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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(07): E842-E848
DOI: 10.1055/a-2333-8002
Original article

Incomplete small bowel capsule endoscopy: Risk factors and cost-effectiveness of real-time viewing

Matilde Topa 
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
,
Alessandro Rimondi 
2   Post graduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
,
Andrea Sorge
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
,
Veronica Smania
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
,
Lucia Scaramella
3   Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Nicoletta Nandi
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
,
Flaminia Cavallaro
3   Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Maurizio Vecchi
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
3   Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Luca Elli 
3   Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Gian Eugenio Tontini
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (Ringgold ID: RIN9304)
3   Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract

Background and study aims International guidelines recommend real-time viewing (RTV) in capsule endoscopy for gastric emptying monitoring, yet it is often overlooked in clinical practice. We aimed to assess risk factors for incomplete small bowel capsule endoscopy (SBCE) and evaluate the clinical relevance and cost-effectiveness of RTV implementation.

Methods We included consecutive SBCEs from 2013 to 2020. RTV was not applied per local protocol. We used multivariate logistic regression to identify risk factors for incomplete SBCE, including prolonged gastric transit time (GTT) and prolonged small bowel transit time (SBTT).

Results Analyzing 858 SBCEs, we observed a completion rate of 94.6%. Prolonged GTT and SBTT were present in 4.9% and 18.2% of complete SBCEs, and in 13% (P=0.03) and 10.8% (P=0.24) of incomplete SBCEs, respectively. Only 0.7% (6 of 858) had incomplete SBCE with prolonged GTT. In both univariate and multivariate analysis, a modifiable (prolonged GTT odds ratio [OR] 2.9; 95% confidence interval [CI] 1.1–7.5) and two unmodifiable risk factors (inpatient status OR 2.3; 95% CI 1.1–4.5) and history of incomplete SBCE (OR 4.2; 95% CI 1.3–13.7) were independently linked to higher incomplete SBCE rates. The pretest completion probability was 90.5% and 95.8% in patients with and without unmodifiable risk factors, respectively (P <0.01). The direct cost of systematic RTV adoption and prokinetics administration would be €5059, aiming to identify and treat each case of prolonged GTT associated with incomplete SBCE.

Conclusions Modern devices make incomplete SBCE rare, usually not tied to prolonged GTT. In a low-incidence scenario, widespread RTV use brings high costs and uncertain effectiveness.

Keywords

Endoscopy Small Bowel - Capsule endoscopy - Quality and logistical aspects - Quality management - Small bowel endoscopy


Publication History

Received: 27 December 2023

Accepted after revision: 06 April 2024

Accepted Manuscript online:
27 May 2024

Article published online:
03 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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