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110 SIGNIFICANCE OF NEGATIVE CAPSULE ENDOSCOPY ON FUTURE GI INVESTIGATION - BENEFIT OF A NEGATIVE FINDING P Intaraprasong, J Shah, JK Law, S Shapira, R Enns BACKGROUND: Capsule Endoscopy (CE) is a safe, painless, effective ambulatory technique for the evaluation of small bowel mucosa and in the setting of obscure gastrointestinal bleeding (OGIB). A positive finding typically leads to definitive, often curative therapy. Our group previously demonstrated the benefit of a negative CE study in resource utilization and potential for cost saving.
Division of Gastroenterology, Department of Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia
OBJECTIVE: This study extended patients follow-up and data collection to determine the benefit of a negative CE on specific aspects of resource utilization.
METHOD: Negative CE studies completed at a single academic center were reviewed between 12/01 to 01/06. Of 429 capsules studies for OGIB; 197 were negative. From a prospectively collected database, information regarding investigations (endoscopic and non-endoscopic), transfusion requirements and management before and after CE were analyzed. Statistical analysis was carried out using McNemar's and Wilcoxon Signed Rank Tests to compare similar time periods before and after the patients capsule study.
RESULT: The number of patients undergoing =>3 upper endoscopies were decreased post CE (10.0% vs 1.3%, p<0.001). The number of patients undergoing =>3 colonoscopies were decreased post CE (median of 1 vs 0, p< 0.001). Transfusion requirement also decreased post CE (mean number of units of PRBCs: 7.33 vs 1.10, p<0.01). Prior to their negative CE, 41 patients had transfusions =>5 units prbcs whereas after CE only 14 required this amount of blood product support (p<0.01). There were 16 pts (11.3%) who had repeat CE of whom 3 patients underwent surgery management.
CONCLUSION: Even though a capsule study is relatively expensive, a negative CE study is associated with a decreased requirement for further investigations (particularly endoscopic) which may result in decreased total resource utilization. The finding that blood transfusions apparently decrease following a negative study indicates that this group has a low risk of future significant bleeding events and that these patients can be followed supportively.