Video Capsule Endoscopy Completion Rates and Total Transit Times Are Similar With Oral or Endoscopic Delivery

Abstract

Introduction: Endoscopic deployment of video capsule endoscopy (VCE) directly into the small bowel has been suggested as a means to increase completion rates. Our aim was to compare VCE completion after oral ingestion and endoscopic deployment for hospitalized and ambulatory patients. Methods: We performed a review of all VCE at our institution over a 3-year period (April 2010 - March 2013). Inpatient and outpatient cohorts grouped by the method of capsule delivery were formed. Groups were compared using chi-square or Fisher’s exact tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables. Multivariable logistic regression modeling of VCE completion was utilized, adjusting for variables with a p value ≤0.1 in group comparisons. Log-rank analysis was used to compare transit times. Results: We performed a total of 687 procedures during the study period, including 316 inpatient (36 with endoscopic deployment, 280 with oral ingestion) and 371 outpatient (20 with endoscopic deployment, 351 with oral ingestion). Deployment into the small bowel was Successful in 54/56 attempts (96.4%). The indications for endoscopic placement were: history of VCE gastric retention 20 (36%), unknown 12 (21%), dysphagia 9 (16%), upper endoscopy procedure on same date 8 (14%), upper tract surgical history 6 (11%), and duodenal stricture 1(2%). For VCE on hospitalized patients, the completion rates were similar after endoscopic deployment and oral ingestion (72% vs 73%, p=0.94, Figure 1). The completion rates were also similar for ambulatory patients (90% vs 87%, p=0.69, Figure 1). There remained no difference after multivariable modeling for both inpatients (p=0.71) and outpatients (p=0.53). Small bowel transit time was prolonged for inpatients after endoscopic deployment (290 min. vs 222 min., p=0.03). Other transit times, including total bowel transit, were not significantly different.Figure 1Conclusion: Completion rate is similar after oral or endoscopic deployment for both inpatient and outpatient VCE. Endoscopic deployment is effective in patients with contraindications to standard oral ingestion, but should otherwise be avoided to limit unnecessary procedural risks and costs.