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, 10 (4), e0126509
eCollection

Video Capsule Endoscopy in Patients With Chronic Abdominal Pain With or Without Associated Symptoms: A Retrospective Study

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Video Capsule Endoscopy in Patients With Chronic Abdominal Pain With or Without Associated Symptoms: A Retrospective Study

Jeremy Egnatios et al. PLoS One.

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart with classification of patients with chronic abdominal pain (CAP), along with sub-group classification based on clinical presentation.
Abbreviations: PMH (past medical history), CD (Crohn’s disease), UC (ulcerative colitis).
Fig 2
Fig 2. Abnormal findings in those receiving VCE for CAP versus those receiving VCE studies for all other indications (non-CAP).
CAP-O represents CAP with no other symptoms. CAP-A represents CAP and any associated symptoms (See Methods for description). * represents a p-value of < 0.05. ** represents a p-value of < 0.01
Fig 3
Fig 3. Difference in patients with chronic abdominal pain (CAP).
(A) Abnormal findings by referral source. Patients receiving capsule endoscopy for CAP from the community setting had a significantly higher rate of abnormal findings than those referred for capsule studies from a tertiary center. (B) Patients with CAP who also received gastric emptying studies.
Fig 4
Fig 4. 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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