Accuracy of Capsule Endoscopy to Determine the Lesion Location and Route of Insertion for Enteroscopy in the Evaluation of Small Bowel Disease

Abstract

Introduction: To evaluate the accuracy of the CE progress indicator in determining correct therapeutic procedure. Methods: A retrospective chart review was performed on 106 patients who underwent consecutive CE and endoscopy (EGD, colonoscopy, push enteroscopy, antegrade balloon enteroscopy, or retrograde balloon enteroscopy) between January 2004 and October 2013. Lesion location by CE was assessed based on the “progress indicator” (PI) provided by Given Imaging, Inc. Rapid 6® software. The location of the lesion by endoscopy was determined from endoscopy reports. The 2 methods were compared for level of discrepancy or agreement in the location of the lesion. Exclusion criteria included normal capsule endoscopy, failure of capsule to reach the cecum, or failure of the patient to undergo recommended therapeutic intervention. Results: Thirty-nine patients met criteria to be involved in the study. Out of the 39 positive capsule studies, 27 lesions were successfully identified on endoscopy (69% yield). After reviewing the CE, 9 patients underwent EGD, 22 patients underwent antegrade enteroscopy, 2 underwent retrograde enteroscopy, 4 patients underwent push enteroscopy, and 1 patient underwent EUS. Lesions referred for EGD were between 0-5% on the PI with a 78% positive yield (7 out of 9 procedures). Lesions referred for push enteroscopy were between 0-15% on the PI with 50% positive yield (2 out of 4 procedures). Lesions referred for antegrade enteroscopy were between 0-99% on the PI with a 73% positive yield (16 out of 22 procedures). Lesions referred for retrograde enteroscopy were greater than 81% on the PI with a 50% positive yield (1 out of 2 procedures). Lesion referred for EUS was 1% on the PI with a 100% yield. Conclusion: CE progress indicator may be used to guide the selection of enteroscopy approach. EGD, PE, antegrade SBE, retrograde SBE are optimal when abnormalities on CE are seen at ≤5%, ≤13%, ≤99% and ≥85% on the PI, respectively.