Yield of Balloon Assisted Enteroscopy After Abnormal Capsule Endoscopy Depends on the Source of the Capsule Endoscopy

Abstract

Introduction: Capsule endoscopy (CE) findings often result in referral to tertiary care centers for enteroscopy. There is published data analyzing CE prior to single balloon enteroscopy (SBE) but there are no studies comparing referral and non-referral CE that later underwent SBE. The aim of this study was to compare the diagnostic & therapeutic yield in patients undergoing SBE after CE either referred or performed at our institution. Methods: We performed a retrospective cohort study using the electronic health records of 428 patients undergoing SBE. After excluding those patients without CE, 240 patients were analyzed. Two groups were created:group-1 consisted of inside CE(n= 110) & group-2 consisted of outside CE (n=130). Data collected included demographics, diagnostic/therapeutic information, and complications. The association between dependent and independent variables were assessed using an independent sample t-test and logistic regression. The results are summarized as mean difference(MD) and standard deviation(SD) or odds ratio(OR) and 95% confidence intervals(CI). Results: Overall, gender, age, race, and abdominal surgeries were not significantly different between the groups. However, patients were more likely to be hospitalized in the inside group 45.5% vs. outside group 21.5% OR 3.04(1.73-5.32; p <0.0001). Likewise, days of hospitalization was significantly higher in the inside group 13.5+/- 10.8 vs. 7.3+/- 7.6 in the outside group MD 6.24(95% CI 1.6-10.9; p = 0.009). Patients who had inside CE had higher rates of blood transfusions 33.6% vs. 18.4% in the outside group OR 2.7(1.45-4.92; p= 0.002). No significant difference was found in the diagnostic yield OR 1.49(0.89-2.5; p=0.13). Nonetheless, therapeutic yield was significantly higher with inside CE 47.2% vs. outside CE 33.8% OR 1.75(1.04-2.95; p=0.035). Conclusion: We found a higher therapeutic yield for SBE done after CE performed inside our institution. Although diagnostic yield was also higher in this group, it did not reach statistical significance. Review of the video recording should be considered by tertiary care center gastroenterologists prior to balloon assisted enteroscopy in patients referred with a CE done at an outside institution.Figure 1