P1246 - Diagnostic Yield and Clinical Predictors of Video Capsule Endoscopy Findings in Veterans

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Anshika P. Khare, MD (she/her/hers)

Emory University School of Medicine
Atlanta, GA

Anshika P.. Khare, MD¹, Maureen Onweni-Eze, MD², Rebecca Zhang, MS³, Shreya Raja, MD³
¹Emory University School of Medicine, Atlanta, GA; ²Atlanta VA Medical Center, Emory University School of Medicine, Decatur, GA; ³Emory University, Atlanta, GA

Introduction: The clinical impact of video capsule endoscopy (VCE) in non-Veterans has been studied previously; however, studies in Veterans are limited. Our study addresses this knowledge gap and is the largest study to date. Our primary objectives were to determine the diagnostic yield in Veterans, to identify clinical predictors for small bowel lesions, and to analyze rebleeding and readmission rates.

Methods: 296 consecutive VCE performed with the PillCam SB3 system (Medtronic) at the Atlanta VA from 2017 to 2022 were retrospectively reviewed. Relevant clinical parameters were recorded; incomplete studies were excluded. Preparation with clear liquid diet and half gallon of polyethylene glycol 3350 solution was given prior to VCE. T-tests were used to compare the average values of continuous variables of interest between patients with and without positive findings. Chi-square tests were performed to compare the proportions of dichotomized variables of interest. When a count is less than 5, Fisher’s exact test was used instead. Statistical analyses were performed with SAS 9.4.

Results: Mean age was 63 years (yr) and 88% were male. Iron deficiency anemia was the most common indication (72%). Older Veterans were more likely to have melena as their VCE indication (69 vs. 62 yr, p=0.0003) and have arteriovenous malformations (AVM) (67 vs. 62 yr, p=0.0002), mass (85 vs. 63 yr, p=0.01) and blood (66 vs. 63 yr, p=0.01). The most common small bowel findings are shown in Table 1. Veterans with ulcers and erosions had lower ferritin, and those with AVM, red spots, erythema and blood had lower hemoglobin levels (Table 1). Veterans with coronary artery disease (CAD) were more likely to have any findings than those without CAD (25% vs.11%, p=0.04). Veterans with heart failure (HF) were more likely to have ulcers (15% vs. 5%, p=0.01) and blood (20% vs. 9%, p=0.04) than those without HF. No association between anticoagulant or antiplatelet use and bleeding on VCE was found. Non-steroidal anti-inflammatory drug (NSAID) use was a predictor for finding small bowel lesions (30% vs. 16%, p=0.045). Veterans who underwent subsequent therapeutic procedures had higher rates of rebleeding (35% vs 1%, p< 0.0001), readmission (32% vs. 4%, p< 0.0001) and repeat VCE (24% vs. 8%, p=0.0002) compared to those who did not undergo additional procedures.

Discussion: The most frequently identified lesions were red spots and AVMs. Age, CAD, HF, NSAID use were clinical predictors for findings.

Most Common Small Bowel Findings (N=296)	Percent (%)	Hemoglobin (g/dL) with vs. without finding (Mean ± Standard Deviation)	Ferritin (ng/mL) with vs. without finding (Mean ± Standard Deviation)
Red Spots	43.9	11.1 ± 2.4 vs. 9.9 ± 2.4 p< 0.0001	51.7 ± 95.9 vs. 60.3 ± 116.0 p=0.52
Arteriovenous Malformations	27.7	9.5 ± 2.1 vs. 10.8 ± 2.5 p< 0.0001	60.1 ± 113.7 vs. 55.4 ± 105.9 p=0.76
Lymphangiectasias	23.3	10.8 ± 2.4 vs. 10.3 ± 2.4 p=0.18	48.3 ± 167.0 vs. 48.8 ± 82.8 p=0.13
Erythema	16.2	11.1 ± 2.4 vs. 10.3 ± 2.4 p=0.04	39.1 ± 65.0 vs. 59.9 ± 113.9 p=0.11
None	15.2	9.8 ± 2.4 vs. 10.5 ± 2.4 p=0.05	69.8 ± 121.6 vs. 54.1 ± 105.0 p=0.39
Blood	10.8	9.2 ± 2.3 vs. 10.6 ± 2.4 p=0.002	53.2 ± 108.2 vs. 57.1 ± 108.0 p=0.86
Ulcer	6.7	10.4 ± 2.3 vs. 10.4 ± 2.5 p=0.95	31.1 ± 35.8 vs. 58.2 ± 110.5 p=0.03
Erosions	6.7	10.9 ± 3.0 vs. 10.4 ± 2.4 p=0.42	26.3 ± 21.7 vs. 58.9 ± 111.3 p=0.0005
Polyp	4.4	11.4 ± 3.0 vs. 10.4 ± 2.4 p=0.16	72.5 ± 68.4 vs. 56.1 ± 109.0 p=0.67
Duodenitis	1.5	10.2 ± 2.7 vs. 10.4 ± 2.4 p=0.66	39.7 ± 50.6 vs. 58.5 ± 112.3 p=0.14
Mass	0.6	11.0 ± 0.28 vs. 10.4 ± 2.5 p=0.74	30.0 (no SD) vs. 56.8 ± 108.0 p=0.81

Table: Table 1: VCE Small Bowel Findings and Laboratory Values Associated with Findings

Disclosures:

Anshika Khare indicated no relevant financial relationships.

Maureen Onweni-Eze indicated no relevant financial relationships.

Rebecca Zhang indicated no relevant financial relationships.

Shreya Raja: Abbvie – Stock-publicly held company(excluding mutual/index funds). AstraZeneca – Stock-publicly held company(excluding mutual/index funds). Biogen – Stock-publicly held company(excluding mutual/index funds). Crispr Therapeutics – Stock-publicly held company(excluding mutual/index funds). Editas Medicine – Stock-publicly held company(excluding mutual/index funds). Eversana/Evoke – Speakers Bureau. Medtronic – Stock-publicly held company(excluding mutual/index funds). Novartis – Stock-publicly held company(excluding mutual/index funds). Novavax – Stock-publicly held company(excluding mutual/index funds). Twist Bioscience Corp – Stock-publicly held company(excluding mutual/index funds).

Anshika P.. Khare, MD¹, Maureen Onweni-Eze, MD², Rebecca Zhang, MS³, Shreya Raja, MD³. P1246 - Diagnostic Yield and Clinical Predictors of Video Capsule Endoscopy Findings in Veterans, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.