Impact of Inpatient Status and Gender on Small-bowel Capsule Endoscopy Findings

Background: Video capsule endoscopy (VCE) is most commonly performed in the outpatient setting to evaluate obscure GI bleeding.

Objective: To determine the impact of gender and inpatient status on VCE findings.

Design: Retrospective study.

Setting: Two tertiary medical centers and a VA medical center.

Patients: A total of 167 inpatients and 540 outpatients undergoing 707 VCE examinations for obscure GI bleeding.

Interventions: VCE study.

Main Outcome Measurements: Patient age, sex, indication for VCE, gastric and small-bowel transit times, significant VCE findings including detection of blood in the lumen and major lesions outside the small bowel, and presence of comorbid conditions.

Results: Significant VCE findings were identified more frequently during inpatient VCE examinations (48% vs 37%, P = .009). Endoscopic placement, nongastric passage, and incomplete studies to the cecum were more common for inpatient VCE examinations. Gastric transit time, but not small-bowel transit time, was longer in inpatient VCE studies. Inpatient VCE examinations were more common in male patients (73% vs 61%, P = .004) and patients with overt bleeding (83% vs 46%, P < .05). The overall diagnostic VCE rate was higher for male patients because of a higher prevalence of angiodysplastic lesions and major findings outside the small bowel.

Limitations: Retrospective study. Lack of information regarding timing of VCE study, most recent episode of obscure bleeding, and comorbidity data for outpatients.

Conclusion: The overall diagnostic yield was higher for inpatient VCE examinations. Male patients were more likely to demonstrate significant findings on both inpatient and outpatient VCE studies because of a higher prevalence of angiodysplastic lesions and findings outside the small bowel.