Su1254 FACTORS PREDICTING INCOMPLETE SMALL BOWEL CAPSULE ENDOSCOPY

Abstract

Although small bowel capsule endoscopy (SBCE) is an important diagnostic tool, rates of incomplete examination of the small intestine (i.e. the capsule cannot reach the caecum during recording) have been reported in up to 30% of the procedures. In a retrospective analysis of consecutive SBCE procedures we aimed to identify predictive factors associated with incomplete SBCE. Consecutive patients undergoing SBCE in a tertiary referral center were included in the study. Pillcam SB2 and SB3 capsules were employed and the standard international protocol for small bowel preparation was applied. Each examination was evaluated independently by two physicians experienced with the method. Logistic regression analysis was applied to identify independent factors associated with incomplete SBCE. SBCE from 1021 consecutive patients [mean age (SD) 55.0±19.1 years, males 51.9%] performed between 1st January 2011 and 31st October 2017 were assessed. Overall 62.7% of the SBCE were performed using the Pillcam SB2 capsule. Of the patients, 184 (18.0%) were inpatients and 84 (8.2%) had a prior abdominal surgery. The most common indications for SBCE were obscure gastrointestinal bleeding (41.8%), suspected Crohn’s disease (CD) (11.9%), assessment of known CD (11.3%), and chronic unexplained diarrhea (11.3%). Bowel preparation was poor in 5% of the examinations. The mean gastric transit time (GTT) was 44.4 min. Incomplete SBCE was recorded in 121 (11.9%) patients. The most common findings were ulcerations (18.6%) and angiodysplasias (14.6%). Multiple logistic regression revealed several predictive factors for incomplete SBCE shown in Table 1. ROC curve (Figure 1) showed that the optimal cut-off of GTT for the prediction of incompletion was 30 min (sensitivity 63%, specificity 67%). We identified several factors predictive of incomplete SBCE, such as being inpatient, use of the SB2 capsule, finding erosions or blood in the lumen, prior abdominal surgery, and prolonged GTT. These results may guide appropriate use of SBCE, improve completion rates and the diagnostic yield of the test in future procedures.View Large Image Figure ViewerDownload Hi-res image Download (PPT)