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FACTORS ASSOCIATED WITH INCOMPLETE SMALL BOWEL CAPSULE STUDIES
A Jacques, J Telford, J Law, R Kwok, E Lam, B Segal, P Lakzadeh, P Kazemi, R Enns
St Paul's Hospital UBC, Vancouver, British Columbia
Aims: Failure to obtain adequate images of the entire small bowel is a significant problem to patients undergoing small intestinal capsule studies. At least 20% of studies fail to have the capsule reach the cecum; and in those studies reports must specify that the study was incomplete. If factors could be determined to predict which patients might be at risk for this problem; specific steps (i.e. preparations, motility agents) could be considered in those patients to enhance the possibility of a complete study.
Objective: To determine factors associated with incomplete capsule studies.
Methods: A prospectively collected database has been collected involving 653 small intestine capsule studies. Data collected included demographics, indication for the procedure, mobility status, narcotic use, diabetes mellitus, renal insufficiency, visibility and completeness of the procedure. For the purpose of this study, incomplete studies were considered those that either did not reach the cecum or alternatively, had incomplete visualization (involving 25% of the study) due to debris. Those patients with incomplete studies were compared to those with completed studies using the variables noted above. Logistic regression model is pending.
Results: A total of 653 small bowel capsule studies were performed. Of these 170 (26%) were rated as incomplete (2 failed to exit the esophagus, 18 failed to exit the stomach, 24 had poor visibility and 126 did not reach the cecum). Of the 20 studies that didn't image the small intestine at all; 3 were inpatients, 5 were diabetics, 1 had severe renal insufficiency and 1 was on narcotics. Of the 37 patients who were either inpatient or non-ambulatory (ie. wheelchair), 15 studies (41%) were incomplete. Patients on narcotics- 15% had incomplete studies, those with diabetes mellitus 19% and those with renal insufficiency 9%. Patients who had incomplete studies were more likely to be inpatients (p<0.03), have diabetes mellitus (p=0.05) and be on narcotics (p=0.05).
Conclusions: Patients who are poorly mobile and those with renal insufficiency or taking narcotics should be considered at high risk for incomplete capsule studies.