First Study Involving Simultaneous Ingestion of Two Video Capsules (VCs): A Comparison of Olympus VC and Given Imaging VC in the Detection of Obscure GI Bleeding (OGIB)

Abstract

First Study Involving Simultaneous Ingestion of Two Video Capsules (VCs): A Comparison of Olympus VC and Given Imaging VC in the Detection of Obscure GI Bleeding (OGIB) David Cave, David E. Fleischer, Russell Heigh, Jonathan Leighton, Virender Sharma, Patricia Hibberd, Danette Musil, Jennifer Langelier, Doug Faigel Background: Video capsule (VC) endoscopy has been a valuable method for detecting small intestinal (SI) causes of OGIB. To date only one commercial product has been available. Methods: This study is the first to compare a new device, the EndoCapsule VC (Olympus Corporation), with the original PillcamSB (Given Imaging) in patients with OGIB. The devices were compared in the same patient on the same day. The order of ingestion was randomized and the VCs were swallowed 40 minutes apart after bowel preparation and fasting. Devices were of similar size and images taken at 2 frames/sec. Each device had a separate sensor array and recording device. Battery life was w8 hrs for each. Patients all had negative upper and lower endoscopies, and had either been transfused or had a 25% reduction in Hct. The study was performed at 2 sites. Initially a Given VC was read locally by one investigator for clinical management. Coded data disks were read by blinded investigators and compared. Results: 20 patients [11 males; 9 females; average age 71.9 years] ingested both VCs; had no technical difficulties; and had complete exams of the SI. Mean Hct Z 23.4% (range 16-29%). Abnormalities of the SI thought to explain the bleeding were seen in 13 cases with the Olympus VC and in 15 cases with the Given VC. An adjudication panel is studying cases in which there were differences in diagnosis. Both capsules were recovered by the patient in 90% of cases. The 4 other capsules were identified by the patients but not recovered. No complications occurred. Unique observations were made possible by simultaneous ingestion of the 2 different VCs: (1) Because the 2 capsules transmit at different frequencies, there was no electrical interference or cross-talk; (2) Despite a difference in ingestion time of 40 mins, one capsule was seen by other in 13/20 patients; (3) VCs ‘‘tumble’’ and do not advance thru SI without ‘‘rotating’’; and (4) In three cases, active bleeding was seen by one VC but not the other, implying that OGIB may be intermittent, and possibly accounting for differences in yield when VCs are used for diagnosis of OGIB. Conclusions: (1) Both devices provided excellent images of the SI mucosa and were valuable in diagnosing causes of OGIB; (2) Simultaneous transmission from the 2 VCs was possible without electrical interference; (3) For the first time the intermittent nature of SI GI bleeding was observed and the travel of a capsule thru the SI was seen.