Randomized Study to Diagnose Small Bowel Pathology Using Paired Capsule Endoscopy with Two Different Devices

Abstract

Background: Capsule endoscopy is widely used as a diagnostic procedure in the evaluation of obscure gastrointestinal bleeding. In the past, only one capsule endoscope was commercially available (Pillcam SB, GivenImaging). Olympus Medical Systems has recently developed a capsule endoscope (EndoCapsule) that uses different technology and produces higher resolution images. The primary aim of the study is to compare the diagnostic yield of the two different capsule endoscopes. Patients and Mehtods: Patients with signs of gastrointestinal bleeding and negative upper endoscopy and colonoscopy were included in the study. After written informed consent, the patients were randomized to have two capsule endoscopies using different capsule endoscopes (Given Pillcam SB and Olympus EndoCapsule) in random order. The time intervall between the end of the first capsule examination and the start of the bowel preparation for the second procedure was at least one day. Results: 26 patients (10 women, 16 men; mean age 67.2 ± 10.5 years) with obscure gastrointestinal bleeding were included in the study. All capsule examinations were carried out without any complications. All Olympus Endocapsules reached the colon within the available mean recording time of 593 ± 62 minutes. In contrast, 5/26 Given capsules did not pass the ileocecal valve during the recording time (475 ± 92 minutes). With the Olympus device a bleeding source in the small bowel was detected in 16 patients (angiodysplasia n = 14, multiple ulcera n = 1, acitve bleeding n = 1) compared to 12 patients (angiodysplasia n = 11, active bleeding n = 1) using the Given device. In 3 out of the 4 patients with a definitive bleeding source seen by the Olympus capsule and not by the Given Capsule, in case when the Given Pillcam did not reach the cecum. Conclusion: In this study the Olympus Endoscapsule detected more bleeding sources in patients with obscure gastrointestinal bleeding than the Given Pillcam SB. A possible reason ist the longer recording time of the Olympus Endocapsule due to the optimized battery power with a longer recording time.