Sa1540 Spirus Enteroscopy Using Capsule Location Index for Achieving High Diagnostic and Therapeutic Yield

Sa1540 Spirus Enteroscopy Using Capsule Location Index for Achieving High Diagnostic and Therapeutic Yield Rohan H. Mandaliya*, Jason Korenblit, Brendan O’Hare, Anastasia Shnitser, Ramu Kedika, Rebecca Matro, Dina Halegoua, Anthony Infantolino, Mitchell Conn Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA; Internal Medicine, Abington Memorial Hospital, Abington, PA Background: SE (Spirus Enteroscopy) is a new small bowel endoscopic technique which allows deep intubation of the small bowel. Our institution has one of the largest experiences with this technique. Aim: To review the diagnostic and therapeutic yield, and safety of SE; and the predictive role of prior CE (Capsule Endoscopy) at a large academic center. Methods: A retrospective review of patients undergoing SE after prior CE between 2008-2013 was performed. A capsule location index (CLI) was defined as the fraction of total small bowel transit time when the lesion was found on CE. Statistical analysis was performed using Chi-Square and Fisher’s test. Results: A total of 174 SE were available for analysis, antegrade (147) and retrograde (27). Mean age of patients was 66 years. 94(54%) were men and 81(46%) were women. Indications of SE included obscure GI bleeding (141, 81%), diarrhea (11), abdominal pain (13), small bowel obstruction (5), and 1 each for retained foreign body and endocapsule, FAP and Puetz Jeghers syndrome. Abnormalities on SE were detected in 61% of the patients. The most common findings were vascular ectasias (VE) (60, 34%). Abnormalities were located in jejunum (55%), ileum (26%) and duodenum (19%). Therapy was performed in (110, 63%) patients, including APC (66), biopsy (53), endoclip (20), polypectomy (7), dilatation of stricture (2) and retrieval of an endocapsule (1). Procedure was safe in patients who had prior gastric roux-en-Y bypass (nZ6) and entero-enteral anastomosis (nZ5). Procedure related trauma occurred in 4 patients, esophageal mucosal tear with successful placement of clip (3) and a transient intusucception (1). 137 (79%) had prior capsule studies available to review. 131 were positive and 6 were negative. Of the 131 positive CE, corresponding lesions were detected by SE in 81 patients, with a yield of 62%. 115 of 131 positive capsule studies were complete to calculate CLI. Positive antegrade SE had a mean CLI of 0.22 (range 0.0-0.76) compared to 0.40 (range 0.0-0.86) for negative antegrade SE. There was a significant difference in the diagnostic yield with CLI cut off of 0.30 (81%(57/70) when CLI!0.30 vs. 35%(18/51) when CLIOZ0.30, p!0.0001). Mean CLI was 0.88 for positive retrograde SE and 0.76 negative retrograde SE. The best CLI cut off was 0.84 with the diagnostic yield of 75%(6/8) when CLIOZ0.84 vs. 25%(2/8) when CLI!0.84, pZ0.06. A CLI range of 0.60-0.75 had the lowest yield (15%, 2/13) by either approaches. (9 antegrade and 4 retrograde) VE seen on CE was detected in 83% patients on SE; highest yield compared to other findings, p!0.01. Conclusions: 1. Spirus enteroscopy is safe with a high diagnostic and therapeutic yield. 2. CLI is predictive of the success of SE and determines the best route of SE. 3. Lesions with a location index in the range of 0.600.75 have the least likelihood of detection by either approach. Findings on Spirus Enteroscopy Findings on Spirus Enteroscopy www.giejournal.org Number of Patients (n) VE (Vascular Ectasia) nZ60