IS SMALL BOWEL TRANSIT TIME A DETERMINANT FACTOR FOR THE DIAGNOSIS OF POTENTIALLY BLEEDING LESIONS AT CAPSULE ENDOSCOPY?

Aims Small bowel capsule endoscopy (SBCE) is the gold standard in the study of small bowel bleeding (SBB). Recent studies suggested that longer small bowel transit times (SBTT) may be associated with higher diagnostic yield of SBCE.The aim of the study is to investigate if longer SBTT is a predictive factor of positive findings on SBCE in a population that performed SBCE due to suspected SBB.

Methods Retrospective study. Included consecutive SBCE between May 2007 and May 2019 due to suspected SBB. Positive SBCE was considered in the presence of lesions with high potential bleeding-P2, according to the Saurin classification.

Results Four hundred and seven patients performed SBCE between this period. Included 372 patients, 65.9% female with median age 67 (IQR: 19-97) years. From this population, P2 lesions were present in 133 (35.8%) patients.

We observed that patients with P2 lesions in SBCE presented longer SBTT (median: 297[55-670] versus 256[56-619] min; p=0.006), were older (p< 0.001), more frequently males (p=0.016), suffered more frequently from hypertension (p=0.007), diabetes (p=0.035),chronic kidney disease (p=0.002) and heart failure (p< 0.001). No differences were observed between patients with anticoagulants and antiplatelet agents. We found a significant correlation between SBTT and age (rs 0.136;p=0.008). SBCE with SBTT≥4h presented higher rate of P2 lesions (40.0%vs28.5%;p=0.025), mainly angioectasias (33.6%vs24.1%;p=0.049). In logistic regression, the significant predictive factors of the presence of P2 lesions were age (OR1.03; IC 95% 1.008-1.044; p=0.004), SBTT (OR 1.003; IC95%1.001-1.005; p=0.021)and male gender (OR 1.61; IC95%1.01-2.57; p=0.045).

Conclusions Patients with longer SBTT presented higher rates of lesions with high potential bleeding (P2). SBTT along with previous well defined factors-age and male gender were the only independent predictor factors of the presence of P2 lesions. This finding may suggest that slower passage of the capsule in the small bowel may allow a better diagnostic yield for significant lesions.