Clinical Impact of Capsule Endoscopy on Management of Gastrointestinal Disorders

Background & Aims: The impact of capsule endoscopy (CE) findings on patient management is unknown. We assessed the impact of CE findings on patient management, and whether physicians use these to alter management plans. Methods: Physicians requesting CE were contacted before the examination and asked what their management recommendations would be if CE were not available. These responses were compared with management recommendations by the same requesting physician after the CE. The responses were recorded on a data form. The physicians reading the CE were blinded to the pre-CE responses. The end points assessed were change in overall management and specific change in diagnostic and treatment strategy. Results: Responses were obtained from physicians before and after CE in 98 patients. Requesting physicians (n = 40) were composed of gastroenterologists (92%), internists (3%), and other specialties (5%). Physicians changed post-CE overall management plans in 67% of patients. Of these physicians, 74% did so as a result of CE findings (P = .001). Specifically, physicians changed post-CE diagnostic strategy in 61% of patients; the diagnostic strategy was changed to less complex or decreased risk associated in 43% of patients. Of those requesting physicians who changed their diagnostic strategy, 75% did so as a result of CE (P = .004). When treatment strategy was evaluated before and after CE, there was a change in 31% of patients. Conclusions: Physicians requesting CE alter management in the majority of patients on the basis of CE findings. Diagnostic strategy is changed in the majority of patients, and often a less complex approach is pursued.