title: Enhanced diagnostic yield with prolonged small bowel transit time during capsule endoscopy.
abstract: BACKGROUND
  The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE.
  
  
  METHODS
  We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield.
  
  
  RESULTS
  Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9%) and with excellent bowel preparation (n=177, 83.5%). Mean SBTT was 237.0 min (3.9 hrs). Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4 hr (p=0.41), OR=1.8 in SBTT=4-6 hrs (p=0.30), OR=9.6 in SBTT=6-8 hrs (p=0.05).
  
  
  CONCLUSIONS
  Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a "slower" study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. jmbuscaglia@notes.cc.sunysb.edu
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Buscaglia
authors.forename: Sumit
authors.initials: S
authors.lastname: Kapoor
authors.forename: John O
authors.initials: JO
authors.lastname: Clarke
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Bucobo
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Giday
authors.forename: Priscilla
authors.initials: P
authors.lastname: Magno
authors.forename: Elaine
authors.initials: E
authors.lastname: Yong
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Mullin
mesh_terms: D000328:Adult; D053704:Capsule Endoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007421:Intestine, Small / Q000502:physiology; D008297:Male; D008875:Middle Aged; D013997:Time Factors