 117, and 99 patients in groups A, B, C, and D, respectively. Antithrombotic
www.giejournal.org
drugs were administered in 5% (8), 15.1% (14), 18% (21), and 26.3% (26) of patients in groups A, B, C, and D, respectively. The use of antithrombotic drugs significantly increased with age (P < 0.01). Angioectasia and/or mucosal injury were demonstrated in 37.5% (3), 21.4% (3), 42.9% (9), and 57.7% (15) of patients in groups A, B, C, and D, respectively. Small intestine transit times were 250.4, 280.2, 304.2, and 318.9 min in groups A, B, C, and D, respectively. Although the small intestine transit time was significantly shorter in group A compared to the other groups (P < 0.05, P < 0.01, P < 0.01), no significant differences were observed among the other three groups. Conclusions: The oral use of the antithrombotic drugs increased with age, along with the concomitant findings of angioectasia and/or mucosal injury. The small intestine transit time was significantly longer in elderly people who were at least 55 years old. These findings suggest the development of OGIB in the elderly. Therefore, in cases of OGIB in the elderly, we should consider utilizing CE to monitor for mucosal disorders related to the intake of antithrombotic drugs, particularly in patients older than 55 years old.
Su1234 Visceral adipose tissue, NSAID intake, and PPI intake are factors affecting small bowel transit time in capsule endoscopy Yuki Otake*, Toshiyuki Sakurai, Naoyoshi Nagata, Koh Imbe, Kazuhiro Watanabe, Chizu Yokoi, Yasushi Kojima, Masao Kobayakawa, Junichi Akiyama, Mikio Yanase Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan Background and Aims: Physical factors affecting small bowel transit time (SBTT) in capsule endoscopy (CE) remain unknown, and only a few reports suggested that aging might affect SBTT. Recently, a positive association between visceral adipose tissue (VAT) and irritable bowel syndrome was reported, and it suggested that VAT might increasingly affect intestinal motility. Our aims were to 1) investigate the association between VAT and SBTT and 2) other factors affecting SBTT in CE. Subjects and Methods: Patients who underwent CE in our hospital from January 2011 to December 2014 were included. Subjects were divided into two groups: SBTT shorter than 240 min (group S) and SBTT longer than 240 min (group L). We analyzed the association between SBTT and age, sex, height, body weight, body mass index (>25 or <25), VAT ( >100 cm2 or <100 cm2), physical activity (>2 or < 2), history of abdominal surgery, and medications that patients took at that time, including PPIs, aspirin, and NSAIDs. VAT was measured at the level of the umbilicus on CT scan which had taken within 1 year before or after CE. Patients who did not undergo abdominal CT scan within 1 year after CE were excluded. Results: Of 142 patients who underwent CE, 124 (62 men) were eligible for assignment, of which 40 (21 men) were in group S and 84 (41 men) were in group L. The proportion of patients with VAT >100 cm2 (group S vs. group L; 50% vs. 22.6%, pZ0.002), BMI >25 (30% vs. 13.1%, pZ0.024), diabetes (20% vs. 7.1%, pZ0.034), NSAID intake (22.5% vs. 7.1%, pZ0.014) was significantly higher in group S. The proportion of patients taking PPI was higher in group L (32.5% vs. 51.2%, pZ0.051). Multivariate analysis of group L showed that VAT >100 cm2 (ORZ0.37, 95% CIZ0.13–0.99, pZ0.05), NSAID intake (ORZ0.27, 95% CIZ0.08–0.96, pZ0.043), and PPI intake (ORZ3.01, 95% CIZ1.22–7.42, pZ0.017) were significant factors. Conclusion: VAT >100 cm2 and NSAID intake might increase small intestinal motility, and PPI intake might weaken it.
Su1235 Laboratorial Markers as a Selection Tool for Capsule Endoscopy May Rule in, but Not Rule out, the Diagnosis of Crohn’s Disease Bruno Rosa*1, Margarida Marques2, Pedro Boal Carvalho1, Helder Cardoso2, J. Firmino-machado4, Guilherme Macedo2, José Cotter1,3 1 Gastroenterology, Hospital da Senhora da Oliveira - Guimarães, Portugal, Guimarães, Portugal; 2Gastroenterology, Hospital de São João, Porto, Portugal; 3Life and Health Sciences Research Institute, University of Minho, Braga/Guimarães, Portugal; 4Public Health Unit, ACES Porto Ocidental, Porto, Portugal Introduction: The diagnosis of Crohn’s disease (CD) usually requires not only a strong clinical suspicion, but also a combination of laboratorial markers and endoscopic procedures. The diagnostic workup of CD in patients with negative ileocolonoscopy often includes expensive and time-consuming procedures, such as small bowel capsule endoscopy (SBCE) or cross-sectional imaging. A pre-selection for patients who would benefit of additional diagnostic procedures, as well as those in whom further investigation is unwarranted, would reduce diagnostic delay and allow for better allocation of resources. We aimed to identify analytical variables with discriminative power for the need of additional diagnostic procedures in patients with suspected CD and negative ileocolonoscopy. Methods: Multicentric retrospective study including patients with suspected CD and negative or inconclusive ileocolonoscopy. At enrollment, patients’ clinical and demographic characteristics were assessed, and a blood panel was obtained, including hemoglobin, leukocyte and platelet cell count, ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin and total serum protein levels. Patients were followed during 12 months, and the primary outcome was the confirmation of the diagnosis of CD,
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB321