HOME
Return to Table of Contents
107 THE USEFULNESS AND IMPACT ON MANAGEMENT OF POSITIVE AND NEGATIVE CAPSULE ENDOSCOPY G Chami, M Raza, CN Bernstein PURPOSE: Little has been reported on the clinical utility of positive capsule endoscopy (CE) findings. It is also difficult to place a value on a negative study. We aimed to determine the usefulness of positive and negative CE's and the impact of each on short and long term patient management.
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
METHODS: Medical records were reviewed for 72 consecutive CE patients. Based on outcomes from referring physicians it was decided if CE was useful, partially useful or not useful in the overall patient management, and whether CE a) assisted in providing a diagnosis, b) impacted the short-term management or c) impacted the long-term management.
RESULTS: Indications for CE were overt bleeding (36%), occult bleeding (19%), iron deficiency (19%), abdominal pain and weight loss (10%), assessing extent or clinching diagnosis of Crohn's (8%), and FAP screening (4%). Positive studies were seen in 54% of overt bleeds, 50% of occult bleeds, 43% of iron deficiency and 33% of Crohn's. Of the 72 CE in which results are available thus far, 31 were positive (43%) and 41 were negative (57%) studies. CE aided in diagnosis in 17 of 21 (81%) positive and seven of 31 (23%) negative studies (P<0.01). Positive and negative CE impacted on short-term management in 11 of 21 (52%) vs five of 31 (16%) (P<0.01) and long-term management in four of 21 (19%) vs three of 31 (10%), respectively. Overall, CE impacted on management in short term in 16 of 52 (31%), and in long term in seven of 52 (13%). For positive and negative studies, respectively, CE was considered a) useful in 45% vs 26% (35% overall), b) partially useful in 33% vs 16% (23% overall), and c) not useful in 19%, positive vs 58% negative studies (42% overall).
CONCLUSION: CE was considered useful or partially useful in over one-half of cases, and often impacted on management. A positive CE was found to be useful, aiding in diagnosis most of the time. This was significantly different from a negative study, which only aided in diagnosis a minority of the time. A positive CE was also found to impact on short term management more often than a negative CE. However, the difference was negligible for long-term management. While a physician's decision on whether or not to order CE should be based in part on the pretest probability of a positive exam, the clinical utility of a negative study should also be considered.