Small-Bowel Capsule Endoscopy in Clinical Practice: Has Anything Changed Over 13 Years?

  • Marco Soncini
  • Carlo Maria Girelli
  • Roberto de Franchis
  • Emanuele Rondonotti
  • SBCE Lombardia Study Group
  • On behalf AIGO, SIED and SIGE Lombardia
Original Article
  • 36 Downloads

Abstract

Background

In Lombardia, one of the 20 Italian administrative Regions, small-bowel capsule endoscopy (SBCE) was introduced in 2001. In January 2011, the Regional Health Authorities established a reimbursement for outpatient SBCE.

Aim

To prospectively record data on SBCE between 2011–2013 and compare them to similar data retrospectively collected from the same geographical area (covering the period 2001–2008) and published in 2008.

Methods

Consecutive SBCEs performed between January 2011 and December 2013 in Lombardia were prospectively collected.

Results

In 3 years, 3142 SBCEs were collected; the diagnostic yield (DY) and the overall complication rate were 48.4 and 0.9%, respectively. The main indication was suspected small-bowel bleeding (76.6% of patients); complete small-bowel inspection was achieved in 2796 (89.0%) patients. SBCE was performed as an outpatient procedure in 1945 patients (61.9%). A significant increase in the rate of patients undergoing SBCE for suspected small-bowel bleeding was observed from 2001–2008 to 2011–2013 (67.3 vs. 76.1%; p < 0.001). There was an increase in the number of complete small-bowel examinations (81.2 vs. 89.0%; p < 0.001) and of outpatient SBCEs (6.7 vs. 61.9%; p < 0.001). Conversely, both the retention rate (2.1 vs. 0.8%; p < 0.001) and the rate of patients undergoing SBCE for Crohn’s disease (11.5 vs. 5.5%; p < 0.001) decreased significantly. The overall DY remained stable (50.6 vs. 48.4%; p = 0.089).

Conclusion

Our study shows that, over 13 years, the SBCE safety profile and completion rate significantly improved over time; a change in the spectrum of clinical indications was also observed.

Keywords

Small-bowel capsule endoscopy Reimbursement policy Capsule retention Diagnostic yield 

Notes

Acknowledgments

We would like to thank Silvia Paggi for her invaluable help in the editing process.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Katsinelos P, Chatzimavroudis G, Terzoudis S, et al. Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience. Med Princ Pract. 2011;20:60–65.CrossRefPubMedGoogle Scholar
  2. 2.
    Sidhu R, Sanders DS, Kapur K, et al. Capsule endoscopy changes patient management in routine clinical practice. Dig Dis Sci. 2007;52:1382–1386.CrossRefPubMedGoogle Scholar
  3. 3.
    Li F, Gurudu SR, De Petris G, et al. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc. 2008;68:174–179.CrossRefPubMedGoogle Scholar
  4. 4.
    Johnston CA, Yung DE, Joshi A, et al. Small bowel malignancy in patients undergoing capsule endoscopy at a tertiary care academic center: case series and review of the literature. Endosc Int Open. 2017;5:E463–E470.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yung DE, Rondonotti E, Giannakou A, et al. Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy. United Eur Gastroenterol J. 2017;5:974–981.CrossRefGoogle Scholar
  6. 6.
    Hoog CM, Bark LA, Arkani J, et al. Capsule retention and incomplete capsule endoscopy examinations: an analysis of 2300 examinations. Gastroenterol Res Pract. 2012;2012:518718.CrossRefPubMedGoogle Scholar
  7. 7.
    Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010;71:280–286.CrossRefPubMedGoogle Scholar
  8. 8.
    Rondonotti E, Soncini M, Girelli CM, et al. Small bowel capsule endoscopy in clinical practice: a multicenter 7 year survey. Eur J Gastroenterol Hepatol. 2010;22:1380–1386.CrossRefPubMedGoogle Scholar
  9. 9.
    Rondonotti E, Soncini M, Girelli CM, et al. Can we improve detection rate and interobserver agreement in capsule endoscopy? Results of a training among readers with different experience. Dig Liver Dis. 2012;44:1006–1011.CrossRefPubMedGoogle Scholar
  10. 10.
    Rondonotti E, Soncini M, Girelli CM, et al. Cost estimation of small bowel capsule endoscopy based on “real world” data: inpatient or outpatient procedure? Dig Liver Dis. 2010;42:798–802.CrossRefPubMedGoogle Scholar
  11. 11.
    Soncini M, Russo A, Campi E, et al. Capsule endoscopy of the small bowel in the clinical practice: outpatient management is feasible and cheaper. Minerva Gastroenterol Dietol. 2010;56:383–387.PubMedGoogle Scholar
  12. 12.
  13. 13.
    Saurin JC, Delvaux M, Gaudin JL, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push enteroscopy. Endoscopy. 2003;35:576–584.CrossRefPubMedGoogle Scholar
  14. 14.
    Rondonotti E, Soncini M, Girelli CM, et al. Short article: negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients. Eur J Gastroenterol Hepatol. 2016;28:871–875.CrossRefPubMedGoogle Scholar
  15. 15.
    Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015;47:352–376.CrossRefPubMedGoogle Scholar
  16. 16.
    Robinson CA, Jackson C, Condon D, et al. Impact of inpatient status and gender on small-bowel capsule endoscopy findings. Gastrointest Endosc. 2011;74:1061–1066.CrossRefPubMedGoogle Scholar
  17. 17.
    Ribeiro I, Pinho R, Rodrigues A, et al. What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding? Rev Esp Enferm Dig. 2015;107:753–758.PubMedGoogle Scholar
  18. 18.
    Matsumura T, Arai M, Saito K, et al. Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: over 1-year follow-up study. Dig Endosc. 2014;26:650–658.CrossRefPubMedGoogle Scholar
  19. 19.
    Riccioni ME, Urgesi R, Cianci R, et al. Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: recurrence of bleeding on long-term follow-up. World J Gastroenterol. 2013;19:4520–4525.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy. 2016;48:373–379.PubMedGoogle Scholar
  21. 21.
    Nakamura M, Hirooka Y, Yamamura T, et al. Clinical usefulness of novel tag-less Agile patency capsule prior to capsule endoscopy for patients with suspected small bowel stenosis. Dig Endosc. 2015;27:61–66.CrossRefPubMedGoogle Scholar
  22. 22.
    Rezapour M, Amadi C, Gerson LB. Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc. 2017;85:1157–1168.CrossRefPubMedGoogle Scholar
  23. 23.
    Gerson LB, Fidler JL, Cave DR, et al. ACG Clinical Guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015;110:1265–1287.CrossRefPubMedGoogle Scholar
  24. 24.
    Enns RA, Hookey L, Armstrong D, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017;152:497–514.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastroenterology and Digestive Endoscopy UnitAzienda Ospedaliera S. Carlo BorromeoMilanItaly
  2. 2.Gastroenterology and Digestive Endoscopy UnitHospital of Busto ArsizioBusto ArsizioItaly
  3. 3.University of MilanMilanItaly
  4. 4.Gastroenterology UnitOspedale ValduceComoItaly

Personalised recommendations