GIE 2017 June Author Interviews
Following is a transcript of the video discussion:
Interview with Lauren Gerson and Mona Rezapor
LG: Hi, everyone. I’m Dr. Lauren Gerson, a senior associate editor for Gastrointestinal Endoscopy. It’s my pleasure to have with me Dr. Mona Rezapor, who is a second-year gastroenterology fellow at California Pacific Medical Center in San Francisco. We’re here today to discuss our paper published in the upcoming issue of GIE entitled “Retention Associated with Video Capsule Endoscopy: Systematic Review and Meta-Analysis.”
As most of you know, video capsule endoscopy has been available in the United States since 2000, and its main indication is for evaluation of patients with suspected small bowel bleeding, inflammatory bowel disease, and other suspected small bowel disorders. It measures approximately 11 by 26 millimeters, and the main feared complication is potential retention, which has been cited to occur in approximately 1 to 2% of patients with bleeding but anywhere from 13% even up to 25% of patients with Crohn’s disease, particularly in the pediatric population. The main indication throughout this study was to systematically analyze retention rates associated with capsule endoscopy when administered for different indications.
MR: Thank you. For our meta section, we did a comprehensive literature review in PubMed and SCOPUS. The comprehensive literature review was done from 1995 to 2015. We were looking at studies that were on video capsule endoscopy and reported their retention rates. We were specifically looking at studies that reported retention rates for small-bowel bleeding and occult, inflammatory bowel disease divided into suspected and established, and abdominal pain and/or diarrhea.
We further did a subanalysis looking at those studies that had done a patency capsule or a CT or MR enterography in patients who had strictures on patency capsule, and excluding those patients, and then further doing a video capsule endoscopy and reporting their retention rates for the video capsule endoscopy.
LG: From a statistical point of view, we performed a standard meta-analysis using a program called Comprehensive Meta-Analysis and calculated pooled retention rates for each of the various categories. We then constructed forest plots that are shown in the paper, and did publication, and did analysis of potential publication bias if there were more than ten studies in each category.
For the patients with suspected small bowel bleeding, the overall retention rate was approximately 2%. The most common cause was strictures in more than 50% of the patients most of the time due to either NSAIDs or Crohn’s disease in close to 47% of the patients. This required about 60% of the cohort to undergo surgical resection. We don’t know exactly in how many cases enteroscopy was attempted as this technology was only available in the US after 2004.
MR: For inflammatory bowel disease for suspected patients – these are patients who had symptoms consistent with inflammatory bowel disease – the retention rate was 3.6%. Again, most of these were due to strictures, about 70% of them. In patients with established IBD, the retention rate was about 8.2%. Again, about 87% of these were due to strictures.
For patients who underwent video capsule endoscopy for abdominal pain and/or diarrhea, their retention rates were about 2.2%. About 24% of these were due to strictures.
Looking at all indications and all the studies that we analyzed, the retention rate, again, was about 2%. On our subanalysis, looking at seven studies that performed either a patency capsule or a CT enterography, there were about – the retention rates initially with a patency capsule was about 12%. Once those patients with retention were excluded, the video capsule retention rate was 2.7%, so considerably decreased.
About 54% of all of the retention rates were due to strictures. A minority of these patients, only about 11%, developed obstructive symptoms. However, with that number, greater than 50% did undergo surgery to remove the capsule ultimately.
LG: In summary, we showed that patients according to the guidelines with suspected inflammatory bowel disease or established IBD continue to have relatively high retention rates, approximately 5% in established patients. Performing either a patency capsule or an MR enterography initially had a retention rate of around 12%, but this was reduced to 2.7% after the studies were performed. It is, therefore, worthwhile studying these patients prior to administration of the capsule just to avoid the complication of retention.
These patients, obviously, can be managed now with deep enteroscopy to remove the capsule if retained. Again, this paper, I think, is valuable because it helps establish what patients that are going capsule what the potential for retention is in various indications.
MR: Thank you.
LG: Thank you.