S3043 Inpatient Video Capsule Endoscopy: Why the Incomplete Rates?

Introduction: Incomplete bowel transit after video capsule endoscopy (VCE) placement is a common challenge in patients undergoing small bowel evaluation, especially amongst hospitalized patients. Our aims were to compare VCE completion rates between patients who underwent VCE as inpatients vs outpatients and identify patient related risk factors associated with incomplete studies. Methods: This was a single center, retrospective study of patients who underwent small bowel VCE at a tertiary referral center between 1/2022 and 6/2024. Baseline patient characteristics including demographics and medical history were collected. Details of capsule placement and recordings were also obtained. Continuous variables were summarized as mean (SD) and categorical variables were reported as frequency (%). Continuous variables were compared using independent t-test and categorical variables were compared using Chi-square test. Comparisons between inpatient and outpatient groups and then between complete vs incomplete studies were performed. Analysis was performed using SPSS-29 and P-values <0.05 were considered statistically significant. Results: A total of 128 patients undergoing VCE were included: 63 inpatients and 65 outpatients. Both groups were comparable in terms of age, sex, BMI, ethnicity, and comorbid conditions. More outpatients were on GLP1 receptor agonists (RA) compared to inpatients (13.8% vs 1.6%, P = 0.02). VCEs performed in the inpatient setting were more likely to be incomplete compared to outpatients (39.7% vs 12.3%, P < 0.001). Mean gastric transit time was longer for inpatients compared to outpatients (126.1 min ± SD 107.9) vs 39.1 min ± SD 49.2, P = 0.03). Conclusion: Inpatients have prolonged gastric transit times compared with outpatients which is associated with an increased rate of incomplete studies. This is despite more outpatients being on GLP1 RA. One strategy to consider for increasing completion rates is to administer 12-hour capsules for all inpatients and encourage ambulation when possible. Another approach would be to implement a standardized protocol where the capsule location is assessed early after capsule ingestion to ensure it has left the stomach. Future studies including a larger sample size are needed to understand additional characteristics associated with incomplete inpatient VCE studies.