Are There Gender Differences in Patients Undergoing Inpatient Versus Outpatient Video Capsule Endoscopy for Obscure Bleeding?: 2010 ACG/Naomi Nakao Gender-Based Research Award

Abstract

Purpose: The purpose of this retrospective study was to determine the presence of gender differences in patients with obscure GI bleeding undergoing video capsule endoscopy (VCE). We also examined whether findings differed depending upon inpatient status during VCE examination. Methods: We performed a retrospective study of VCE examinations performed for evaluation of obscure bleeding. Data collected included patient age, gender, indication for VCE, gastric (GTT) and small bowel transit (SBTT) times, and VCE findings. We graded VCE findings based on the P0-P2 grading system [Saurin Endoscopy 2003;35:576-584] where P0 was a normal exam, P1 a finding of questionable relevance, and P2 a lesion considered to be of significant clinical relevance (including fresh blood in the lumen). We considered significant lesions outside of the small bowel as “other findings” including erosive esophagitis, erosive gastritis or other gastropathy, diverticulosis with hemorrhage, or neoplasms in the stomach or large intestine. If more than one lesion was found on the examination, we classified the study using the most significant clinical lesion. We used Fisher's exact testing for categorical data analysis and Student's t test for continuous data analysis. A p value <0.05 was considered significant. Results: We included a total of 707 VCE studies, 167 (24%) performed on inpatients, and 505 as outpatient exams. VCE examinations were performed in 450 (64%) men and 257 women. Table 1 demonstrates technical and clinical data comparing inpatient and outpatient examinations. Inpatient VCE examinations were more likely to occur in males with overt bleeding. Endoscopic placement, non-gastric passage, and incomplete studies to the cecum were more common for inpatient VCE examinations. Despite longer GTT for inpatient VCE studies, there was no difference in SBTT. The prevalence of P2 lesions including angiodysplastic lesions, ulcerations, neoplasms, and stricturing diseases were equal between groups, but there were more significant findings outside the small bowel detected during inpatient VCE studies. (p=0.02, Table 1) Analysis of findings by gender revealed that overt bleeding was more likely to be the indication for VCE rather than occult bleeding for both men and women. However, VCE examinations in men were more likely to demonstrate significant findings, primarily angiodysplastic lesions. (AVMs, Table 2)[221] Table 1. Results of inpatient and outpatient VCE examinations[221] Table 2. Gender differences in VCE examinationsConclusion: Compared to outpatient VCE examinations, inpatient VCE exams were more likely to demonstrate findings outside of the small intestine within reach of standard endoscopic examination. Men undergoing VCE were more likely to be inpatients and demonstrate significant findings, primarily angiodysplastic lesions of the small bowel.