Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 5, 2022; 13(6): 88-95
Published online Nov 5, 2022. doi: 10.4292/wjgpt.v13.i6.88
Effect of small bowel transit time on accuracy of video capsule endoscopy in evaluating suspected small bowel bleeding
Nandakumar Mohan, Simone Jarrett, Alexander Pop, Daniel Rodriguez, Robert Dudnick
Nandakumar Mohan, Simone Jarrett, Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
Alexander Pop, Robert Dudnick, Division of Gastrointestinal Diseases and Hepatology, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States
Daniel Rodriguez, Department of Urban Health and Nutrition, Lasalle University, Philadelphia, PA 19141, United States
Author contributions: Mohan N is the primary author and principal investigator; Jarrett S and Pop A are secondary authors and secondary investigators; Dudnick R is the primary attending and supervisor; Rodriguez D is the statistician.
Institutional review board statement: The study was reviewed and approved by the Albert Einstein Healthcare Network Institutional Review Board (Approval No. IRB-2019-195).
Conflict-of-interest statement: None of the authors listed, including principal investigator, have any conflict of interests to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nandakumar Mohan, DO, Doctor, Internal Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA 19141, United States. mohannan@einstein.edu
Received: March 17, 2022
Peer-review started: March 17, 2022
First decision: June 16, 2022
Revised: August 2, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: November 5, 2022
Processing time: 228 Days and 17.9 Hours
Abstract
BACKGROUND

Obscure small bowel bleeding is defined as gastrointestinal bleeding (GIB) that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy (VCE) being the next gold standard step for evaluation. Small bowel transit time (SBTT) is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.

AIM

To determine if SBTT within the VCE study, correlates to overall detection of obscure small bowel bleeds. Furthermore, we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.

METHODS

This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center, Philadelphia, between 2015 and 2019. Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB. Patients with incomplete VCEs, poor preparation, or with less than 6 mo of follow up were excluded. A re-bleeding event was defined either as overt or occult within a 6-mo timeframe. Overt re-bleeding was defined as Visible melena or hematochezia with > 2 gm/dL drop in hemoglobin defined an overt re-bleeding event; whereas an unexplained > 2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.

RESULTS

Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008. However, the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.

CONCLUSION

In terms of SBTT and association with accuracy of VCE finding a bleeding focus, 220 min was found to be adequate transit time to accurately find a bleeding focus, when present. It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.

Keywords: Small bowel transit time, Endoscopy, Video capsule endoscopy, Obscure bleed, Small bowel, Anemia

Core Tip: Understanding the utility of Small bowel transit time (SBTT) in Video Capsule Endoscopies can help with assessing accuracy and yield of video capsule endoscopy studies as well as whether a certain SBTT exists to achieve appropriate accuracy in detecting small bowel bleeding acutely or if a threshold exists in order to predict future small bowel bleeding.