Video capsule endoscopy completion and total transit times are similar with oral or endoscopic delivery

Abstract

Background and study aims: Video capsule endoscopy (VCE) is limited by incomplete procedures. There are also contraindications to the standard ingestion of the capsule that require endoscopic placement. Our aim was to compare the study completion rate of VCE after oral ingestion and endoscopic deployment. Patients and methods: We performed a review of all VCE from April 2010 through March 2013. Inpatient and outpatient cohorts grouped by the method of capsule delivery were formed and compared. Multivariable logistic regression modeling was utilized adjusting for variables with a P value ≤ 0.1 in group comparisons. Log-rank analysis was used to compare transit times. Results: A total of 687 VCE were performed, including 316 inpatient (36 endoscopic deployment, 280 oral ingestion) and 371 outpatient (20 endoscopic deployment, 351 oral ingestion). For VCE on hospitalized patients, the completion rates were similar after endoscopic deployment and oral ingestion (72 % vs 73 %, P = 0.94). The completion rates were also similar for ambulatory patients (90 % vs 87 %, P = 0.69). There remained no difference after multivariable modeling for inpatients (P = 0.71) and outpatients (P = 0.46). Total transit times were not significantly different. Conclusions: VCE completion rates and total transit times are similar after oral or endoscopic deployment for both hospitalized and ambulatory patients. Endoscopic placement is effective in patients with contraindications to standard oral ingestion, but should otherwise be avoided to limit unnecessary procedural risks and costs.

The Effect of Prucalopride on Small Bowel Transit Time in Hospitalized Patients Undergoing Capsule Endoscopy

“…In the present study, the SBTT in the prucalopride group was substantially shorter than the SBTT reported in the literature for both inpatient and outpatient VCE. Furthermore, the completion rate in the prucalopride group was also substantially higher than the completion rate reported in the literature for the inpatient VCE and is comparable to the completion rates for outpatient VCE [ 9 – 11 ]. For the control group, the SBTT and completion rate were similar to what is reported in the literature [ 7 – 9 , 11 ].…”

“…Furthermore, the completion rate in the prucalopride group was also substantially higher than the completion rate reported in the literature for the inpatient VCE and is comparable to the completion rates for outpatient VCE [ 9 – 11 ]. For the control group, the SBTT and completion rate were similar to what is reported in the literature [ 7 – 9 , 11 ]. Therefore, the differences in the SBTT and the completion rates between the two groups in our study did not result from disproportionately longer SBTT and lower completion rate in the control group biasing the results in favor of the prucalopride group.…”

“…Several factors have been recognized as potential risk factors for incomplete VCE including the inpatients status, prior small bowel surgery, prolonged gastric passage, older age, diabetes, and poor bowel preparation [ 7 – 9 , 26 ]. Hospitalized patients are particularly at risk for incomplete VCE, with a completion rate in the range of 64 to 73% [ 7 – 11 ]. One potential strategy is to accelerate the passage of the capsule through the stomach and small bowel preventing prolonged transit time.…”

“…Inpatient VCE is commonly performed to investigate the source of obscure gastrointestinal bleeding. The inpatient status is a well-known risk factor for incomplete small bowel examination with a reported completion rate as low as 64%, limiting the diagnostic utility of VCE [ 7 – 11 ]. The performance of VCE after hospital discharge is potentially associated with a decrease in the diagnostic yield, delays therapeutic interventions, and is not always possible.…”

Contraindications for video capsule endoscopy

“…A single center study reported a higher completion rate and diagnostic yield when a real time viewer was used and the capsule was placed endoscopically into the duodenum in the case of prolonged gastric transit time (> 60 min)[35]. The unselected primary endoscopic placement of the capsule into the duodenum to circumvent possible gastroparesis had no effect on complete small bowel visualization in a single center analysis of 687 hospitalized or out-patients compared to swallowing the capsule[36]. In a prospective single-center study including 100 VCE studies, a pathologic Gastroparesis Cardinal Symptoms Index questionnaire could not predict a prolonged gastric transit time nor did a delayed gastric passage have any clinical significance[37].…”