C0321 - Algorithmic Approach to GI Bleed Using Video Capsule Endoscopy Prior to Double Balloon Enteroscopy Is Associated With Higher Therapeutic Yield and Decreased Readmission at a Tertiary Medical Center

Tyler Colvin, MD¹, Mahmoud Aryan, MD¹, Lauren Daley, MD¹, Parth Patel, MD¹, Krishna Venkata, MD², Shajan Peter, MD^1
1University of Alabama at Birmingham, Birmingham, AL; ²University of Alabama at Birmingham, Montgomery, AL

Introduction: Occult bleeding is usually secondary to small intestinal pathology and can be further evaluated with either video capsule endoscopy (VCE) or double balloon enteroscopy (DBE) after a negative colonoscopy and endoscopy. The traditional algorithmic diagnostic approach consists of performing a VCE before DBE. We analyzed the success rates of using the traditional algorithmic approach as compared to a single diagnostic test (DBE) for the evaluation of obscure GI bleeding (OGIB).

Methods: We performed a retrospective chart review of 805 patients who underwent double balloon enteroscopy (DBE) for evaluation of gastrointestinal bleeding at our institution from 11/2012-12/2020. Patient demographics, endoscopy indication, VCE use, endoscopic intervention, hospital readmission, and incidence of recurrent GI bleeding were obtained. Variables were compared between the 2 groups via Chi-Squared test and student 2 sample t-test. Univariate and multivariable logistic regression analysis were run for adjusted odds ratio (OR) for 30-day readmission.

Results: Our cohort has 805 patients with 374 males (46.4%) and an average age of 64.3 ± 14.7 years. Anterograde DBE was more commonly performed (77.0%) compared to retrograde, and most procedures were performed in the outpatient setting (64.2%). There were 354 patients (44.0%) that received a combination of VCE with subsequent DBE while the remaining 451 patients (56.0%) were evaluated with only DBE. Diagnostic success was higher in the algorithmic approach (VCE +DBE) (62.3%) when compared to DBE group (55.4%)(p=0.094). There was significantly higher therapeutic yield (59.9% vs 51.0%) (P=0.01) and shorter procedure time (35.6 ± 15.6 vs 39.6 ± 21.3 minutes, p=0.003) in those who received VCE+DBE compared to just DBE. Multivariable logistic regression analysis demonstrated that such VCE algorithmic approach was associated with decreased readmission rates at 1 month [Odds Ratio (OR): 0.56, 95% CI (0.33-0.94), p=0.027]. Inpatient status was associated with increased 30-day readmission as depicted in table 2 (both p< 0.05).

Discussion: The use of an algorithmic approach with VCE followed by subsequent DBE was found to have several significant benefits in our cohort including increased therapeutic yield, decreased readmission rates, and decreased procedure time. Although limited in the setting of urgent GI bleed, our study shows significant benefit of using an algorithmic approach in the evaluation of OGIB.



Disclosures:


Tyler Colvin, MD¹, Mahmoud Aryan, MD¹, Lauren Daley, MD¹, Parth Patel, MD¹, Krishna Venkata, MD², Shajan Peter, MD¹. C0321 - Algorithmic Approach to GI Bleed Using Video Capsule Endoscopy Prior to Double Balloon Enteroscopy Is Associated With Higher Therapeutic Yield and Decreased Readmission at a Tertiary Medical Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.