Su1325 PROLONGED OPERATING TIME HAVE A SUBSTANTIAL EFFECT ON PROMOTING COMPLETE EXAMINATION RATE OF CAPSULE ENDOSCOPY COMPARED WITH ENDOSCOPIC DELIVERY OF CE ALONE

Abstract

Small bowel capsule endoscopy (SB CE) has become the gold standard for the investigation of small bowel diseases. The most common applications of CE include obscure gastrointestinal bleeding (OGIB), suspected Crohn’s disease, small-intestine tumors and polyps, etc. The diagnostic yield of SB CE has been reported to vary widely and can be affected by many factors, such as indications, bowel preparation, reviewers’ experience, and so on. Complete examination was defined as capsule passing through the whole small intestine during its working time, and the complete examination rate (CER) is also one of the important factors that can influences the diagnostic yield of CE. Some methods have been adopted to promote the CER; among them are real-time monitoring plus endoscopic delivery of CE into the duodenum and prolonging examination time with increased battery life. In order to study which of the two methods mentioned above is more effective for improving the CER, three types of modality of CE examination were analyzed. We conducted a retrospective review of 241 consecutive patients, 61 of whom had undergone 8-h PillCam SB CE (8 h operating time) from July 2005 to April 2011 without real-time monitoring, 7 consecutive 8-h PillCam SB CE and 173 consecutive 12 h PillCam SB2-ex (12 h operating time) patient all with real-time monitoring and endoscopic delivery of CE if necessary (CE unable pass through the pylorus 1.5 h after the start of the inspection) from July 2011 to November 2018. We grouped the patients as follows: A, 61 cases 8-h PillCam CE without real-time monitoring; B, 180 cases 8-h PillCam CE with monitoring (7 actual 8 h, and 173 actual 12 h but assumed the CE only work for 8 h and only data of the former 8 h were calculated); C, 173 cases 12 h PillCam SB2-ex actual data. GTT (gastric transit time), SBTT (Small bowel transit time) and CER of the three groups were analyzed. We found that twenty-nine (16.1%, 29/180) endoscopic delivery of CE were performed in group B, but there was no difference between group A and B in GTT, SBTT or CER. CER of group C (94.8%, 164/173) was much higher than that of group A (78.7%, 48/61) or B (72.8%, 131/180) (Chi-square test with Bonferroni correction; C vs. A, p ＜ 0.01 & C vs. B, p ＜ 0.001), and SBTT of group C (322.0 ± 133.1 min) was much longer than that of group A (253.8 ± 80.9 min) or B (269.3 ± 98.4 min) (One-Way ANOVA Tamhane's T2 or Dunnett's T3 test; C vs. A & C vs. B, p ＜ 0.001) (table 1). In conclusion, longer operating time have a substantial effect on promoting complete examination rate of CE, while endoscopic delivery of CE have little or no effect on it. Endoscopic delivery of CE plays a role in eliminating the risk of inspection failure, such as unable to ingestion, or excessive time wasted in the esophagus or stomach, but too early or too frequently endoscopic delivery of CE is not necessary.