Factors Influencing the Diagnostic Yield of Capsule Endoscopy (CE) in Patients with Obscure...

Abstracts

areas in 163 patients (median: 4), 14 dilatations and 21 other interventions.Complications were reported in 18 cases containing 4 cases with bleeding, 2 casesof mild to moderate pancreatitis after oral DBE (0,26% of oral DBE), 1perforation after polypectomy (1,4% of all polypectomies), 7 cases ofcomplications triggered by sedation and 4 other complications. Conclusion: DBEis a safe endoscopic procedure with a complication rate of 0,7% in this largeprospective study. The achievement of total enteroscopy is 34% and thereforelower than expected. Pancreatitis after oral DBE and perforation afterpolypectomy during DBE are the main complications with a low incidence of0,26% and 1,4%, respectively.

T1621

Prevalence of Small Bowel Bleeding in Patients with

Gastrointestinal Overt Bleeding: A Multi-Center Experience

of 1052 Consecutive PatientsHirotoshi Okazaki, Yasuhiro Fujiwara, Satoshi Sugimori,Natsuhiko Kameda, Hirohisa Machida, Tetsuya Tanigawa,Masatsugu Shiba, Kenji Watanabe, Kazunari Tominaga, Toshio Watanabe,Nobuhide Oshitani, Tetsuo ArakawaObjectives: Obscure gastrointestinal bleeding (OGIB) represent approximately 5% of all episodes of gastrointestinal bleeding. Recent diagnostic advancementsuch as capsule endoscopy and double balloon enteroscopy yield the detectionof small bowel lesions responsible for OGIB. The aim of this study is to clarify theprevalence of small bowel bleeding in Japanese patients with overt GI bleedingdefined as the GI bleeding manifest as visible bright red or altered blood inemesis or feces. Subjects and Methods: Data were collected retrospectively fromconsecutive patients with acute GI overt bleeding in 10 participating hospitalsbetween January 2006 and December 2006. All patients were examined by upperGI endoscopy and/or colonoscopy. When the source of bleeding has not beenidentified after these procedures, capsule endoscopy and/or double balloonenteroscopy were performed to clarify the source of bleeding. Results: Of the1052 patients with acute overt GI bleeding, 522 (49.6%) patients were diagnosedas having upper GI bleeding due to gastric ulcer (214 cases, 20.3%), duodenalulcer (86 cases, 8.2%), Mallory-Weiss syndrome (45 cases, 4.3%) and esophagealvarices (32 cases, 3.0%), 441 (41.9%) as lower GI bleeding due to ischemic colitis(92 cases, 8.7%), hemorrhoid (79 cases, 7.5%), diverticulum (77 cases, 7.3%), andcolon cancer (37 cases, 3.5%), and 12 (1.1%) as small bowel bleeding. Amongsmall bowel bleeding, ulcerative lesions were found in 7 (58.3%) patients,angiodysplasia in 3 (25.0%) patients, and tumor in 2 (16.7%) patients. Six (50.0%)lesions in the jejunum, 5 (41.7%) lesions in the ileum, and 1 lesion was located inthe jejunum and ileum. Patients with small bowel bleeding was significantlyyounger compared with those with upper or lower GI bleeding. Conclusions:Small bowel bleeding is rare among the overt GI bleeding, and ulcerative lesionsare most common in Japan.

T1622

Estimation of the Depth of Double Balloon Enteroscopy (DBE)

Passage in the Small Intestine: Is It Possible to Simplify the

Process?Simon K. Lo, Shahab MehdizadehDBE is now the standard endoscopic instrument of the small intestine. Its abilityto travel far poses a new challenge in assessing the length of scope insertion. Thetechnique introduced by May (Endoscopy 2005;37:66) is currently the methodadopted by most endoscopists. While this ex-vivo model was proven accurate, ithas not been fully validated in humans and is labor intensive. Aim: To determineif there is a simpler alternative to the current method. Method: Two ways of smallbowel measurement were introduced in our institution. The conventionalcontrast radiography method (CCR) utilized contrast infusion into the smallbowel lumen at the farthest point of scope passage. Fluoroscopy was used toestimate the location as a segment of the jejunum or ileum. The metricmeasurement method (MM) added together the distances in cm during scopewithdrawal . The data were collected prospectively. All procedures and distanceestimations were done by a single endoscopist. Results: Between 3/07-11/07, 66oral and 25 retograde DBE were recorded for analysis. The jejunum and ileumwere divided into proximal, mid and distal regions and were assigned numericalscores of 1-6. The numbering order was reversed for retrograde DBE. Analysisshowed a good correlation between CCR and MM (Spearman r Z 0.61, CI Z 0.4-0.7). See Figure. There was also a good correlation for retrograde DBEprocedures(r Z 0.64, CI Z 0.3-0.8). Adjustment for height and BMI yieldedsimilar results Conclusions: CCR and MM are 2 potential methods to simplify theestimation of depth of insertion. While CCR is closest to the conventional mannerof estimation used by the radiologists, it requires fluoroscopy and posesa radiation risk. We are able to show that there is a good general correlationbetween our MM and CCR methods. Further refinements of our methodologywill likely result in a simpler and more conventionally applicable modality.

