PTH-141 Wireless Capsule Endoscopy – Diagnostic Yield and Clinical Utility Varies Widely According to Indication

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IntroductionWireless capsule endoscopy (WCE) is a well established technique for imaging the small bowel, with an increasing clinical uptake and range of indications. We aimed to evaluate the utility of WCE, comparing the diagnostic yield of procedures by indication.MethodsWe performed a retrospective analysis of all WCE procedures performed at our centre, January 2007 to March 2013.ResultsA total of 293 procedures were performed in 279 patients, male 47%. Median age at time of procedure was 59 (IQR 45–71). The indications were: iron deficiency anaemia (IDA)/occult GI bleeding 154 (53%), known Crohn’s disease requiring assessment 58 (20%), abdominal pain (+/- other symptoms) 33 (11%), overt GI bleeding 20 (7%), isolated diarrhoea 10 (3%), coeliac disease 6 (2%), isolated weight loss 4 (1%), other 8 (3%). Of those undergoing WCE for symptoms (47; 16%), Crohn’s disease was excluded (an aim of performing the study) in 34 (72%).The median gastric transit time was 27 min (IQR 14–55), small bowel transit time 243 min (IQR 181–300). Unplanned endoscopy for failure of capsule progression was required in 8 cases (3%). 5 procedures (2%) failed to image the small bowel (failed to leave stomach (3), battery failure (1), poor views (1)). A prokinetic was used in 9% (n = 27) of procedures. Overall the diagnostic yield was 50%. Separating by indication, the diagnostic yield was highest for overt GI bleeding, 70% overall (n = 14), identifying both 9/20 small bowel causes and 5/20 in colon/upper GI tract. Yield for Crohn’s disease assessment was 63%, IDA/occult GI bleeding 46%, abdominal pain (+/- other GI symptoms) 47%. The diagnostic yield of WCE for abdominal pain in the absence of other symptoms or abnormal radiology/ileoscopy was only 14%. 23 out of 27 patients evaluated for symptoms (in the absence of anaemia/known Crohn’s) were discharged requiring no further investigation following a negative result.ConclusionWireless capsule endoscopy has a good diagnostic yield, especially for evaluating GI blood loss (overt or occult) and assessing small bowel Crohn’s disease. Among highly symptomatic patients, WCE can facilitate completion of investigatory pathways and enable discharge to primary care. The utility of WCE in investigating isolated abdominal pain appears limited.Disclosure of InterestNone Declared.

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