Diagnostic yield of inpatient capsule endoscopy
BACKGROUND:Capsule endoscopy (CE) provides a novel approach to evaluate obscure gastrointestinal bleeding. Yet CE is not routinely utilized in the inpatient setting for a variety of reasons. We sought to identify factors that predict complete CE and diagnostically meaningful CE, as well as assess the impact of inpatient CE on further hospital management.1 na d2 METHODS: We conducted a retrospective review of patients undergoing inpatient CE at a tertiary referral, academic center over a 3Â year period. We analyzed data on patient demographics, medical history, endoscopic procedures, hospital course, and results of CE. The primary outcome was complete CE and the secondary outcome was positive findings of pathology on CE. RESULTS:131 patients were included (56.5% were men 43.5% women, median age of 71.0Â years). Overall, CE was complete in 77.1% of patients. Complete CE was not related to motility risk factors, gender, or administration modality. Patients with incomplete CE tended to be older, have lower BMI, and Caucasian, however results did not reach statistical significance (pâ€‰=â€‰0.06; pâ€‰=â€‰0.06; pâ€‰=â€‰0.08 respectively). Positive CE was noted in 73.3% of patients, with 35.1% of all patients having active bleeding. Positive CE was not associated with AVM risk factors or medication use. 28.0% of patients underwent subsequent hospital procedures, among which 67.6% identified the same pathology seen on CE. CONCLUSIONS:Contrary to previous studies, we found the majority of inpatient CEs were complete and positive for pathology. We found high rates of correlation between CE and subsequent procedures. The use of CE in the inpatient setting helps to guide the diagnosis and treatment of hospitalized patients with obscure gastrointestinal bleeding.
Inpatient capsule endoscopy of patients with iron deficiency anemia is associated with higher therapeutic yield and shorter time from negative endoscopy to evaluation [Meeting Abstract]
Introduction: Capsule endoscopy (CE) is a novel non-invasive technique for evaluating endoscopynegative iron deficiency anemia (IDA). CE was historically utilized in the outpatient setting for multiple reasons, however several hospital systems are beginning to adopt inpatient CE. Data comparing inpatient to outpatient CE for evaluation of IDA is lacking.
Method(s): We performed a retrospective case-control study comparing patients hospitalized at an urban academic medical center with IDA and suspected occult gastrointestinal bleeding (OGIB) who received outpatient vs inpatient CE. Patients who received outpatient CE were seen from January 2014 to January 2018, after which our institution implemented a protocol for inpatient CE evaluation and acquired a GI hospitalist who could rapidly review video from CE and also perform deep enteroscopy when indicated. Patients who received inpatient CE were seen from February 2018 to October 2019. We collected data on patient demographics, BMI, comorbidities, hospital course, results of CE, and healthcare utilization. The primary outcome was therapeutic yield of CE.
Result(s): We identified 28 patients hospitalized with IDA and OGIB with negative upper and lower endoscopy who underwent CE in the outpatient setting post-discharge. These patients were matched with 28 patients who received CE during admission (total n = 56). Active bleeding was more likely to be visualized on inpatient CE (25 vs 0%, P<0.01, Table 1), and hemostasis was achieved in 2/7 (29%) of these inpatients on subsequent double-balloon enteroscopy. Time from negative endoscopy to CE was significantly lower in inpatients (1.0 vs. 36.5, P , 0.01). Patients who received inpatient CE had longer lengths of stay (5.50 vs. 4.00, P 5 0.02). There were no significant differences in demographics, BMI, or completion rate.
Conclusion(s): Active bleeding was more likely to be visualized on inpatient CE. Hemostasis was achieved in a significant group of patients with bleeding identified on CE. The cohort of patients who received inpatient CE had longer LOS. Prospective studies are required to further delineate the impact of inpatient CE on the management of patients with IDA from OGIB.
Obliterative Muscularization of the Small Bowel Submucosa in Fibrostenotic Crohn's Disease
Facing Crohn's - A Rare Association
Siri here, cecum reached, but please wash that fold: Will artificial intelligence improve gastroenterology? [Editorial]
Predictors of hospital readmission among patients with obscure gastrointestinal bleeding following inpatient capsule endoscopy [Meeting Abstract]
INTRODUCTION: Patients with obscure gastrointestinal bleeding (OGIB) often require frequent hospital admissions and endoscopic procedures to identify and treat bleeding. Capsule endoscopy (CE) provides a novel approach to evaluate OGIB. The role of inpatient CE in hospital readmissions has not been previously reported. We sought to identify patient and clinical factors associated with hospital readmission among patients with OGIB following inpatient CE.
METHOD(S): We conducted a retrospective review of adult patients undergoing inpatient CE at a tertiary referral, academic medical center between 4/1/17 and 4/1/19 to evaluate for predictors of readmission. We reviewed patient demographics, medical history, medications, hospital course, results of CE, and 30-day readmission rates. Arteriovenous malformation (AVM) risk factors were defined as having comorbid cardiac valvular disease or advanced chronic kidney disease (stage 3-5). A positive CE was defined as having abnormal small bowel pathology or bleeding.
