A RETROSPECTIVE REVIEW OF CAPSULE ENTEROSCOPY AT ONE TERTIARY CARE INSTITUTION

Abstract

Purpose: Capsule Enteroscopy (CE) is increasingly being utilized to diagnostically evaluate the small bowel but its efficacy is not completely well established. Methods: We reviewed the records of 100 patients who underwent CE and studied various parameters including demographics, indications, previous investigations, findings, recommendations, and complications. Results: Our patient population was 51% male and 49% female. The average age was 61 years (17–91). The weight range was 50–140 kg. Elevated BMI did not hinder any CE performance. The indications for the procedure were overt bleeding (47%), iron deficiency anemia with or without guaiac positive stool (41%), IBD (3%), and suspected small bowel tumor (9%). Investigations prior to CE included EGD (92%), colonoscopy (99%), push enteroscopy (41%), and SBFT (49%). Overall 85% of the CE's had an adequate preparation to allow necessary interpretation. The average gastric emptying time was 33 minutes and the average small bowel transit time was 221 minutes. There were 40 normal and 60 abnormal studies. After CE, 51% were suggested to have further endoscopic evaluation (76% were enteroscopies −8% of which were intraoperative). Of the 60 abnormal studies 42 revealed AVMs (6 actively bleeding and 36 non-bleeding), 11 polyps/tumors, 3 ulcers and 2 strictures. 67% of the patients with AVMs did not have prior endoscopy revealing AVMs. These AVM's were found in 49% of patients with overt bleeding, 41% with IDA and 17% incidentally in the remaining indications. 55% of studies done to evaluate for tumors/polyps were positive, while 2 were found in work-up of IDA. 80% of SBFT done prior to CE were reported as normal. Of these, 51% had abnormal findings on CE the most common of which are AVMs and polyps. 87% of the studies reached the cecum upon termination of the capsule's battery. Of the remaining 13 studies 69% had delayed transit. Laparotomy confirmed 2 small bowel masses (although the capsules passed spontaneously). Previously non-detected strictures resulted in 2 capsule impactions. One capsule was endoscopically retrieved, while the other required laparotomy. No patients had any acute obstructive symptoms. Conclusions: This study provides useful information regarding safety and utility of CE. In our population, 60% of patients were found to have some abnormality on capsule. Angiodysplasias were the most common cause of blood loss found. Our complication rate was 2%, but with no acute obstructions. In our experience, CE is more clinically useful than SBFT in evaluating the small bowel.