The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding

Debora Compare; Costantino Sgamato; Alba Rocco; Pietro Coccoli; Durante Donnarumma; Stefano Andrea Marchitto; Sofia Cinque; Pietro Palmieri; Gerardo Nardone

doi:10.1055/a-2251-3285

The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding

Endosc Int Open. 2024 Feb 28;12(2):E282-E290. doi: 10.1055/a-2251-3285. eCollection 2024 Feb.

Authors

Debora Compare¹, Costantino Sgamato¹, Alba Rocco¹, Pietro Coccoli¹, Durante Donnarumma¹, Stefano Andrea Marchitto¹, Sofia Cinque¹, Pietro Palmieri¹, Gerardo Nardone¹

Affiliation

¹ Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.

Abstract

Background and study aims The diagnostic yield of small-bowel capsule endoscopy (SBCE) in suspected small bowel bleeding (SSBB) is highly variable. Different reimbursement systems and equipment costs also limit SBCE use in clinical practice. Thus, minimizing non-diagnostic procedures is advisable. This study aimed to assess the SBCE diagnostic yield and identify factors predicting diagnostic findings in a cohort of patients with SSBB. Patients and methods In this retrospective cohort study, we analyzed the medical records of patients who consecutively underwent SBCE for SSBB over 9 years. By logistic regression, we identified covariates predicting diagnostic findings at SBCE. Finally, we performed a post-hoc cost analysis based on previous gastroenterologist or endoscopist consultations versus direct SBCE ordering by other specialists. Results The final analysis included 584 patients. Most SBCEs were ordered by a gastroenterologist or endoscopist (74%). The number of SBCEs without any finding was significantly lower in the gastroenterologist/endoscopist group P <0.001). The SBCE diagnostic yield ordered by a gastroenterologist or endoscopist was significantly higher than that by other specialists (63% vs 52%, odds ratio [OR] 1.57; 95% confidence interval [CI] 1.07-2.26, P =0.019). At multivariate analysis, older age (OR 1.7, 95%CI 1.2-2.4, P =0.005), anemia (OR 4.9, 95%CI 1.9-12, P =0.001), small bowel transit time (OR 1, 95%CI 1-1.02, P =0.039), and referring physician (OR 1.8, 95%CI 1.1-2.7, P =0.003) independently predicted diagnostic findings. Implementing prior gastroenterologist or endoscopist referral vs direct SBCE ordering would reduce medical expenditures by 16%. Conclusions The professional background of referring physicians significantly improves the diagnostic yield of SBCE and contributes to controlling public health costs.

Keywords: Capsule endoscopy; Endoscopy Small Bowel; Small intestinal bleeding.

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