A re-review of caspule endoscopies of patients referred for deep enteroscopy changes their management

BackgroundPatients are commonly referred to tertiary centers for deep enteroscopy because of abnormal findings on video capsule endoscopy (VCE). The aim of this study was to determine how often clinical management changes when VCEs are reviewed by an enteroscopist prior to scheduling a procedure.MethodsA retrospective review was performed of patients referred for deep enteroscopy because of abnormal capsule endoscopy. All VCE images were reviewed prospectively by the tertiary center's enteroscopist. Patients were then scheduled for deep enteroscopy or other management based on the capsule review. The rate of disagreement in the capsule findings, changes in management, and the diagnostic and therapeutic yield of enteroscopy were calculated.ResultsVideo capsule endoscopy was available in 45 patients who were referred for deep enteroscopy. The mean age was 61 years (51% were females). Indications included obscure GI bleeding (37 patients), abnormal imaging (3 patients), abdominal pain (2 patients), Peutz-Jegher syndrome (2 patients), and weight loss (1 patient). Referring physician findings included polyps or masses (13 patients), angioectasia (13 patients), ulcers (9 patients), active bleeding (9 patients), nonspecific findings (8 patients), and normal (2 patients). A capsule review led to disagreement of the findings of 13 (29%) patients and led to a change in the management of 9 (20%) patients. The most common reason for a change in management was overcalled lesions. Thirty-seven patients underwent enteroscopy with a diagnostic yield of 48.8% and therapeutic intervention in 24.4%.ConclusionA review of referral VCE studies led to a change in management in a large percentage of patients, particularly when the indication was polyp, mass, or ulcer. Patients referred for deep enteroscopy should have their capsule re-read by an enteroscopist prior to scheduling the procedure.