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16 REPEATED CAPSULE ENDOSCOPY: IS THERE A BENEFIT? SC Shapira1, MJ Wood2, R Enns1, M Appleyard2 BACKGROUND: Capsule endoscopy (CE) is an ambulatory, sensitive, noninvasive technique primarily used to evaluate the small intestine. A negative CE is, at times, followed by multiple additional investigations. This study reviewed all patients at two tertiary care centres that have undergone repeat capsule endoscopies to determine if there is clinical benefit of a repeat study.
1St Paul's Hospital, University of British Columbia, Vancouver, British Columbia; 2Royal Brisbane Hospital, Brisbane, Australia
METHODS: Repeat CE studies (performed between 12/01 and 11/04) completed at two tertiary care academic centres were reviewed. 35 individuals underwent two CE (2 patients underwent 3 CE). The review was performed to collect data on demographics, indication for CE, investigations (endoscopic and nonendoscopic), transfusions and management, pre- and post-CE. The information was available from a prospectively collected CE database and from patient charts; however, in cases where data was absent, patients' physicians and/or the patients themselves were contacted.
RESULTS: The total of CE performed at St Paul's Hospital have been 319 [250 for obscure GI bleeding (OGIB)] and at Royal Brisbane Hospital have been 285 (237 for OGIB). Of thirty five patients who had at least 2 CEs (mean age 58, 49% female), 32 were for OGIB, 2 for Crohn's and 1 for abdominal pain. Of patients with OGIB, 19 had occult, 10 overt and three patients were classified as occult on one study and overt on another. Mean transfusional requirements were 12.31 units (range 0 to 100) with 22 also receiving iron supplementation and four on coumadin. Before the first CE, the mean number of EGDs was 2.14 (range 1 to 6), push enteroscopies 0.74 (0 to 3) and colonoscopies 1.94. For the indication of OGIB, 11 had a negative first study. Of these, repeat CE found active bleeding/definite abnormality in seven (64%). Twelve patients had findings on the first study with the second CE clarifying the diagnosis in seven. Eight of the first CE were incomplete and of these an abnormality was seen in five (63%) on repeat CE. Fourteen patients had some form of intestinal surgery before the first CE and nine underwent surgery for further investigation or definitive management after their second CE. Another nine patients underwent repeat therapeutic endoscopic treatment guided by their second CE.
CONCLUSIONS: Repeat CE provides useful diagnostic information in patients with both negative and positive initial CEs. Repeat CE leads to definitive management (either endoscopic or surgical) of the bleeding source in most patients with OGIB.