Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 697-702
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.697
Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding
Carlo Maria Girelli, Marco Soncini, Emanuele Rondonotti
Carlo Maria Girelli, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio (VA), 21052 Busto Arsizio (VA), Italy
Marco Soncini, Gastroenterology, S. Carlo Hospital, 20121 Milan, Italy
Emanuele Rondonotti, Gastroenterology, Valduce Hospital, 22100 Como, Italy
Author contributions: All authors provided substantial contributions to the conception, design, and/or acquisition of data, and/or the analysis and interpretation of data; Girelli CM performed the statistical analysis and wrote the manuscript; Soncini M implemented and updated the database; Rondonotti E provided intellectual content in the interpretation of study results; all authors critically revised and approved the final draft of the manuscript.
Institutional review board statement: Permission to review patient records was granted by the Local Ethics Committee. Further specific ethical review and approval were not required because the study was considered an evaluation of previously collected SBCE records, using anonymous data previously obtained as part of routine clinical care.
Informed consent statement: All enrolled patients gave their written informed consent to participate.
Conflict-of-interest statement: All authors have no disclosures to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlo M Girelli, MD, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio (VA),Via Arnaldo da Brescia, 1, 21052 Busto Arsizio (VA), Italy. cargirel@gmail.com
Telephone: +39-03-31699261 Fax: +39-03-31699265
Received: October 23, 2016
Peer-review started: October 25, 2016
First decision: November 21, 2016
Revised: November 27, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: January 28, 2017
Processing time: 87 Days and 16.3 Hours
Abstract
AIM

To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.

METHODS

Small-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.

RESULTS

We 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%).

CONCLUSION

In 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.

Keywords: Capsule endoscopy; Small-bowel transit time; Detection rate; Diagnostic yield; Small bowel; Obscure gastrointestinal bleeding; Prokinetics; Suspect small-bowel bleeding

Core tip: There is growing evidence that a slower small-bowel transit time (SBTT) increases the diagnostic yield of small-bowel capsule endoscopy (SBCE). The present study-an analysis of a large database of consecutive, prospectively collected, complete SBCE performed for obscure gastrointestinal bleeding-confirms this finding. However, we found a correlation between SBTT and age, with age serving as an independent predictor on multivariable analysis. Prokinetics, used to increase the completion rate of SBCE, may hamper the detection rate of significant lesions and should only be used in selected patients.