Small bowel capsule endoscopy: Indications, results, and clinical benefit in a University environment

Juliane Flemming, Silke Cameron, Juliane Flemming, Silke Cameron

Abstract

Capsule endoscopy (CE) opened a new method for visualization of the small intestine. We here further explore its clinical implications.We retrospectively analyzed the clinical benefit of CE in view of medical history, diagnostics, and therapy. Our patient collective consisted of 203 patients. CE was investigated in the context of bleeding, anemia, abdominal pain, diarrhea, Crohn's disease, and suspected tumors.The study collective consisted of 118 male and 85 female patients with a mean age of 58 years (range 8-90 years). Complete bowel transit took place in 82% of the patients. The diagnostic yield in the detection of obscure gastrointestinal bleeding was 80% and for anemia 78%. Mucosal lesions were the most common finding (43%). Unclear abdominal pain had the lowest diagnostic yield (41%). Ensuing therapeutic interventions were mostly medical (66%), and to a minor extent surgical (4.4%) as well as endoscopic (4%).In conclusion, small intestinal CE is a secure method to clarify small intestinal diseases, especially obscure gastrointestinal bleeding, even in pre-operated patients without stenosis symptoms. Our study emphasizes in a collective of patients with extensive prior diagnostics that due to CE therapeutic measures resulted in 73%.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Schematic structure of the capsule, (B) capsule endoscopy in the small bowel. The figure has been modified from[12,13].
Figure 2
Figure 2
Capsule retention and endoscopic recovery. (A) Capsule image of the lesions in Crohn's disease affecting the terminal ileum/ileocoecal valve, (B) X-ray depicting the capsule within the ileal region, (C) ultrasound image with visualization of thickened ileal wall, (D) prominent ileocoecal valve with small opening to the terminal ileum, (E) endoscopic image of the terminal ileum, (F) capsule recovery with polypectomy snare.
Figure 3
Figure 3
(A) CE images of normal small bowel, (B) NSAID-associated ulcerations limited to the small intestine, (C) ulcerations in a patient with Crohn's disease, (D) small bowel bleeding, (E) lymphangiectasia, (F) polyps in familial adenomatous polyposis syndrome. Modified from[13].

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