Does a longer small bowel transit time improve the diagnostic yield of small bowel capsule endoscopy?

Aims The diagnostic yield of video capsule endoscopy (VCE) can be influenced by multiple factors, including small bowel transit time. In this study, we will investigate the influence of small bowel transit time (SBTT) on the diagnostic yield of VCE.

Methods This is a monocentric retrospective study carried out in the Department of Functional Digestive Explorations at Ibn Sina University Hospital, Rabat, over a period spanning 6 years, from January 2018 to August 2023. All patients with an indication for small bowel exploration for suspected bleeding, after a negative standard endoscopic workup:esophagogastroduodenoscopy(EGD)and ileocoloscopy, suspected or follow-up Crohn's disease, suspected complication of celiac disease, in the context of malabsorption syndrome, Rendu Osler disease or small bowel lymphoma.

Results The mean age was 55.2 (range, 16-90), with a M/F sex ratio of 0.84. The most frequent indication for VCE was the investigation of unexplained GI bleeding after a normal FOGD and colonoscopy (n=39, i.e. 50.6%). Investigation of anaemic syndrome without exteriorized GI haemorrhage was the second most frequent indication (n=19, i.e. 24.7%), followed by the search for, or follow-up of, a case of small bowel Crohn's disease (n=10, i.e. 13%), the search for complications of celiac disease (n=4, i.e. 5.2%), and in the context of suspected exudative enteropathy (n=2,i.e. 2.6%), Rendu Osler's disease (n=2,i.e. 2.6%) and in the context of a known small bowel lymphoma (n=1,i.e.%1.3). Of all the cases studied, 60 patients (78%) had a satisfactory preparation. The quality of preparation was average in 13 cases (16.9%) and poor in 4 others (5.1%). Median small bowel transit time was estimated at 3h and 10 min (with extremes ranging from 24 min to 7H57 min). Most patients (n=46, or 59.7%) recorded a SBTT of 120 to 360 minutes, while 24 patients (31.2%) had an exceptionally rapid SBTT of 0 to 120 minutes, while 7 patients (9.1%) recorded a delayed SBTT of more than 6H. Analysis of the diagnostic yield of VCE in relation to small bowel transit time showed a statistically significant association (p<0.028) between better diagnostic yield and longer small bowel transit time. Compared to patients with SBTT of 0-120 minutes (0-2 hrs), there was a strong association between positive findings and SBTT of 120-360 minutes (2-6 hrs) (OR=0,3, 95%CI=0,1-0,8, p=0.013) and over 360 minutes (> 6 hrs) (OR=0,1, 95%CI=0,1-1, p=0.28).This finding was statistically significant.

Conclusions In conclusion, prolonged intestinal transit time were significantly associated with the identification of abnormal findings on SBCE and an increased diagnostic yield

Publication History

Article published online:
27 March 2025