The diagnostic role of capsule endoscopy CE has rapidly evolved over the past two decades and is currently regarded as one of the gold standard test to investigate the small bowel. Although most publications are from tertiary referral centres, there is a paucity of data on feasibility and clinical utility of CE in a district General hospital (DGH) setting in the United Kingdom (UK). We aimed to evaluate the capsule endoscopy service in our Hospital since it has been established in 2011.Methods
We retrospectively reviewed and analysed the CE reports of all patients who had the test between April 2011 and April 2017. Exclusion criteria: Retained capsule, difficulty to swallow capsule and inadequate views due to poor bowel prep. We assessed demographics, indications, outcome, complications and completion of the test among the whole cohort. We also looked at the diagnostic yield (DY).Results
In the aforementioned period, Small bowel CE was performed on 1029 patients. 71 (6.9%) patients were excluded as per exclusion criteria. 958 (528F/430M; Mean age 59 years, Range: 17–92) patients’ reports were reviewed and analysed. OGIB was recorded as the main indication 81.4% (iron deficiency anaemia, IDA: 74.9% (n=718), overt bleeding 6.5% (n=62)). Other indications included investigation of small bowel Crohn’s disease (CD) 10.3% (n=99), weight loss: 1.7% (n=16), angiodysplasia: 1.3% (n=12), abdominal pain: 2% (n=19) and others: 7.2% (n=69). Complete small bowel examination was achieved in 902 patients (94.2%). 56 patients (5.8%) had sub optimal views due to rapid transit time. The test was normal in 61% (n=581). Small bowel angioectasia was detected in 13.8% (n=132). Other findings included apthoid ulcers: 11.8% (n=113), inflammation and oedema suggestive of Crohn’s disease in 8% (n=76), polypoidal lesion 1.5% (n=17), colonic pathologies 1.5% (n=14) and others 5.8% (n=56). Patients with suspected small bowel Crohn’s disease had initial patency capsule to prevent lodgement. Retention was recorded in 3% of patients (n=3) due to strictures. One patient’s stricture improved with steroids therapy, the second patient underwent surgery for a malignant stricture and the third patient had enteroscopy and removal of the capsule; biopsies of the stricture were in-conclusive. The overall cohort DY for all indications was 39% (n=377/958).Conclusions
This is the largest series from a DGH in England. Our data has shown that CE is safe, non-invasive and feasible in a district hospital setting. It has a good DY, acceptable to patient and allows adequate look at the small bowel. Recommendations: Despite the major role of CE in GI investigation, there is a lack of structured training. We recommend formal accreditation and training to be added to the Gastroenterology advance training curriculum.