Published online Nov 5, 2022. doi: 10.4292/wjgpt.v13.i6.88
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
Identified and evaluated the various use case scenarios and benefits of video capsule endoscopy (VCE) and used prior existing data to identify a metric within the existing technology to be used for improved and more accurate medical care.
To find a metric within already existing VCE studies to help predict re-bleeding episodes when the study comes back negative. Finding an appropriate metric to use to be able to predict such a clinical outcome would allow for improved and early clinical intervention.
To assess whether small bowel transit time (SBTT) influences VCE yield in detecting a small bowel bleed and if there was any correlation between SBTT and re-bleeding rates when VCE study was negative. If a correlation to re-bleeding rates could be found, it could allow for earlier follow-up with the patients and possible earlier interventions prior to re-bleeding events.
Single center retrospective electronic health record-based analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center, Philadelphia. To identify the optimal threshold time, receiver operator characteristic (ROC) curve was used. area under the curve (AUC) was also used to assess the measure’s ability to discriminate between variables.
Our study found that there was no valuable threshold time for SBTT that could be linked to re-bleeding rates in negative VCE studies. While our study may have been too small in scale to truly see a correlational link in the predictive value of SBTT, we were able to show that SBTT is a good metric to follow in detection of the initial bleed, therefore highlighting the importance of the metric itself as a clinical tool that can aid in improvement of overall clinical care. The major problem that remains to be solved is that, with a larger amount of statistical power and the backing of multi-institutional data, will a correlational threshold for SBTT be found? If so, what is that threshold and how can it be implemented directly to benefit patient care?
While we were unable to find a correlation between SBTT and re-bleeding rates in negative VCE studies, our study was able to identify a threshold value of 220 min for SBTT in order to accurately identify a small bowel source of bleeding. This study proposes that SBTT, a tangible metric within VCE studies, due to its ability to correlate to identification of obscure gastrointestinal bleeds, should be a major metric used to predict valuable clinical outcomes.
Future studies are needed to further look into correlational data for SBTT along with newer parameters such as types and severity of lesions in initially positive VCE as well as in negative VCE with later re-rebleeding events. This would allow for clinicians to have more tools at hand in order to predict clinical severity for their patients with obscure GIB.