Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding

Abstract

AIMTo define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODSSmall-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.RESULTSWe retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).CONCLUSIONIn this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.

Small Bowel Transit Time in Capsule Endoscopy: a determinant factor for the diagnosis of small bowel bleeding

“…In addition, older patients presented a longer SBTT, likely due to the reduced motility that occurs with aging, which partially explains the higher diagnostic yield of P2 lesions in this population, being is in line with previous series. 8,14 In accordance to our results, Girelli C. et al found that longer SBTT along with older age were associated with higher rates of P2 lesions. 8 Blanco-Velasco and coworkers suggested that SBTT ≥4 hours were associated with an improved diagnostic yield with a odds ratio of 3.13.…”

“…8,14 In accordance to our results, Girelli C. et al found that longer SBTT along with older age were associated with higher rates of P2 lesions. 8 Blanco-Velasco and coworkers suggested that SBTT ≥4 hours were associated with an improved diagnostic yield with a odds ratio of 3.13. 10…”

“…[4][5][6][7] Recent investigation have hypothesized that longer SBTT could be a factor associated with higher rates of lesion detection in SBB. [8][9][10] In our cohort, in univariate analysis we found in accordance to previous studies that older patients, male gender, and with chronic comorbidities such as hypertension, diabetes, CKD and HF presented more frequently with P2 lesions in SBCE. [4][5][6][7] Moreover, in our study, patients with P2 lesions in SBCE presented longer SBTT, suggesting that slower passage of the capsule in the small bowel allows for a better inspection of the small bowel mucosa and it is associated with higher diagnostic yield for significant lesions.…”

“…[4][5][6][7] Moreover, in our study, patients with P2 lesions in SBCE presented longer SBTT, suggesting that slower passage of the capsule in the small bowel allows for a better inspection of the small bowel mucosa and it is associated with higher diagnostic yield for significant lesions. 8 Furthermore, beyond male gender and older age, in logistic regression, SBTT constitutes an independent predictor factor of the presence of P2 lesions. In addition, older patients presented a longer SBTT, likely due to the reduced motility that occurs with aging, which partially explains the higher diagnostic yield of P2 lesions in this population, being is in line with previous series.…”

“…[4][5][6][7] Recently, small-bowel transit time (SBTT) was pointed as a factor associated with the diagnostic yield of significant lesions in SBB. [8][9][10] Incomplete SBCE evaluation may impair the diagnostic yield and factors such as hospitalization, previous surgery or radiation, diabetes mellitus and very old age have been identified as potential risk factors. The combined strategy of checking the position of SBCE with real time viewer and the selective administration of prokinetics has been adopted to overcome this limitation.…”