Mahmoud El Iskandarani, MD1, Bara El Kurdi, MD1, Tyler Aasen, DO1, Mohammad Alomari, MD2, Sumbal Babar, MBBS1, Ibrahim Haddad, MD1, Laith Al Momani, MD1, Mark Young, MD1
1East Tennessee State University, Johnson City, TN; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Capsule endoscopy (CE) has been increasingly used for the diagnosis of small bowel pathology, mainly, obscure gastrointestinal bleeding. Incomplete examination can lead to delayed intervention. Possible risks of incomplete examination have been extensively studied. We hypothesized that hospitalized patients might be at higher risk of incomplete examination due to acute illness. Therefore, we conducted a systematic review and meta-analysis to assess the effect of inpatient status on the completion of CE.
Methods: Unrestricted searches of MEDLINE, EMBASE, Cochrane bibliographic databases were performed inception through March 2019 for studies comparing CE completion rates in hospitalized vs. non-hospitalized patients. Results were screened for relevance and eligibility criteria. Relevant data was extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias
Results: A total of 6 retrospective studies published between 2010-2018 were included examining 2,467 patients who underwent CE (702 inpatient vs 1,763 outpatient) were included. Outpatient CE completion rate was significantly higher compared to inpatient with an OR of 4.48 (95% CI 1.99-10.09; I2=85%). In three studies, small bowel transit time found to be shorter in the outpatient CE group with mean difference of -14.51 minutes (95%CI -34.87-5.84), however, this did not reach statistical significance. No publication bias was noted.
Discussion: Our findings suggests that outpatient CE was associated with higher completion rates than inpatient CE. This could be related to prolonged small bowel transit time in hospitalized patients related to acute illness, comorbidities, narcotic use, and bed rest which are more prevalent in hospitalized compared to non-hospitalized patients. Our findings suggest that it might be prudent to reserve CE examinations to the outpatient setting when possible.
Citation: Mahmoud El Iskandarani, MD; Bara El Kurdi, MD; Tyler Aasen, DO; Mohammad Alomari, MD; Sumbal Babar, MBBS; Ibrahim Haddad, MD; Laith Al Momani, MD; Mark Young, MD. P1273 - INPATIENT STATUS IS ASSOCIATED WITH INCOMPLETE CAPSULE ENDOSCOPY EXAMINATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Program No. P1273. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.