Usefulness and impact on management of positive and negative capsule endoscopy

OBJECITIVE: To determine the usefulness of positive and negative capsule endoscopies (CEs), and the impact of each on short- and long,term patient management. METHODS: Medical records were reviewed for 70 consecutive CE patients. Based on Outcomes from referring physicians, it was determined whether CE was useful, partially useful or not useful at all in the overall patient management, and whether CE assisted in providing a diagnosis, and impacted on short-term long-term management. RESULTS: CE indications included overt bleeding (37%), occult bleeding (20%), iron deficiency (17%), abdominal pain and weight loss (13%), assessing the extent of or confirming a diagnosis of Crohn's disease (9%) and screening for familial adenomatous polyposis 0%). Positive studies were seen in 58% of overt bleeds, 50% of Occult bleeds, 33% of iron deficiencies and 33% of Crohn's diseases. Overall, 28 studies (40%) were Positive Studies and 42 (60%) were negative studies. CE aided in diagnosis in I I of 28 (39%) positive and 12 of 42 (29%) negative studies (P=0.35). Positive and negative CEs had an impact on short,term management in 12 of 28 (43%) versus 18 of 42 (43%) cases, respectively (P=1.0), and on long-term man, agement in 14 of 28 (50%) versus 15 of 42 (36%) cases, respectively (P=0.23). For positive and negative studies, respectively, CE was considered useful in 12 of 28 (43%) versus 15 of 42 (36%) cases (39% overall), partially useful in 10 of 28 (36%) versus 10 of 42 (24%) cases (28% overall), and not useful at all in six of 28 (21%) versus 17 of 42 (40%) cases (33% overall). CONCLUSIONs: Although a negative CE may aid in making a definitive diagnosis in only 29% of patients, its effect on management and overall usefulness is similar to that of a positive CE. A physician's decision on whether to order CE should not be based solely on the pretest probability of a positive examination but also on the clinical utility of a negative study.