P4938 - Updated Analysis on a Call for Early Wireless Capsule Enteroscopy in Suspected Small Bowel Bleed: A Single Tertiary Care Referral Center Experience

Award: Presidential Poster Award

Rachan Narala, MD¹, Matthew Chen, BA², Denis Nguyen, MD¹, Yousuf Kidwai, MD¹, Surinder Mann, MD¹, Neel K. Mann, MD, MPH¹, Amila Adili, MPH¹, Melissa Wilson, MPH, PhD^1
1Keck School of Medicine of the University of Southern California, Los Angeles, CA; ²Keck School of Medicine of the University of Southern California, Torrance, CA

Introduction: Current guidelines recommend < 48 hours between presentation of a suspected small bowel bleed (SSB) and deployment of wireless capsule enteroscopy (WCE). We analyzed if more granular time intervals can further improve WCE diagnostic yield.

Methods: 790 WCEs were performed during December 2019 to April 2024, and a retrospective chart review was performed on 231 WCEs for SSB. The primary endpoint was time from SSB presentation (< 12hr, < 24hr, < 48hr, < 72hr) to deployment of WCE and its diagnostic yield. A positive WCE was defined as heme or a clinically actionable lesion confined to the small bowel that was beyond reach of bidirectional endoscopy. Secondary endpoints included hospital length of stay (LOS) and number of red blood cell (RBC) units transfused.

Demographic and clinical characteristics were presented across two groups: no bleed vs bleed on WCE. The Wilcoxon rank-sum test compared continuous variables, and bivariate analysis was done using Chi-square tests. Primary outcome factors were assessed using multinomial logistic regression.

Results: Of 231 patients, 165 were in the no bleed group and 66 in the bleed group. Baseline Hgb levels were statistically lower in the bleed group (p=0.006). There was a significantly higher diagnostic yield in the inpatient setting compared to outpatient (p=.022).

The timing from SSB to WCE did not show significant impact on the odds of detecting bleed across all intervals (< 12h, < 24h, < 48h, < 72h). However, WCE performed at 48 hours compared to 72 hours after presentation was statistically significant (p< .02) for a positive WCE. Additionally, WCE between 24h-48h and 48h-72h significantly reduced LOS (p=0.001 and p=0.019, respectively). Active smoking status was found to be a significant predictor of diagnostic yield (OR 3.30, p< 0.04).

Discussion: This study confirms the 48 hour interval as a benchmark for capsule deployment. WCE within 24-72 hrs after presentation resulted in a statistically significant shorter LOS. Furthermore, WCE positivity was statistically significant with inpatient deployment compared to outpatient. Earlier WCE deployment could be more cost-effective, given a negative WCE could lead to earlier hospital discharge. Although not statistically significant, the highest yield was at the 12-24 hour mark. This warrants a larger study to further investigate this time interval, and also encourages the utility of deploying WCEs at the time of bidirectional endoscopy for SSB, especially in the inpatient setting.


Disclosures:


Rachan Narala, MD¹, Matthew Chen, BA², Denis Nguyen, MD¹, Yousuf Kidwai, MD¹, Surinder Mann, MD¹, Neel K. Mann, MD, MPH¹, Amila Adili, MPH¹, Melissa Wilson, MPH, PhD¹. P4938 - Updated Analysis on a Call for Early Wireless Capsule Enteroscopy in Suspected Small Bowel Bleed: A Single Tertiary Care Referral Center Experience, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.