RESULT(S): 86 patients were included. Overall, 64% were male with a median age of 69 years (Table 1). The main indication for inpatient CE was overt bleeding (59%). Complete CE was noted in 70 patients (81%), and positive CE in 48 patients (56%). Overall, 17 patients (19.8%) were readmitted within 30 days of index admission. Length of stay (LOS) on index admission was longer among those readmitted (Mean LOS 10 days vs 7.9 days, P = 0.07). Readmission was not related to age, gender, complete CE, positive CE or bleeding on CE. There was a trend for readmission among patients who had previously been admitted within 30 days (41% vs 22%, P = 0.1). There was a trend towards readmission for patients with diabetes mellitus (DM) and AVM risk factors. Medication use was not associated with readmission.
CONCLUSION(S): Patient with OGIB have high rates of hospital admission. The use of inpatient CE can provide guidance on subsequent therapy in patients with OGIB, with the potential to decrease hospital admissions. We found high rates of 30-day hospital readmission among patients with OGIB after inpatient CE. No significant predictors of readmission were noted, though several factors, including increased LOS on index admission, DM, AVM risk factors, and recent admission trended towards readmission. Larger studies are necessary to fully elucidate predictors of readmission. To our knowledge, this is the first study to address the effect of inpatient CE and hospital readmissions
DIAGNOSTIC YIELD OF INPATIENT CAPSULE ENDOSCOPY [Meeting Abstract]
Background: Capsule endoscopy (CE)provides a novel approach to evaluate small bowel pathology, aiding in the diagnosis and management of many conditions including inflammatory bowel disease, celiac disease, and obscure gastrointestinal bleeding. Yet, CE is not routinely utilized in the inpatient setting due to a variety of factors. Studies have noted lower rates of completion and lower diagnostic yield of CE among inpatients compared to outpatients. We sought to identify patient and clinical factors that predict completion and diagnostic yield on CE.
Method(s): We conducted a retrospective chart review of adult patients undergoing inpatient CE with PillCam SB3 12-hour capsule at a tertiary referral, academic medical center between 1/1/18 and 10/30/18. We reviewed patient demographics, medical history, hospital course, and results of CE. Motility risk factors were defined as comorbid diabetes mellitus or systemic disease affecting motility (scleroderma, hypothyroidism, amyloid etc). Arteriovenous malformation (AVM)risk factors were defined as having comorbid cardiac valvular disease or advanced chronic kidney disease (stage 3-5). Complete CE was defined as the capsule passing the ileocecal valve. The yield of significant findings on CE (positive CE)was defined as finding abnormal small bowel pathology on CE. The primary outcome was complete CE. The secondary outcome was positive CE.
Result(s): 47 patients were included. Overall, 64% were male, 60% white, and a median age of 69 years. Motility disease risk factors were noted in 30 patients (64%). AVM risk factors were noted in 24 patients (51%). The most common indication for CE was overt-obscure bleeding (64%), followed by occult-obscure bleeding (36%). Overall, complete CE was noted in 40 patients (85%). Complete CE was not related to motility risk factors, age, elderly status, or gender. Positive CE was noted in 27 cases (57%), and active bleeding was found in 10 cases (21%). Positive CE was significantly greater in patients with AVM risk factors. (OR 4.66, 95% CI 1.3-16.2, p=0.01). The use of antiplatelet, anticoagulation, proton-pump inhibitors, or nonsteroidal anti-inflammatory drugs were not associated with positive CE. 17 patients required further intervention, of which 10 (59%)underwent double-balloon enteroscopy at our institution.
Discussion(s): Optimal management of obscure gastrointestinal bleeding often involves evaluation of the small bowel. Contrary to previous studies, we found the majority of inpatient CE were complete and yielded small bowel pathology. Patients with AVM risk factors were associated with positive CE. No predictors of complete CE were identified. We propose the diagnostic yield may be higher than previously cited due to better technology with SB3 pill. Based on these results, we propose that CE should be considered among inpatients with obscure gastrointestinal bleeding. [Figure presented]
Esophageal Food Impaction Management: A Meta-Analysis Comparing Push and Pull Methods [Meeting Abstract]
The Effect of Colonoscopy Reimbursement Reductions on Gastroenterologist Practice Behavior
GOAL: The purpose of this study was to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume. BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services proposed reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening, it is crucial to understand how reimbursement changes could affect these efforts. STUDY: Randomly selected respondents from the American College of Gastroenterology membership database were surveyed on incremental changes in practice behavior if colonoscopy reimbursement were to decrease by 10, 20, 30, or 40 %. Data were analyzed using both Pearson's Chi-square and analysis of variance. RESULTS: Two thousand and nine gastroenterologists received the survey with a 16.3 % response rate. Procedure volume significantly decreased with degree of reimbursement reductions (p < 0.001). With a 10 % decrease, 72 % of respondents reported no change in the number of colonoscopies performed. With a 20 % decrease, 39 % would decrease their procedure volume, while 21 % of respondents would increase their procedure volume. With a 30 and 40 % decrease, procedure volume decreased by 48 and 50 %, respectively. In terms of retirement, current plans predict a cumulative retirement rate of 29.4 % at 10 years. More than 42 % of respondents plan to retire after 2030. In the 2014-2023 retirement subgroup (N = 74 responses), there was a significant hastening of retirement year at 20 % (p = 0.016), 30 % (p < 0.001), and 40 % (p < 0.001) reimbursement reductions as compared to baseline responses. CONCLUSION: Decreasing colonoscopy reimbursements may have a significant effect on the effective gastroenterology work force.
ACUTE LIVER INJURY IN A PATIENT WITH METASTATIC PHEOCHROMOCYTOMA [Meeting Abstract]