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Published on: August 26, 2014
Clinical impact of capsule endoscopy on management of gastrointestinal disorders
Nuzhat A Ahmad1, Nayyar Iqbal, Annemarie Joyce
1Gastroenterology Division, Department of Medicine, Hospital of University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. nuzhat.ahmad@uphs.upenn.edu
Insights
Capsule endoscopy (CE) significantly impacts patient management. Physicians frequently alter diagnostic and treatment strategies based on CE findings, often opting for less complex approaches.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Endoscopic Procedures
Background:
- The clinical utility of capsule endoscopy (CE) in altering patient management remains under investigation.
- Physician decision-making processes following CE require further elucidation.
Purpose of the Study:
- To evaluate the impact of capsule endoscopy findings on patient management decisions.
- To determine the extent to which physicians modify management plans based on CE results.
Main Methods:
- Physicians were surveyed pre- and post-CE regarding their intended management strategies.
- Management recommendations were compared to assess changes in overall plan, diagnostic strategy, and treatment strategy.
- Physicians reading the CE results were blinded to pre-CE management recommendations.
Main Results:
- Capsule endoscopy findings led to changes in overall patient management in 67% of cases.
- Diagnostic strategies were altered in 61% of patients post-CE, with 43% shifting to less complex approaches.
- Treatment strategies were modified in 31% of patients following CE.
Conclusions:
- Capsule endoscopy findings are a significant driver of changes in patient management.
- Physicians frequently adjust diagnostic strategies based on CE results, often simplifying the patient's care pathway.
Background & Aims:
The impact of capsule endoscopy (CE) findings on patient management is unknown. We assessed the impact of CE findings on patient management, and whether physicians use these to alter management plans.
Methods:
Physicians requesting CE were contacted before the examination and asked what their management recommendations would be if CE were not available. These responses were compared with management recommendations by the same requesting physician after the CE. The responses were recorded on a data form. The physicians reading the CE were blinded to the pre-CE responses. The end points assessed were change in overall management and specific change in diagnostic and treatment strategy.
Results:
Responses were obtained from physicians before and after CE in 98 patients. Requesting physicians (n = 40) were composed of gastroenterologists (92%), internists (3%), and other specialties (5%). Physicians changed post-CE overall management plans in 67% of patients. Of these physicians, 74% did so as a result of CE findings (P = .001). Specifically, physicians changed post-CE diagnostic strategy in 61% of patients; the diagnostic strategy was changed to less complex or decreased risk associated in 43% of patients. Of those requesting physicians who changed their diagnostic strategy, 75% did so as a result of CE (P = .004). When treatment strategy was evaluated before and after CE, there was a change in 31% of patients.
Conclusions:
Physicians requesting CE alter management in the majority of patients on the basis of CE findings. Diagnostic strategy is changed in the majority of patients, and often a less complex approach is pursued.
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