PREDICTORS FOR FINDING LESIONS IN SMALL BOWEL BY ENTEROSCOPY AFTER A POSITIVE CAPSULE ENDOSCOPY

Aims Several studies had evaluated the concordance between capsule endoscopy (CE) and overtube-assisted enteroscopy (OAE) with inconsistent results and some miss lesions in either procedure. The aim of this study is to identify the factors that predict the visualization of small bowel lesions by enteroscopy after a positive capsule endoscopy

Methods This is a retrospective, observational and comparative single center study that evaluated all the patients who had OAE after a positive CE between January 2017 and August 2019. Data collected included demographics, indications, comorbidities, surgeries, examinations dates, radiological exams, and CE and OAE outcomes. Positive CE was defined as the identification of a small bowel lesion (angioectasias, ulcers, tumors/polyps and erosions). Data were evaluated using a multiple logistic regression and presented as mean ± SD, percentage or OR, 95%CI.

Results There were 91 patients included (age 58 ±16.5 years, 53 female). The indications were overt small bowel bleeding (SBB) (68.1%), occult SBB (8.8%), tumor/polyps (8.8%) and Crohn’s disease (14.3%). 62 OAE (68.1%) found the same findings than the CE. The predictive factors for positive OAE were multiple lesions (OR 8.10, 1.50-43.78; p=0.015), < 15 days between CE and OAE (OR 5.31, 1.19-23.66; p=0.029) age over 60 years (OR 3.00, 1.00-9.02; p=0.049). In a subgroup of patients with SBB as indication, 46 OAE (65.7%) found the lesions than the CE. The predictive factors in this group were multiple lesions (OR 10.42, 1.37-79.30; p=0.024), < 15 days between CE and OAE (OR 13.51, 1.78-102.22; p=0.012), age over 60 years (OR 7.45, 151-36.75; p=0.014), and ulcers (OR 4.67, 1.08-20.22; p=0.039).

Conclusions Predictive factors for positive OAE after positive CE are multiple lesions, less than 15 days between both procedures and patients over 60 years old. In patients with SBB, ulcers is also a predictive factor.