The Clinical Impact of a Positive Capsule Study - Does It Alter Long Term Patient Outcomes?

The clinical impact of a positive capsule study - does it alter long term patient outcomes?

Introduction

There is no current literature on patient long term outcomes after receiving definitive treatment following a positive capsule study. To evaluate this, we compared the duration of hospitalisation and blood transfusion requirements before and after definitive treatment.

Methods

Patients with positive capsule between January 2003 to May 2012 were reviewed; in whom recommendations were made to undergo further investigations. Length of in-patient stay and blood transfusion requirements were recorded for the 12 months before and after receiving definitive treatment and any encounters subsequently up to May 2013. Presentations were divided into: a) GI bleeding or anaemia, b) Other cause(s) confirmed other than GI bleeding or anaemia, and c) Cause unknown.

Results

Of 955 patients, further investigations were recommended in 114 patients (12%). The median patient was age 60.98 years with a female to male ratio 1:1.7. The average duration of long term patient follow up was 4.71 years. The duration of in-patient stay 12 months before receiving definitive treatment was 1345 days for all patients accumulatively. 283 days (21.0%) were GI bleeding or anaemia, other cause(s) confirmed for 431 days (32.0%) and unknown for 630 days (46.8%). When compared to 12 months after definitive treatment, total duration for all cause in-patient stay was 1726, for which GI bleeding or anaemia was reduced to 169 days (9.8%), other cause(s) increased to 839 days (48.6%) and unknown for 718 days (41.6%). The duration of long term in-patient stay for all causes accumulative was 9.5 years (3469 days), averaging 0.018 years or 6.45 days of in-patient stay per patient per year. Specifically, 322 (9.3%) of the 3464 days were for GI bleeding or anaemia, 2115 days (61.0%) confirmed for other reasons and 1032 days (29.8%) were unknown.

A total of 828 units of pack red cells were transfused 12 months prior to receiving definitive treatment however this was reduced by 52.5% to 393 units in the subsequent 12 months later. This translates to each patient receiving a total average of 7.26 units before and 3.45 units after definitive therapy. In the long term follow up period, a total of 1221 units were transfused, averaging 2.27 units per patient per year. This is a reduction of 68.7% units transfused per year. Angioectasias were found in 40 of the 114 cases, and responsible for 63 of the 169 days (37.3%) of in-patient for confirmed GI bleeding or anaemia and 204 of 393 (51.9%) units of pack red cells 12 months after definitive therapy. The long term in-patient stay was 170 of 491 days (34.6%) and responsible for 423 of 1221 (34.6%) units of pack red cells transfused.

Conclusion

CE is a non-invasive diagnostic modality that guides further definitive investigations and play an important role in altering patient outcome by reducing length of in-patient hospitalisation and blood transfusion requirements both in the short and long term. Angioectasias are responsible for 35% of OGIB and a significant proportion of in-patient stay and blood transfusions even after definitive therapy given their nature to recur.