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Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study.

Egnatios J, Kaushal K, Kalmaz D, Zarrinpar A - PLoS ONE (2015)

Bottom Line: The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms.Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America.

ABSTRACT

Background: Chronic abdominal pain (CAP) is a common indication for gastroenterology referrals. More insidious causes of CAP isolated to the small bowel, such as malignancies and Crohn's disease, are rising in incidence and causing more gastroenterologists to evaluate their patients with video capsule endoscopy (VCE). However, the role of VCE in patients with CAP is still unclear.

Aims: We assessed the efficacy of VCE in patients with CAP and whether it led to findings that contributed to disease management and meaningful interventions.

Methods: This retrospective study evaluated 607 capsule endoscopy studies at an open referral endoscopy unit. Ninety of the studies were for CAP. These studies were compared to those performed for other indications to compare diagnostic yield. In addition, we investigated whether VCE led to an intervention that improved clinical outcomes.

Results: Overall, the number of abnormal findings in CAP patients was significantly lower than VCE performed for other indications (24.4% vs 39.0%, respectively p = 0.009). When patients with CAP presented with other pertinent clinical findings (e.g. nausea, weight loss, anemia, history of in inflammatory bowel disease, etc.), the likelihood of an abnormal finding increased to a level that was not different from those who received VCE for other indications (27.1%, p = 0.10). The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms. However, the subgroup that benefited the most were those who had a prior history of Crohn's disease. Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).

Conclusions: VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn's disease.

No MeSH data available.


Related in: MedlinePlus

Difference in patients with chronic abdominal pain (CAP).(A) Abnormal findings by referral source. Patients receiving capsule endoscopy for CAP from the community setting had a significantly higher rate of abnormal findings than those referred for capsule studies from a tertiary center. (B) Patients with CAP who also received gastric emptying studies.
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pone.0126509.g003: Difference in patients with chronic abdominal pain (CAP).(A) Abnormal findings by referral source. Patients receiving capsule endoscopy for CAP from the community setting had a significantly higher rate of abnormal findings than those referred for capsule studies from a tertiary center. (B) Patients with CAP who also received gastric emptying studies.

Mentions: Because our retrospective data was collected from an open endoscopy center, we compared patients referred from community physicians (47 patients; 52.2% of patients with CAP) and those from the tertiary care facility (43 patients; 47.8% of patients with CAP). Community physicians referred the majority of patients with CAP and no other symptoms, (20 patients; 64.5% of CAP-O). However, patients referred from community physicians were much more likely to have abnormal findings on VCE studies compared to those from tertiary care facility (34.0% v 14.0%, respectively, p = 0.003) (Fig 3A).


Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study.

Egnatios J, Kaushal K, Kalmaz D, Zarrinpar A - PLoS ONE (2015)

Difference in patients with chronic abdominal pain (CAP).(A) Abnormal findings by referral source. Patients receiving capsule endoscopy for CAP from the community setting had a significantly higher rate of abnormal findings than those referred for capsule studies from a tertiary center. (B) Patients with CAP who also received gastric emptying studies.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4404061&req=5

pone.0126509.g003: Difference in patients with chronic abdominal pain (CAP).(A) Abnormal findings by referral source. Patients receiving capsule endoscopy for CAP from the community setting had a significantly higher rate of abnormal findings than those referred for capsule studies from a tertiary center. (B) Patients with CAP who also received gastric emptying studies.
Mentions: Because our retrospective data was collected from an open endoscopy center, we compared patients referred from community physicians (47 patients; 52.2% of patients with CAP) and those from the tertiary care facility (43 patients; 47.8% of patients with CAP). Community physicians referred the majority of patients with CAP and no other symptoms, (20 patients; 64.5% of CAP-O). However, patients referred from community physicians were much more likely to have abnormal findings on VCE studies compared to those from tertiary care facility (34.0% v 14.0%, respectively, p = 0.003) (Fig 3A).

Bottom Line: The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms.Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University of California San Diego, La Jolla, California, United States of America.

ABSTRACT

Background: Chronic abdominal pain (CAP) is a common indication for gastroenterology referrals. More insidious causes of CAP isolated to the small bowel, such as malignancies and Crohn's disease, are rising in incidence and causing more gastroenterologists to evaluate their patients with video capsule endoscopy (VCE). However, the role of VCE in patients with CAP is still unclear.

Aims: We assessed the efficacy of VCE in patients with CAP and whether it led to findings that contributed to disease management and meaningful interventions.

Methods: This retrospective study evaluated 607 capsule endoscopy studies at an open referral endoscopy unit. Ninety of the studies were for CAP. These studies were compared to those performed for other indications to compare diagnostic yield. In addition, we investigated whether VCE led to an intervention that improved clinical outcomes.

Results: Overall, the number of abnormal findings in CAP patients was significantly lower than VCE performed for other indications (24.4% vs 39.0%, respectively p = 0.009). When patients with CAP presented with other pertinent clinical findings (e.g. nausea, weight loss, anemia, history of in inflammatory bowel disease, etc.), the likelihood of an abnormal finding increased to a level that was not different from those who received VCE for other indications (27.1%, p = 0.10). The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms. However, the subgroup that benefited the most were those who had a prior history of Crohn's disease. Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%).

Conclusions: VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn's disease.

No MeSH data available.


Related in: MedlinePlus