592 Comparison of Endoscopic Placement versus Oral Ingestion of Small Bowel Video Capsule for Evaluation of Inpatients With Small Intestinal Bleeding

INTRODUCTION: Wireless small bowel video capsule endoscopy (VCE) is used to evaluate small intestinal bleeding after upper endoscopy and colonoscopy fail to identify a source of bleeding. The majority of patients swallow the capsule but endoscopic placement in the duodenum is an option. Limited data suggests higher rate of gastric retention of capsule in inpatients due to a variety of reasons, resulting in an incomplete exam. Hypothetically, endoscopic placement should increase likelihood of complete small bowel evaluation but there is little data comparing the two approaches. We aimed to compare completion rates and outcomes of capsule studies via endoscopic placement (CS-EP) versus oral ingestion (CS-OI) in inpatients undergoing VCE. METHODS: Patients who had VCE studies performed inpatient for gastrointestinal bleeding at Rhode Island Hospital between April 2015 and July 2016 were identified retrospectively. Baseline patient demographics, time intervals between reported bleed, date of admission and date of discharge, capsule study, indications for capsule study, completion rates and detection of small bowel bleeding were collected. Statistical tests were done using student's t-test and chi square test. RESULTS: Data was available for 83 patients between April 2015 and July 2016. The most common indications were for obscure bleed (92%) followed by anemia (86%). 29 (35%) patients had small bowel capsule studies that were endoscopically placed. Majority of patients underwent endoscopic placement due to provider preference. CS-EP had a higher proportion of men than CS-OI (66% vs. 44%, P = .06). The mean duration from bleeding episode to capsule study was 8.4 days for both groups. Small bowel bleeding was more likely to be detected by CS-EP than CS-OI (34% vs. 13%, P = 0.02), however completion rates were similar between both studies (69% vs. 76%, P = 0.5). CS-EP had a longer time from study to discharge (days: 7.1 vs. 3.7, P = 0.1) and longer length of stay at the hospital (days: 11.45 vs. 7.47, P = 0.1) compared to CS-OI. CONCLUSION: Based on this single center study, although endoscopic placement of VCE was more likely to detect small bowel bleeding compared to oral ingestion, there was no difference in study completion rates and CS-EP group in fact had a longer length of stay. Investigation into potential causes of longer length of stay and cost of care associated with endoscopic placement are ongoing. Additional data is also being collected for capsule studies performed over several more years.