Risk Factors Of Incomplete Small Bowel Capsule Endoscopy For Inpatients

BackgroundThe intestinal lumen of the small intestine is lengthy,the anatomical structure is special,and the characteristics of complicated bending,etc.These features add challenges to the diagnosis and treatment of small bowel diseases.In the 21st century,the advent of a non-invasive and convenient small bowel examination method,small bowel capsule endoscopy(SBCE)has accelerated the clinicians' exploration of small bowel diseases.Main indications of SBCE are obscure gastrointestinal bleeding(OGIB),abdominal pain,confirmed or suspected CD(Crohn's disease,CD),hereditary polyp syndrome,and celiac disease,etc.As the application of SBCE becomes more and more widely used in clinics,endoscopists or gastroenterologists find that SBCE examination may be accompanied by related complications,such as capsule retention,incomplete SBCE examination,and even perforation.Up to now,incomplete SBCE procedure has become one of the common complications of SBCE procedure.The relevant risk factors for incomplete SBCE examinations have been explored at home and abroad.Due to differences in SBCE type,enrolled population,incomplete SBCE standards and other factors,the incomplete rates of SBCE examinations reported in various literatures are different,but most of results are all above 15%.The occurrence of complications may delay the diagnosis and treatment of small bowel disease and increase the distress of patients and medical workers.Several studies have found that the hospitalization of patients may be a risk factors of incomplete SBCE procedure.As a special group,inpatients have a heavy economic burden and high mental,psychological pressure.It is uneconomical and unrealistic to intervene in advance for all inpatients in order to improve the completion rate of SBCE examination.Therefore,it is very necessary to explore the risk factors related to the incomplete SBCE examination of inpatients,and to intervene in advance for "high-risk" inpatients to improve the completion rate of SBCE examination.At present,the risk factors related to the incomplete SBCE examination of inpatients are still unclear.ObjectiveTo explore the risk factors related to the incomplete SBCE procedure of inpatients.MethodsScreening of inpatients who have underwent SBCE examination in the gastroscope room of the Department of Gastroenterology,Shandong University Qilu Hospital from March 2012 to February 2019 to collect information(including basic characteristics of patients:gender,age,body mass index(BMI),history of smoking,history of alcohol,the American Society of Anesthesiologists Physical Status Classification System(ASA)score,hypertension,diabetes mellitus,cardio-cerebrovascular disease,history of gastrointestinal surgery(surgical history of esophagus,stomach,small intestine and large intestine),intestinal obstruction history,history of constipation;type of capsule endoscopy:Pillcam SB1,Pillcam SB2;reasons of capsule endoscopy procedure,obscure gastrointestinal bleeding(OGIB),abdominal distension,abdominal pain,diarrhea,constipation;the state of inpatient before SBCE examination:anemia status,fasting state(? 2 days,? 3 days,within 1 week),and time interval from painless gastroenteroscopy(the same day,interval(inclusive)2 days,interval(inclusive)3 days,interval(inclusive)1 week).Incomplete procedure of SBCE is defined as the capsule endoscopy did not record the image of the ileocecal department or the capsule still did not pass the ileocecal valve until battery was exhausted.The data of inpatient information was divided into inpatients who underwent an incomplete SBCE and inpatients who underwent a complete SBCE.Then we compared the date between this two groups.We use chi-square test or Fisher's exact tests to select factors related to incomplete SBCE examination.Logistic multivariate regression analysis was used to evaluate the independent risk factors of incomplete SBCE in hospitalized patients.ResultsA total of 218 inpatients were included in the final analysis,including 122 males(60.0%,122/218)and 96 females(40.0%,96/218).There were 23 cases in the incomplete SBCE group and 195 cases in the completion SBCE group.For inpatients,the incomplete rate of SBCE was 10.6%(23/218).The data of sex,BMI,the history of drinking,hypertension,cardio-cerebrovascular disease,history of gastrointestinal surgery(surgical history of esophagus,stomach,small intestine and large intestine),constipation history,capsule endoscope type:Pillcam SB1,Pillcam SB2;the reasons for SBCE and the status of the inpatients before the SBCE procedure:fasting,and time interval from painless gastroenteroscopy,the difference was not statistically significant(P>0.05).In addition,inpatients with smoking history(P=0.103),age? 65 years(P=0.105)or diabetes mellitus(P=0.102)had a tendency of incomplete capsule endoscopy procedure.The data analysis results of this study showed that ASA score ?3 points(26.1%vs.7.7%,OR 4.235,P=0.005),history of intestinal obstruction(13.0%vs.2.1%,OR 7.163,P=0.027),anemia status(73.9%vs.48.2%,OR 3.044,P=0.020)was related to the incomplete SBCE for inpatients.After logistic multivariate regression analysis,ASA score ?3(OR 3.086,P=0.050),history of intestinal obstruction(OR 5.320,P=0.048)and anemia status(OR 2.964,P=0.034)before SBCE examination were independent risk factors of incomplete SBCE for inpatients.Conclusion1.The incomplete rate of SBCE examination for inpatients is 10.6%.2.ASA score ? 3 points,history of intestinal obstruction,anemia status before SBCE examination are independent risk factors for incomplete SBCE in hospitalizedpatients.3.This study recommends that hospitalized patients with the above-mentioned risk factors should be given certain interventions before SBCE examination to improve the complete rate of SBCE procedure for "high-risk" inpatients.