Findings in Endoscopically Deployed Small Bowel Wireless Capsule Endoscopy

Abstract

Purpose: Wireless Capsule Endoscopy (WCE) fails to reach the cecum within the 8 hour battery life in 20 to 25% of patients, resulting in incomplete examination of the small bowel. Endoscopic placement of WCE directly into the proximal small bowel has been employed to improve complete examination rates (CER) by eliminating gastric transit time (GTT), but is a largely uninvestigated technique. Endoscopic placement of WCE directly into the small bowel (SB) with Roth Net® (US Endoscopy) or AdvanCE® (US Endoscopy) has been shown to be safe and effective in patients with dysphagia, gastroparesis, and/or abnormal upper-GI anatomy. The aim of this study is to compare the CER of WCE deployed by Roth Net and AdvanCE directly into the proximal small bowel in a select patient population to that of traditional peroral natural delivery. Methods: WCE studies performed on 790 patients were retrospectively analyzed and outcomes data including method of capsule delivery, CER, GTT, and small bowel transit time (SBTT) were evaluated. Results: WCE was deployed directly into the proximal small bowel in 56 (7.1%) patients, 40 (5.1%) with the AdvanCE delivery device and 16 (2.0%) with Roth Net. Four (7.1%) of these patients had prior incomplete WCE examinations, and 52 (92.9%) patients had contraindications to capsule ingestion or known risk factors for incomplete examination. The remaining 734 (93.9%) capsules were administered via the traditional peroral route followed by natural delivery into the small bowel. Forty-four of the 56 (78.6%) capsules delivered endoscopically reached the cecum, including three of the four (75%) patients with prior incomplete WCE examinations, compared to 584 of the 734 (79.4%) traditionally administered capsules, p=0.86. Mean WCE GTT in the peroral group was 44 minutes. Nineteen of the 790 (2.4%) ingested capsules failed to exit the stomach after 8 hours. In studies where WCE reached the cecum, SBTT was 263 minutes in the endoscopially placed group and 219 minutes in the peroral group (p=0.0003). No adverse outcomes related to WCE were observed. Conclusion: Endoscopic delivery of WCE directly into the proximal small bowel in a select patient population did not result in significantly different complete examination rates over peroral delivery despite significantly slower SBTT. In patients with contraindications to capsule ingestion or those at risk for incomplete examination by traditional techniques, delivery of WCE into the proximal small bowel appears to be safe and results in similar CER. Larger, prospective studies would be useful to determine whether endoscopic delivery increases CER in a matched population. Disclosure: Dr Albers-Speaker's Bureau, Given Imaging, Paid to do national webex educational program × 2 in 2008.