Capsule Endoscopy and Small Intestine Ulceration: What Exactly Does It Mean?

Abstract

Purpose: Small bowel capsule endoscopy (CE) is the gold standard for non invasively assessing the small intestinal mucosa. Not infrequently, however, findings such as ulceration is noted where the differential diagnosis may be wide and the findings non-specific. In this study we review our experience in patients with small bowel ulceration on their CE in an effort to better determine the etiology and management strategies. Methods: Of 1050 total capsules performed between 10/01-04/11, 111 patients (mean follow up 39 months) were deteremined to have single or multiple small bowel ulceration. Only those patients with the specific finding of small bowel ulceration were selected for further analysis. Their history, findings and outcomes in regards to these ‘ulcerations' were then assessed. Results: 111 patients (61 male, 52 +/- 19 years old) subsequently found to have small bowel ulceration on CE were determined to have been referred for the following indications: obscure gastrointestinal bleeding (58%), abdominal pain (12%), iron deficiency anemia (11%), abnormal radiological findings (4.5%), diarrhea (4.5%), inflammatory bowel disease (IBD) (1%), and “other” indications (9%). Of the 111 patients with ulcerative disease noted on capsule study, 66 (59%) were thought to be related to IBD, 10 (9 %) related to NSAIDs, 3 (3%) celiac disease, 5 (4%) ischemic, 4 (4%) vascular lesions and 3 (3%) were related to malignant lesions. Peptic ulcer disease in distal duodenum was found in 3 (3%) of cases. In 17 (15%) of the cases there was no specific diagnosis made based on the capsule findings and follow up. Ancillary findings included active bleeding (14%), angiodysplasias (9%), strictures (5%) and diverticula (2%). Capsule retention occurred in 2 cases and was managed by surgery. Follow up (mean 39 months) was performed to ensure long term accuracy of diagnosis. Conclusion: In our patient population undergoing CE the most common cause of small bowel ulceration was IBD followed by NSAIDs use. When small bowel ulceration is seen and the etiology is unclear, a careful history can elucidate the most likely etiology and subsequently guide further management. A significant portion of these patients (15%) seem to do well despite these ulcerations and have no specific diagnosis. Disclosure: Dr. Robert Enns: Speaker/Consultant- AstraZeneca, Merck, Nycomed, Abbott, Olympus.