S1547 Feasibility of Video Capsule Endoscopy in Patients With Surgically Altered Gastric Anatomy: Propensity-Matched Study

Introduction: There is very scarce information about feasibility and safety of video capsule endoscopy (VCE) in patients with and without surgically altered gastrointestinal anatomy (SAGIA). We compared the safety and feasibility of VCE in patients with SAGIA and to those with normal anatomy (NA). Methods: Patients undergoing VCE at our Institution were included (2010-2022) (Table A). Patients with SAGIA undergoing VCE were 2:1 matched based on gender to patients with normal anatomy (NA). SAGIA group comprised of gastrectomy, gastric bypass, enterectomy, colectomy, esophagectomy or Whipple’s procedure. Primary outcomes were completion rate, gastric and small bowel transit time, and adverse event rate. Results: Amongst 9,584 patients undergoing VCE, 77 patients with SAGIA were matched to 154 patients with NA. Complete data was available for 139 patients with NA which comprised the final control group. Gastric bypass was the most common surgery (n=31 [40.3%]) followed by gastrectomy (complete or partial, n=29 [37.6%]). Video capsule was more likely to be placed by swallowing in SAGIA group in comparison with NA group (76.6% vs 38.8%, P< 0.001). Patency capsule prior to CE was performed more often in SAGIA group compared to NA group (22.1% vs 5.0%, P< 0.001). VCE outcomes are presented in Table B. Study completion rates were similar between SAGIA and NA (97.4% and 95.5%, P=0.56). Rates of gastric (1.5% vs 0.7%, P=0.5) and small bowel (1.5% vs 37%, P=0.6) capsule retention were similar between the SAGIA and NA groups. No patients in either group required intervention for capsule retrieval. Follow up of radiographic imaging was performed more frequently in patients with SAGIA as compared to those with NA (27.3 vs 3.6%, P< 0.001). Conclusion: VCE is safe in patients with SAGIA with comparable completion rates to patients with NA. Patients with SAGIA undergoing VCE are more likely to undergo patency capsule prior to VCE and radiographic imaging post VCE despite the lower frequency of actual capsule retention in patients with SAGIA. This study did not support routine patency capsule or radiographic follow-up in patients with SAGIA. Table A. - Baseline characteristics, type of surgery and indications for video capsule endoscopy in patients with normal anatomy and surgically altered gastrointestinal anatomy (SAGIA) A. Baseline characteristics, type of surgery and indications for video capsule endoscopy in patients with normal anatomy and surgically altered gastrointestinal anatomy (SAGIA) Variable Group SAGA Normal anatomy P value N 77 139 Age at the time of VCE 55.58 (15.82) 59.50 (15.87) 0.083 Gender (%) Female 41 (53.2) 74 (53.2) 1 Race (%) African/Black 17 (22.1) 40 (29.2) 0.696 Asian 1 (1.3) 2 (1.5) Caucasian 58 (75.3) 94 (68.6) Hispanic 1 (1.3) 1 (0.7) BMI 29.60 (10.11) 28.03 (7.38) 0.191 Capsule placement Endoscopically placed 18 (23.4) 85 (61.2) < 0.001 Swallowed 59 (76.6) 54 (38.8) Comorbidities HTN (%) 37 (48.1) 113 (81.3) < 0.001 Autoimmune diseases (%) 4 (5.2) 4 (2.9) 0.46 Hypothyroidism. (%) 18 (23.4) 23 16.5) 0.277 Scleroderma. (%) 3 (3.9) 1 (0.7) 0.131 Diabetes (%) 26 (33.8) 60 (43.2) 0.194 Parkinsonism. (%) 0 (0.0) 4 (2.9) 0.299 Indications for VCE Abdominal pain (%) 9 (11.7) 3 (2.2) 0.009 Concern for IBD (%) 2 (2.6) 1 (0.7) 0.29 Iron deficiency anemia (%) 23 (29.9) 33 (23.7) 0.335 Occult GI bleeding. (%) 10 (13.0) 2 (1.4) 0.001 Overt GI bleeding. (%) 34 (44.2) 108 (77.7) < 0.001 Small bowel polyps. (%) 5 (6.5) 0 (0) 0.005 Other. (%) 26 (33.8) 0 (0.0) < 0.001 Prior Surgeries Gastrectomy (%) 29 (37.6) Gastric bypass (%) 31 (40.3) Enterectomy (%) 7 (9.1) Colectomy/ICR (%) 3 (3.9) Esophagectomy (%) 1 (1.3) Whipple’s procedure (%) 6 (7.8) B. Outcomes of video capsule endoscopy in patients with normal anatomy vs surgically altered gastrointestinal anatomy (SAGIA) Outcomes SAGIA Normal anatomy P value Small bowel transit time (min) 316.56 (142.63) 310.89 (159.59) 0.82 Total transit time (min) 731.00 (197.08) 773.97 (168.97) 0.141 Result Completion 75 (97.4) 128 (95.5) 0.598 Gastric retention at Day 15 1 (1.3) 1 (0.7) Small bowel retention at Day 15 1 (1.3) 5 (3.7) Follow up imaging (%) 21 (27.3) 5 (3.6) < 0.001 B: Footnote: Continuous variables are presented as mean (SD) and categorical variables are presented as n (%).