B0636 - Feasibility of Video Capsule Endoscopy in Patients With Surgically Altered Gastric Anatomy: Propensity-Matched Study

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Manik Aggarwal, MBBS

Cleveland Clinic
Cleveland, Ohio

Manik Aggarwal, MBBS¹, Arjun Chatterjee, MD², Jason Nasser, MD², Jan Santisi, RN¹, John McMichael, PhD², Andrew Ford, MD², Roberto Simons-Linares, MD², Dushyant S. Dahiya, MD³, Alberto Rubio Tapia, MD¹
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Central Michigan University College of Medicine, Saginaw, MI

Introduction: There is very scarce information about feasibility and safety of video capsule endoscopy (VCE) in patients with and without surgically altered gastrointestinal anatomy (SAGIA). We compared the safety and feasibility of VCE in patients with SAGIA and to those with normal anatomy (NA).

Methods: Methods: Patients undergoing VCE at our Institution were included (2010-2022). Patient with SAGIA undergoing VCE were 2:1 matched based on gender to patients with normal anatomy (NA). SAGIA group comprised of gastrectomy, gastric bypass, enterectomy, colectomy, esophagectomy or Whipple’s procedure. Primary outcome was completion rate, gastric and small bowel transit time and adverse event rate.

Results: Amongst 9584 patients undergoing VCE, 77 patients with SAGIA were matched to 154 patients with NA. Complete data was available for 139 patients with NA which comprised the final control group. Gastric bypass was the most common surgery (n=31 [40.3%]) followed by gastrectomy (complete or partial, n=29 [37.6%]). Video capsule was more likely to be placed by swallowing in SAGIA group in comparison with NA group (76.6% vs. 38.8%, p< 0.001). Patency capsule prior to CE was performed more often in SAGIA group compared to NA group (22.1% vs. 5.0%, p< 0.001).

VCE outcomes are presented in table 1B. Study completion rates were similar between SAGIA and NA (97.4% and 95.5%, p=0.56). Rates of gastric (1.5% vs. 0.7%, p=0.5) and small bowel (1.5% vs. 37%, p=0.6) capsule retention were similar between the SAGIA and NA groups. No patients in either group required intervention for capsule retrieval. Follow up of radiographic imaging was performed more frequently in patients with SAGIA as compared to those with NA (27.3 vs. 3.6%, p< 0.001).

Discussion: VCE is safe in patients with SAGIA with comparable completion rates to patients with NA. Patients with SAGIA undergoing VCE are more likely to undergo patency capsule prior to VCE and radiographic imaging post VCE despite the lower frequency of actual capsule retention in patients with SAGIA. This study did not support routine patency capsule or radiographic follow-up in patients with SAGIA.

Table 1A: Baseline Characteristics, Type Of Surgery And Indications For Video Capsule Endoscopy In Patients With Normal Anatomy And Surgically Altered Gastrointestinal Anatomy (SAGIA)
Variable	Group	SAGA	Normal anatomy	P value
n		77	139
Age at the time of VCE		55.58 (15.82)	59.50 (15.87)	0.083
Gender (%)	Female	41 (53.2)	74 (53.2)	1
Race (%)	African/black	17 (22.1)	40 (29.2)	0.696
	Asian	1 (1.3)	2 (1.5)
	Caucasian	58 (75.3)	94 (68.6)
	Hispanic	1 (1.3)	1 (0.7)
BMI		29.60 (10.11)	28.03 (7.38)	0.191

Capsule placement	Endoscopically placed	18 (23.4)	85 (61.2)	< 0.001
	Swallowed	59 (76.6)	54 (38.8)
Comorbidities
HTN (%)		37 (48.1)	113 (81.3)	< 0.001
Autoimmune diseases (%)		4 (5.2)	4 (2.9)	0.46
Hypothyroidism. (%)		18 (23.4)	23 16.5)	0.277
Scleroderma. (%)		3 (3.9)	1 (0.7)	0.131
Diabetes (%)		26 (33.8)	60 (43.2)	0.194
Parkinsonism. (%)		0 (0.0)	4 (2.9)	0.299
Indications for VCE
Abdominal pain (%)		9 (11.7)	3 (2.2)	0.009
Concern for IBD (%)		2 (2.6)	1 (0.7)	0.29
Iron deficiency anemia (%)		23 (29.9)	33 (23.7)	0.335
Occult GI bleeding. (%)		10 (13.0)	2 (1.4)	0.001
Overt GI bleeding. (%)		34 (44.2)	108 (77.7)	< 0.001
Small bowel polyps. (%)		5 (6.5)	0 (0)	0.005
Other. (%)		26 (33.8)	0 (0.0)	< 0.001
Prior Surgeries
Gastrectomy (%)		29 (37.6)
Gastric bypass (%)		31 (40.3)
Enterectomy (%)		7 (9.1)
Colectomy/ICR (%)		3 (3.9)
Esophagectomy (%)		1 (1.3)
Whipple’s procedure (%)		6 (7.8)
Table 1B: Outcomes Of Video Capsule Endoscopy In Patients With Normal Anatomy Vs. Surgically Altered Gastrointestinal Anatomy (SAGIA)
Outcomes		SAGIA	Normal anatomy	P value
Small bowel transit time (min)		316.56 (142.63)	310.89 (159.59)	0.82
Total transit time (min)		731.00 (197.08)	773.97 (168.97)	0.141
Result
Completion		75 (97.4)	128 (95.5)	0.598
Gastric retention at Day 15		1 (1.3)	1 (0.7)
Small bowel retention at Day 15		1 (1.3)	5 (3.7)
Follow up imaging (%)		21 (27.3)	5 (3.6)	< 0.001

Table: Table 1A: Baseline Characteristics, Type Of Surgery And Indications For Video Capsule Endoscopy In Patients With Normal Anatomy And Surgically Altered Gastrointestinal Anatomy (SAGIA).
Table 1B: Outcomes Of Video Capsule Endoscopy In Patients With Normal Anatomy Vs. Surgically Altered Gastrointestinal Anatomy (SAGIA)
Footnote: Continuous variables are presented as mean (SD) and categorical variables are presented as n (%).

Disclosures:

Manik Aggarwal indicated no relevant financial relationships.

Arjun Chatterjee indicated no relevant financial relationships.

Jason Nasser indicated no relevant financial relationships.

Jan Santisi indicated no relevant financial relationships.

John McMichael indicated no relevant financial relationships.

Andrew Ford indicated no relevant financial relationships.

Roberto Simons-Linares indicated no relevant financial relationships.

Dushyant Dahiya indicated no relevant financial relationships.

Alberto Rubio Tapia indicated no relevant financial relationships.

Manik Aggarwal, MBBS¹, Arjun Chatterjee, MD², Jason Nasser, MD², Jan Santisi, RN¹, John McMichael, PhD², Andrew Ford, MD², Roberto Simons-Linares, MD², Dushyant S. Dahiya, MD³, Alberto Rubio Tapia, MD¹. B0636 - Feasibility of Video Capsule Endoscopy in Patients With Surgically Altered Gastric Anatomy: Propensity-Matched Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.