title: Capsule endoscopy: impact on patient management.
abstract: Capsule endoscopy (CE) is an emerging technology in the diagnosis of a variety of gastrointestinal (GI) disorders. However, for CE to play a significant role in the care of GI disease, changes in patient management and positive patient outcomes must be seen. The objective of this study was to determine the impact of CE findings in the management of patients referred for CE. The study was a retrospective chart review of all patients who underwent CE at the University of South Alabama College of Medicine from April 2002 to May 2005. Demographic data was collected, as well as indications for CE. Findings included active bleeding (some within reach of a therapeutic endoscope), masses or polyps potentially missed by prior evaluation, and ulcers or lesions that would require a change in medical or surgical management (eg, the discontinuation of medications such as nonsteroidal anti-inflammatory drugs [NSAIDs] or a change in inflammatory bowel disease [IBD] treatment regimen, based on evidence of active disease from CE). A total of 210 cases were reviewed in this study. Overall, CE findings would lead to a change in patient management in 81 of 210 patients (38.6%). When the sample was restricted to the 93 patients with obscure-occult bleeding, 34 patients (36.6%) would have a change in patient management. Of the 79 obscure-overt bleeding patients, 33 patients (41.8%) would experience a change in patient management. Of the 36 patients who had CE for known or suspected IBD, 13 patients (36%) would have a patient management change based on capsule findings. This study demonstrates that CE meets a reasonable criteria for clinical utility in its ability to change patient management. In our study, 36-41.8% of patients with suspected small-bowel disorders would experience a change in patient management as a result of CE. Also of importance is the ability of CE to provide information that reassures patients and eliminates the need for further testing.
authors.affiliation: Dr. Barnett is an Instructor in Medicine and Fellow in the Division of Gastroenterology at the University of South Alabama.
authors.forename: Cody B
authors.initials: CB
authors.lastname: Barnett
authors.forename: Jack A
authors.initials: JA
authors.lastname: Dipalma
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Olden