A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire.

BACKGROUND AND AIM: Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS: Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS: 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION: This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.

Esophageal lesions detected during small bowel capsule endoscopy : incidence, diagnostic and therapeutic impact.

BACKGROUND: Nowadays, capsule endoscopy is the first-line procedure for the visualization of the small bowel. Although it was primarily designed with this goal, it may also identify other segments of the gastrointestinal tract. The aim of the current study is to evaluate the incidence of esophageal abnormalities detected in patients undergoing small bowel capsule endoscopy and its impact on patient management. PATIENTS AND METHODS: This study is a retrospective analysis of data from 2217 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between January 2008 and February 2016. Patient baseline characteristics, esophageal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was then performed. RESULTS: 2217 patients were finally included in the analysis. 1070 were male (48.2%) and the mean age was 56.1 ± 19.5 years (12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Esophageal abnormalities were detected in 105 out of 2217 patients (4.7%). The most common lesions detected were peptic esophagitis (58.1%) and esophageal varices (17.1%). This information had a clinical/diagnostic impact of 3.3% and a therapeutic impact of 3.2%. CONCLUSION: Capsule endoscopy detects not only small bowel lesions, but also significant esophageal lesions that may be overlooked during initial gastroscopy. Therefore, all images of the esophagus should be read during small bowel capsule endoscopy, since it could provide relevant information that may result in changes on patient´s management.