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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E282-E290
DOI: 10.1055/a-2251-3285
Original article

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

Debora Compare  ‡
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Costantino Sgamato‡
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Alba Rocco
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Pietro Coccoli
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Durante Donnarumma
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Stefano Andrea Marchitto
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Sofia Cinque
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Pietro Palmieri
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
,
Gerardo Nardone
1   Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy (Ringgold ID: RIN9307)
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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

Endoscopy Small Bowel - Capsule endoscopy - Small intestinal bleeding


Publication History

Received: 22 September 2023

Accepted after revision: 22 December 2023

Accepted Manuscript online:
22 January 2024

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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