The Yield of Capsule Enterosocopy Varies in a Community vs University Hospital Setting

Abstract

Purpose: Capsule enteroscopy (CE) is a widely used diagnostic tool for small intestinal disorders. Initial data for CE came from large academic medical centers, yet CE is now widely available in the community hospital setting. The aim of this study was to compare indications and findings for CE at Holy Cross Hospital (HC), a large Ft Lauderdale community hospital with those at the University of Miami during a comparable period of time. Methods: We retrospectively reviewed 103 CE cases performed at HC between 2002–2005 and 107 CE cases performed at U of M during the same time period, using an identical database for: demographics, indications—unexplained occult bleeding (OGIB)and/or iron deficiency anemia (Fe deff); Crohn's (CD), abnormal small bowel X-ray(SBFT), and findings—AVM's, CD, gastroduodenal lesions (GDuod), SB erosions, SB tumors, well as incomplete studies. Both institutions used the same Given® CE system and software. Statistical software (Graph Pad Instat v.3.0) analyzed the data. Failed studies defined as inability to completely examine the SB, either due to gastroparesis, technical failure, or food. Results: Both groups were similar in mean age and gender (50% men HC vs 53%UM) and indications (p= NS). The CE exam was incomplete in 8% of cases in each group. There were some signficant differences in findings between the 2 groups:Table. CE: INDICATIONSTable. CE: FINDINGSConclusions: Concurrent patients undergoing CE in a community hospital vs university hospital setting, show no statistically significant differences in demographics, indications, and rate of incomplete exams(8% in each group). We confirmed a 7–14% incidence of gastroduodenal findings within EGD range in both groups. There were signficantly more normal studies in the HC group and more AVM's detected in the UM group. The data suggests that these differences were observer related rather than due to selection bias, and point to challenges facing deployment of CE technology in the community hospital setting.