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T1623

Factors Influencing the Diagnostic Yield of Capsule Endoscopy

(CE) in Patients with Obscure Gastrointestinal Bleeding (OGIB)Diego Garcia-Compean, Ricardo Flores Rendon,CeSar A. Marrufo-Garcıa, Jesus D. De Leon, Jose a Gonzalez,Arturo Armenta, Hector J. MaldonadoIntroduction: Numerous studies have reported a diagnostic yield of CE of 30 to 82% in patients with OGIB. The selection of patients using very heterogeneouscriteria may explain this broad range. Scarce studies that examine factorsinfluencing the diagnostic yield of CE have been reported. Aims: To identify factorsthat influence diagnostic outcome of CE in patients with OGIB. Material andMethod: Patients of any age and gender with OGIB admitted to our hospital wereincluded. Demographic, clinical and biochemical parameters were registered. CEwas performed with Pill Cam (Given Imaging, Israel). Positive results wereestablished when potentially hemorrhagic lesions were identified on small bowel.Simple and multiple logistic regression analysis of variables were performed andvalues of sensitivity (S), specificity (Sp), positive predictive value (PPV), negativepredictive value (NPV) and accuracy (Ac) were calculated. Results: 80 patients werestudied, 51 % men,medium age of 56 yr. (range 5-87). CE was positive in 59 (74 %)patients. Diagnoses were angiodysplasias (45 %), ulcers and erosions (22 %) andneoplasias (7 %). The table shows the simple and multiple logistic regressionanalysis of the parameters. In the simple logistic regression several parameters weresignificant however in the multiple logistic regression only the overt bleeding wasan independent parameter. In the other hand the overt bleeding had the highestPPV (89 %) and the HbO of 10 g/dl had the highest NPV (80 %). The combinationof the 2 parameters had PPV of 91 %, NPV of 100 % and Ac of 92 %. Conclusions: 1)The type of bleeding (overt or occult) was the most important predictive factor forthe results of the CE; 2) In OGIB with occult bleeding and HbO 10 g/dl the use ofthe CE seems to be useless; 3) with occult bleeding and Hb !of 10 g/dl the CE hadthe major utility and maybe the first diagnostic procedure; 4) In OGIB with overtbleeding with Hb 10 g/dl, taking in account its high PPV, the indication of the CE asthe first procedure might be discussed with regard to other procedures, particularlythe double balloon enteroscopy.

Parameter OR CI 95% p value)

OR CI 95% p value&

lume 67, No. 5 : 2

Gender

3.4

More than 5endoscopies

0.9

)Simple regression; & Multiple regression; ns: non significant; OR: odds ratio.

T1624

Capsule Endoscopy Predicts the Success and Route of Insertion

for Double Balloon EnteroscopyVaibhav Mehendiratta, Mitchell Conn, Anthony Infantolino, MichaelC. Dimarino, Leo C. Katz, David M. KastenbergBackground: Capsule Endoscopy(CE) is the primary choice for diagnosticendoscopic imaging of the small bowel (SB). Double Balloon Enteroscopy (DBE) isan essential tool for therapeutic intervention in the SB. CE is often performed priorto DBE to determine the need for DBE and to determine the route of insertion ofDBE. Aim: To evaluate the utility of CE in predicting the success and route ofinsertion of DBE for evaluation and treatment of SB lesions. Methods: 34 patientswho had SB abnormalities detected on CE and underwent DBE between 08/2006and 10/2007 were included. Charts were reviewed for demographics; indication andfindings on CE and initial DBE; and transit times on CE. A Location Index (LI) oflesions found on CE was derived by dividing the time of progression of capsule

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