P2379 - Trust issues: Assessing the Calculated Location Accuracy of Abnormal Findings on Small Bowel Capsule Endoscopy

Arman Maqsudlu, MD¹, Hera Jamal, DO¹, Fariha Hasan, MD¹, Jesse Viggiano, BS², Anurag Majumdar, BA², Thomas Judge, MD³, Krysta Contino, MD⁴, Anthony Infantolino, MD⁵, Apeksha Shah, MD⁶, Christina Tofani, MD, FACG^7
1Cooper University Hospital, Camden, NJ; ²Cooper Medical School of Rowan University, Camden, NJ; ³Cooper Medical School of Rowan University, Mt. Laurel, NJ; ⁴Digestive Health Institute at Cooper University Hospital, Mount Laurel, NJ; ⁵MD Anderson Cooper Digestive Health, Cherry Hill, NJ; ⁶Digestive Health Institute at Cooper University Hospital, Mt. Laurel, NJ; ⁷Digestive Health Institute at Cooper University Hospital, Camden, NJ

Introduction: The primary indication for video capsule endoscopy (VCE) is to identify small bowel diseases, particularly for investigating obscure gastrointestinal bleeds. VCE measures small bowel transit time (SBTT) from the first duodenal image to the first cecal image, with findings categorized by the percentage of SBTT (%SB). This study aims to assess the accuracy of the %SB calculation by PillCam software for abnormal findings by evaluating the discordance between %SB and the Lewis score.

Methods: This was a retrospective, IRB-approved, single-center study conducted at a tertiary care center. PillCam SB3 capsule endoscopy system was used to identify locations. Inclusion criteria included patients 18 years or older who had a VCE performed at our hospital between 05/2023 and 03/2024. Patients with incomplete VCEs or poor preparation were excluded. The main outcomes were the discordance between the Lewis score and %SB. Secondary outcomes included differences between the standard and %SB-based procedure recommendations. Outcomes were compared using the Wilcoxon Signed Rank test for non-parametric and ordinal variables and the McNemar test for nominal variables. Cohen’s Kappa score assessed agreement between variables. Logistic regression analyzed the impact of co-morbidities and sex on the disagreement between %SB and the Lewis score.

Results: In the analysis, 74 samples were included. We found significant variance between %SB and the Lewis score (P< 0.05) with a Kappa score of 0.364, indicating fair agreement. No significant difference was observed between the procedure recommended by physicians and the procedure recommended based on %SB (P>0.05). However, we found the Kappa score of 0.212 suggests fair agreement. Our experts would have recommended a different procedure than the one performed based on the results from the PillCam software 63.5% of the time.

Discussion: Our findings revealed a significant discordance between the Lewis score and %SB. The agreement level between the procedure recommended based on the Lewis score and the procedure recommended based on %SB is notably low, indicating variability in the recommendations derived from the two scores, which consequently influences the procedure performed. The reasons for the observed discordance between these inherently interchangeable scores remain unclear. Logistic regression suggests a potential association between NSAID use and aortic stenosis with the disagreement. Future plans will focus on increasing the sample size to enhance power.



Disclosures:


Arman Maqsudlu, MD¹, Hera Jamal, DO¹, Fariha Hasan, MD¹, Jesse Viggiano, BS², Anurag Majumdar, BA², Thomas Judge, MD³, Krysta Contino, MD⁴, Anthony Infantolino, MD⁵, Apeksha Shah, MD⁶, Christina Tofani, MD, FACG⁷. P2379 - Trust issues: Assessing the Calculated Location Accuracy of Abnormal Findings on Small Bowel Capsule Endoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.