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231 REPEATED CAPSULE ENDOSCOPY: 'IS THERE A BENEFIT'? N Mahmoudi1, M Appleyard2, SC Shapira1, JK Law1, MJ Wood2, R Enns1 BACKGROUND: Capsule endoscopy (CE) is an ambulatory, sensitive, non-invasive technique primarily used to evaluate the small intestine. A negative CE is, at times, followed by multiple additional endoscopic investigations including repeat capsule studies.
1Division of Gastroenterology, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia; 2Royal Brisbane Hospital, Brisbane, Australia
OBJECTIVES: This study reviewed all patients at two tertiary care academic centers that have undergone repeat CE to determine the indications, associated comorbid and risk factors and yield of repeat study.
METHODS: This retrospective study used a prospective database of all capsule patients from 12/01 to 09/06 who had undergone repeat study. Indications for repeat study were divided into three groups (incomplete initial study, ongoing symptoms, screening/surveillance). Patients' outcomes, demographics, transfusion requirements and current anticoagulation and/or NSAID use as well as other comorbidities were evaluated if applicable.
RESULTS: Over the time period studied, 47 patients had at least two CEs. Mean age was 57.3 (range 18-81), 55% of patients were male. 43 were for obscure GI bleeding (OGIB), 1 for Crohn's disease, 2 for abdominal pain and 1 for screening polyposis syndrome. Of patients with OGIB, 18 had occult, 23 overt and 2 patients were classified as occult on one study and overt on another. Indications for repeat CE included ongoing symptoms in 62% (29/47), limited visibility due to poor bowel preparation in 17% (8/47), failure of capsule to either exit stomach or visualize cecum or technical difficulty downloading data in 19% (9/47) and screening in 2% (1/47). The first and second CE were on average 8.97 months apart. 17 had a negative first study, of these repeat CE found active bleeding/definite abnormality in 9 (53%). 15 of the first CE were incomplete and of these an abnormality was seen in 10 (67%) in repeat study. Overall yield of positive first CE was 31.9% comparing to 59.6% for repeat CE.
CONCLUSIONS: Repeat CE provides useful diagnostic information in patients with both negative and positive initial CEs. Our results have shown a doubling of the yield from repeating capsule endoscopy presumably associated with improved bowel prep/better visualization and occasionally endoscopic capsule placement. Repeat CE leads to definitive diagnosis and management of the bleeding source in most patients with OGIB.