Factors That Affect Complete Small Bowel Transit of Capsule Endoscope

Factors That Affect Complete Small Bowel Transit of Capsule Endoscope Hoon Jai Chun, Yong Sik Kim, Kyung Jo Kim, Young-Ho Kim, Tae Il Kim, Jae Hyuk Do, Ji Kon Ryu, Jeong Seop Moon, Soo-Heon Park, Cheol Hee Park, Ki-Nam Shim, Kee Myung Lee, In Seok Lee, In Seop Jung, Myung Gyu Choi Background/Aims: Capsule endoscopy (CE) is a new method of investigating entire small bowel (SB). Some reported that current battery time was sufficient for observing entire SB, but others reported negatively. The aims of this study were to know the complete SB transit rate of CE and determine the factors affect the entire SB transit of CE in Koreans by multi-center study. Methods: 482 cases of CE performed in 7 institutions in Korea (Korea Gut Image Study Group) from Sep. 2002 to Jul. 2004 were retrospectively reviewed. 54 cases were excluded due to anatomical abnormality or endoscopic assistance. 428 cases were devided into complete and incomplete SB transit groups according to getting ileocecal valve image. Multiple logistic regression analysis was used to identify influencing factors. Results: The complete SB transit rate was 67% and mean battery time was 7 1/2 hrs. Age (p ! 0.05, OR Z 1.028), patient position after capsule ingestion (p ! 0.05, OR Z 4.900), crohn’s disease (p ! 0.05, OR Z 6.122), gastric transit time (p ! 0.05, OR Z 1.102), battery time (p ! 0.05, OR Z 0.989), are related to complete SB transition. Other factors including sex, underlying disease, patient’s activity, bowel preparation method and ingestion of prokinetics have no correlation with complete SB transition. Mean small bowel transit time in complete SB transit group was 4 1/2 hrs and ranged from 44 to 514 min. In incomplete SB transit group (141 cases), 5 cases were reached to stomach, 4 cases to proximal jejunum, 10 cases to distal jejunum, 24 cases to proximal ileum, and the other 98 cases to distal ileum. Conclusions: Complete SB transit rate of CE in Koreans was 67% under current battery time. Age, patient position after capsule ingestion, crohn’s disease, gastric emptying time and battery time were the significant factor influencing complete SB transit of CE. M1355 Risk Score and Predictive Models of Mortality From Non Variceal Acute Upper Gastrointestinal Haemorrhage in Italy: A National Survey Riccardo Marmo, Maurizio Koch, Livio Cipolletta, Lucio Capurso, Mariano Amuso, Alfredo Pastorelli, Elena Sanz Torre, Omero Triossi, Andrea Buzzi, Renzo Cestari, Domenico Della Casa, Massimo Proietti, Anna Tanzilli, Giovanni Aragona, Francescoo Giangregorio, Leonardo Allegretta, Salavatore Tronci, Paolo Michetti, Paola Romagnoli, Andrea Nucci, Francesca Rogai, Morena Tebaldi, Fabrizio Bonfante, Giorgio Chiozzini, Lisa Gerardi, Alessandro Casadei, Claudio Cortini, Claudio Leoci, Gianpiero Bagnalasta, Mario Salvagnini, Mario Gatto Mortality associated with acute upper gastrointestinal bleeding is described high despite advances in diagnosis and therapy but, at our knowledge, study on the recent epidemiology, of acute upper gastrointestinal haemorrhage, on PPI epoch, are few Endoscopic and more recent pharmacologic treatment has recently been shown to reduce rebleeding rates and perhaps mortality. These advances in therapy are becoming more widely adopted and may influence the outcomes of patients with upper gastro intestinal bleeding (UGIB). Aim of the study was 1) verify the mortality rate of patients with UGIB in a nationwide survey, 2) evaluate the treatment role on the outcomes considered, 3) provide a predictive model of mortality taking in account also the therapeutic role. The data presented were collected over 12 months as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. From march 2003 to march 2004 a population based, unselected, multicentre, prospective survey, with 175 items, was conducted from 23 hospitals receiving emergency admissions in various regions equally distributed. 1175 cases of acute upper gastrointestinal haemorrhage ,in which patients aged from 10 to 99 years old, were identified. Results: the mean age was 67,03G 15,76 SD range 10-99, males account for 62% of the serie. Non variceal bleeding (NVB) is the main cause of bleeding in 86,8% (1020 patients). The main co-morbities was hypertension 29.3% and neoplasia was present in 7.8%; Endoscopic treatment was not done in 523 (51.3%); when employed, the more frequent was injection with adrenaline solution 319 (64.2%). After endoscopy the main used pharmacological treatment was proton pump inhibitors 76.7%, while H2 antagonists used in. 3.9% Overall mortality rate was 4,5%. Of the 175 items analyzed, 14 give independent gain in the mortality predictive model: ASA class, time to recovery, age, blood pressure, cardiac frequency, haemoglobin value, neoplasia, renal failure, cirrhosis, hematemesis, blood in gastric lumen, active bleeding, endoscopic treatment failure, and rebleeding. The area under the Roc curve give a .847 value that is one of the most relevant predictive model proposed. Conlusion mortality rate from UGIB in Italy is not so high but rise with age and comorbities. The challenge is to identify those patients who have most high risk for death so that their treatment and survelliance can be optimized. Various risk.