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RELEVANCE OF STRICT SELECTION CRITERIA FOR CAPSULE ENDOSCOPY SERVICES IN CANADA
C Dube, V Webbink, F Adams, J Love, R Hilsden, S Heitman
University of Calgary, Calgary, Alberta
Aims: The diagnostic accuracy of capsule endoscopy (CE) for the investigation of small bowel (SB) pathology exceeds that of conventional radiological examinations. However, the cost-effectiveness of CE depends on the indications for SB investigations in the first place.
We report on the series of patients who underwent CE during the year 2007, with emphasis on the clinical relevance of findings made by CE. During 2007, our capsule service was also performing a cost-effectiveness analysis of CE in obscure GI bleeding (GIB), and therefore the subjects reported herein were those who were ineligible for the controlled study.
Methods: The Capsule Service at the University of Calgary is structured so that approval for CE is dependent on a full clinical consultation with a GI physician. Completed studies are read by two independent readers and discrepancies are discussed prior to final reporting. Charts from all studies performed over 2007 were reviewed and data regarding indications, prep quality, findings and clinical outcomes was retrieved. Patients with obscure GIB were either ineligible for our controlled obscure-occult GIB study or seen once enrollment for the obscure-overt GIB study was completed.
Results: Twenty-five percent of referrals were deemed inappropriate for CE. Reasons for exclusions were: severe comorbidity, chronic NSAID use, previously documented angiodysplasia, IBS, isolated FOBT positive, anemia without iron deficiency. A total of 45 studies were performed: 28 (62%) for obscure GIB (14 overt and 14 occult), 9 (20%) for possible IBD, 3 (7%) each for abnormal SB imaging and possible refractory celiac disease (RCD) and 2 for other reasons. Four studies were incomplete. The overall yield for diagnoses of clinical relevance was 73%; 32% SB ulcers or inflammatory lesions, 17% masses or polyps, 14% angiodysplasia, 5% strictures and 5% blood in the lumen.
Conclusions: CE plays an important role in the investigations of small bowel pathology, provided the appropriateness of the referral is carefully assessed beforehand.