PTU-162 Capsule endoscopy: diagnostic yield and clinical outcomes in North-East Lincolnshire

Abstract

Introduction: Capsule Endoscopy (CE) has become a very important non-invasive tool for the investigation of small bowel pathology. This study examines the patient pathway to CE, from initial referral to final clinical outcome, within our newly established service. Methods: Medical notes for patients who underwent CE in North East Lincolnshire from 2009 to 2011 were reviewed retrospectively. Information analysed included demographics, previous investigation, diagnosis and subsequent treatment. Results: 123 patients underwent CE in the 2-year study period. 22 notes were unobtainable, so 101 were analysed. The study population characteristics include a median age of 59 (16-76 yrs), an equal gender spread (53% female and 47% male) with a 99% white ethnic majority. 95% of referrals were as an outpatient and 92% were made by physicians. The median waiting time was 115 days. The main indications were: recurrent iron deficiency anaemia (48.5%), inflammatory bowel disease (IBD) (33.7%), overt gastrointestinal (GI) bleeding (15%). Patients had commonly undergone previous investigations: marjority had gastroscopy, colonoscopy (82.3%), CT abdomen (22.8%), Barium meal (21.8%), small bowel MRI (18.8%) and flexi-sigmoidoscopy (9.9%). 6.9% (7 patients) had undergone a previous CE. CE detected abnormality in 97% of this cohort, although some were insignificant. The most common pathology was: erosions (54.5%), evidence of blood (41.6%), angiodysplastic lesions (32.6%), ulceration (28.7%), focal inflammation (26.7%) and upper GI inflammation (19.8%). 72.2% of pathology was in the small bowel. Procedural complications included capsule retention (2), and suboptimal views in four patients. CE reporting confirmed diagnoses of angiodysplasia (25.7%), IBD (16.8%), drug induced small bowel erosions (6.9%), duodenitis/gastritis/oesophagitis (5.9%) and ulceration (4.9%). Rarer diagnoses included small bowel tumour and Meckel's Diverticulum. Median reporting time was 35 days. CE significantly contributed to the management of the patients examined: 78% had changes to their medications (eg, stop NSAIDs, start IBD drugs), 62% underwent further investigations (eg, enteroscopy, gastroscopy and colonoscopy), 52% underwent therapeutic intervention (eg, APC, polypectomy and surgical referral). However, in 30% their management was unchanged. The majority of patients (88.1%) are still under active follow-up today. Conclusion: The CE experience at this centre is of a simple, well-tolerated investigation which allows definite diagnoses to be made with minimal complications. Higher diagnostic yield compared to previous published data could be explained by the strict inclusion criteria and recent introduction of this new service. This expanding service highlights the need for more resources to reduce waiting and reporting times in line with other GI investigations.