Outcomes of Video Capsule Endoscopy in the Veterans Population

Abstract

Purpose: Video capsule endoscopy (VCE) is a widely utilized, minimally-invasive imaging modality for the small bowel (SB). Much research has focused on optimization of diagnostic yield and minimization of incompletion rates through careful patient selection. Current data support diabetes and hospitalization as risk factors for incomplete studies and there is emerging evidence that obesity may too be an independent risk factor. Elderly patients have been shown to have a higher diagnostic yield in the general population. However, it is unclear if these data are applicable to the Veterans Affairs (VA) population. Here we evaluate VCE outcomes in the VA population. Methods: VCE studies from the Sacramento VA for 275 consecutive patients between 2006-2009 were retrospectively reviewed. Results were compared to the pre-existing University of California Davis (UCD) Medical Center retrospective database of 250 consecutive patients reviewed between 2008-2009. Completion rates and diagnostic yield were evaluated as primary outcome measures. Results: Among the 275 patients reviewed at the VA, there were a significant number of male patients, 246 (89%) at the VA vs. 107(43%) at UCD, p=0.0001. There were also significantly more elderly, hospitalized and diabetic patients at the VA, p=0.0001, 0.003 and 0.004 respectively. The VA had significantly more patients with hypertension, hyperlipidemia, and coronary artery disease p=0.0001, 0.0001, 0.004 respectively. There was no significant difference in the number of obese patients between the two populations. Gastric transit times were insignificant, but SB transit times were significantly longer in the VA, p=0.0001. No significant difference in study completion rates was observed, p=0.48. There were significantly more clinically relevant SB findings in the VA population, 103 (37%) vs. 71 (28%) at UCD, p=0.03. No major difference in the ability of VCE to guide further intervention was observed. Conclusion: VCE is an efficacious imaging modality for the SB at the VA. Interestingly, there was no significant difference in study completion rates between the VA and UCD Medical Center despite a significantly higher prevalence of diabetics and hospitalized patients. This suggests that there may be additional risk factors, such as obesity, contributing to incomplete examinations. That diagnostic yield in the VA population was greater than the UCD population perhaps reflects the increased prevalence of co-morbidities in this unique group of patients. Further characterization of specific contributing comorbidities will require further investigation. Efforts should be made to maximize the utilization of VCE in the VA population.