Small bowel capsule endoscopy in a tertiary centre: Comparison with ESGE performance measure

Aims Video Capsule Endoscopy (VCE) is a non-invasive diagnostic tool used to visualise the gastrointestinal tract. It is the first line in investigating small bowel pathology and bleeding. We have performed a retrospective analysis of VCE performed in a tertiary centre for the past three years.

Methods The list of patients who had VCE performed for the past three years was obtained from the endoscopy department. Data was collected from the VCE report and from iPortal. We analysed the demographics, indication, pathology detected, quality of bowel preparation, and follow-up procedure.

Results 184 cases were included with 50% (n=92) males. Median age was 57 with the range between 25 to 83. 83.7% (n=154) have Colon Capsule CLEansing Assessment and Report (CC- CLEAR) score documented. The overall cleansing classification was the sum of each segment score (right-sided, transverse and left-sided). Each segment was scored according to an estimation of the percentage of visualized mucosa (0,<50%; 1, 50%-75%; 2,>75%; 3,>90%) [1]. With regards to=the CC- CLEAR score, 46.7% (n=86) was excellent (score 8-9), 25% (n=46) was good (score 6-7) and 12% (n=22) was poor (score 0-5) [1]. 39% (n=72) had 1 mg prucalopride administered to decrease bowel transit time. 2% (n=4) had 2mg prucalopride. In terms of follow up plan, 38% (n=70) were discharged with no further procedure, 25.5% (n=47) were referred for polypectomy either via colonoscopy or flexible sigmoidoscopy, 9.8% (n=18) were referred for colonoscopy and 6.5% (n=12) for flexible sigmoidoscopy due to poor view or for completion. 1.6% (n=3) was referred for CT colonoscopy. 12.5% (n=23) were referred for 3 yearly surveillance colonoscopies and 1.1% (n=2) for one-yearly surveillance colonoscopy. 3.8% (n=7) had colonoscopy deferred. 0.5% (n=1) was referred for colonoscopy to assess inflammation and 0.5% (n=1) was referred for enteroscopy due to a flat lesion detected in distal duodenum and jejunum.

Conclusions The rate of adequate bowel prep with CC-CLEAR documented was 71.7%. Analysis of factors affecting bowel preparations needs to be conducted to optimise visualisation. Our capsule retention rate was 2.72% which was just above the international target standard (2%) [2].

• References

• 1 de Sousa Magalhães R, Arieira C, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J.. Colon Capsule CLEansing Assessment and Report (CC-CLEAR): a new approach for evaluation of the quality of bowel preparation in capsule colonoscopy. Gastrointest Endosc 2021; 93 (1): 212-223 Epub 2020 Jun 11. PMID: 32534054
• 2 Spada C, McNamara D, Despott EJ, Adler S, Cash BD, Fernández-Urién I, Ivekovic H, Keuchel M, McAlindon M, Saurin JC, Panter S, Bellisario C, Minozzi S, Senore C, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Valori R, Bisschops R, Rutter MD.. Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2019; 51 (6): 574-598 Epub 2019 May 10. PMID: 31075800