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. 2024 Jul 3;12(7):E842-E848.
doi: 10.1055/a-2333-8002. eCollection 2024 Jul.

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

Matilde Topa  1 , Alessandro Rimondi  2 , Andrea Sorge  1 , Veronica Smania  1 , Lucia Scaramella  3 , Nicoletta Nandi  1 , Flaminia Cavallaro  3 , Maurizio Vecchi  1   3 , Luca Elli  3 , Gian Eugenio Tontini  1   3
Affiliations

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

Matilde Topa et al. Endosc Int Open. .

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: Capsule endoscopy; Endoscopy Small Bowel; Quality and logistical aspects; Quality management; Small bowel endoscopy.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Prisma flowchart diagram.
Fig. 2
Fig. 2
Rate of small bowel capsule endoscopy (SBCE) completeness and gastric transit time among incomplete examinations.
See this image and copyright information in PMC

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