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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

Sensitivity analysis with 2:1 age and gender matched control (CAP).(A) Abnormal finding rates in patients with CAP and no other symptoms compared to matched patients who were evaluated for gastrointestinal bleeding (B) Comparison of the clinical impact of VCE in the CAP-O cohort and its matched gastrointestinal bleed group. (C) Abnormal finding rates in patients with CAP and other symptoms compared to age and gender matched patients who were evaluated for gastrointestinal bleeding. (D) Comparison of the clinical impact of VCE in the CAP-A cohort and its matched gastrointestinal bleed group. * represents a p-value of < 0.05. ** represents a p-value of < 0.01
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pone.0126509.g004: Sensitivity analysis with 2:1 age and gender matched control (CAP).(A) Abnormal finding rates in patients with CAP and no other symptoms compared to matched patients who were evaluated for gastrointestinal bleeding (B) Comparison of the clinical impact of VCE in the CAP-O cohort and its matched gastrointestinal bleed group. (C) Abnormal finding rates in patients with CAP and other symptoms compared to age and gender matched patients who were evaluated for gastrointestinal bleeding. (D) Comparison of the clinical impact of VCE in the CAP-A cohort and its matched gastrointestinal bleed group. * represents a p-value of < 0.05. ** represents a p-value of < 0.01

Mentions: In order to determine whether the abnormal finding rate and the frequency of interventions that improved outcomes were similar between patients who received VCE for CAP and patients who received VCE for an indication with strong evidence (i.e. obscure gastrointestinal bleed), we performed a sensitivity analysis. We decided to use VCE-GIB population since the evidence is strong that these patients would benefit from a VCE, and its indication clearly stated in society practice guidelines [10]. In the initial analysis, 86 patients who received VCE for obscure gastrointestinal bleed (VCE-GIB-mA) were randomly selected to correspond with the 43 patients we had follow up data for. These patients were age- and gender-matched to the patients in the CAP-A group (see methods for selection process). In the VCE-GIB-mA group, we found an abnormal finding rate that was not significantly different than that of the CAP-A cohort (40.7% v 27.1%, p = 0.32, respectively, Fig 4A). We repeated this analysis for the CAP-O cohort by age- and gender-matching VCE-GIB-mO patients whom we had follow up data for in a 2:1 ratio (total of 36 patients). Fifteen out of the 36 cases (41.7%) had abnormal findings on VCE study. The CAP-O cohort had significantly lower rate of abnormal findings than the VCE-GIB-mO patients (19.7% v 41.7%, p = 0.009, respectively, Fig 4B).


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)

Sensitivity analysis with 2:1 age and gender matched control (CAP).(A) Abnormal finding rates in patients with CAP and no other symptoms compared to matched patients who were evaluated for gastrointestinal bleeding (B) Comparison of the clinical impact of VCE in the CAP-O cohort and its matched gastrointestinal bleed group. (C) Abnormal finding rates in patients with CAP and other symptoms compared to age and gender matched patients who were evaluated for gastrointestinal bleeding. (D) Comparison of the clinical impact of VCE in the CAP-A cohort and its matched gastrointestinal bleed group. * represents a p-value of < 0.05. ** represents a p-value of < 0.01
© Copyright Policy
Related In: Results  -  Collection

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

pone.0126509.g004: Sensitivity analysis with 2:1 age and gender matched control (CAP).(A) Abnormal finding rates in patients with CAP and no other symptoms compared to matched patients who were evaluated for gastrointestinal bleeding (B) Comparison of the clinical impact of VCE in the CAP-O cohort and its matched gastrointestinal bleed group. (C) Abnormal finding rates in patients with CAP and other symptoms compared to age and gender matched patients who were evaluated for gastrointestinal bleeding. (D) Comparison of the clinical impact of VCE in the CAP-A cohort and its matched gastrointestinal bleed group. * represents a p-value of < 0.05. ** represents a p-value of < 0.01
Mentions: In order to determine whether the abnormal finding rate and the frequency of interventions that improved outcomes were similar between patients who received VCE for CAP and patients who received VCE for an indication with strong evidence (i.e. obscure gastrointestinal bleed), we performed a sensitivity analysis. We decided to use VCE-GIB population since the evidence is strong that these patients would benefit from a VCE, and its indication clearly stated in society practice guidelines [10]. In the initial analysis, 86 patients who received VCE for obscure gastrointestinal bleed (VCE-GIB-mA) were randomly selected to correspond with the 43 patients we had follow up data for. These patients were age- and gender-matched to the patients in the CAP-A group (see methods for selection process). In the VCE-GIB-mA group, we found an abnormal finding rate that was not significantly different than that of the CAP-A cohort (40.7% v 27.1%, p = 0.32, respectively, Fig 4A). We repeated this analysis for the CAP-O cohort by age- and gender-matching VCE-GIB-mO patients whom we had follow up data for in a 2:1 ratio (total of 36 patients). Fifteen out of the 36 cases (41.7%) had abnormal findings on VCE study. The CAP-O cohort had significantly lower rate of abnormal findings than the VCE-GIB-mO patients (19.7% v 41.7%, p = 0.009, respectively, Fig 4B).

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