title: Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.
  
  
  METHODS
  Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatientsvsinpatients), bowel cleanliness, and center volume.
  
  
  RESULTS
  We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n= 776, 54%) were older (P< 0.0001), had a longer small-bowel transit time (P= 0.0015), and were more frequently examined in low-volume centers (P< 0.001). Age and small-bowel transit time were correlated (P< 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).
  
  
  CONCLUSIONS
  In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
authors.affiliation: Carlo Maria Girelli, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio (VA), 21052 Busto Arsizio (VA), Italy.
authors.forename: Carlo Maria
authors.initials: CM
authors.lastname: Girelli
authors.affiliation: Carlo Maria Girelli, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio (VA), 21052 Busto Arsizio (VA), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Soncini
authors.affiliation: Carlo Maria Girelli, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio (VA), 21052 Busto Arsizio (VA), Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D005772:Gastrointestinal Transit; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D055815:Young Adult
keywords: Capsule endoscopy; Detection rate; Diagnostic yield; Obscure gastrointestinal bleeding; Prokinetics; Small bowel; Small-bowel transit time; Suspect small-bowel bleeding