Earlier Implementation of Capsule Endoscopy for Obscure Gastrointestinal Bleeding Decreases Resource Utilization

Abstract

Earlier Implementation of Capsule Endoscopy for Obscure Gastrointestinal Bleeding Decreases Resource Utilization Stacey Shapira, Robert Enns, Eugina Yu Background: Capsule Endoscopy (CE) is becoming widely available to image the small intestine. In the setting of obscure gastrointestinal bleeding (OGIB) its diagnostic yield exceeds 50%. The location of CE in the diagnostic algorithm for investigation of OGIB is still debated. Objective: To evaluate if clinical practice has changed with more rapid referral for CE and whether this change decreases endoscopic exams without affecting clinical outcomes. Methods: All CE for OGIB from a single academic centre were reviewed. 310 CE were completed from 12/01-11/04 (267 for OGIB). We collected data on investigations, transfusions and management prior to the first CE. CEs from 2001-2002 (Group 1) were compared to those from 2003-2004 (Group 2). The information was available prospectively from a CE database. Statistical analysis was carried out using Chi-Square, Fisher’s Exact or Wilcoxon Rank Sum Tests. Results: Complete data was available on 221 of 267 CEs completed for OGIB. The time to referral for CE was O24 weeks of disease in both groups (83 vs 74%) however there was a trend to earlier referral in group 2 (!12 wks 8 vs 15%). The number of patients undergoing i Y3 upper endoscopies before CE was greater in Group 1 (upper: 52 vs 30%, p ! .001). Nuclear scans and angiograms were fewer for Group 2 (40 vs 19%, p ! .001). The mean number of colonoscopies, small bowel barium studies or transfusions was not different between the two groups. Enteroscopies were performed more frequently in Group 1 pre-CE (mean: 0.7 vs 0.3, p ! .001) but a trend suggested more enteroscopies after CE in Group 2 (21% vs 13%. There was no difference in the number of lesions found on CE that were accessible by standard endoscopic techniques (24 vs 17%) or the number of definitively positive findings (57 vs 55%) between the two groups. Conclusion: The number of investigations performed prior to CE referral has significantly decreased at this centre and the detection rate of abnormalities remains unchanged. This suggests that earlier implementation of CE in the diagnostic algorithm for OGIB has the potential for more targeted post-CE therapies as well as significant cost savings. Abstracts