Response:

Abstract

I appreciate the comments by Dray et al regarding video capsule endoscopy (VCE) for the diagnosis of small-bowel polyps in patients with familial adenomatous polyposis (FAP), and I agree that such patients rarely develop cancers in regions of the small intestine other than the duodenum and terminal ileum, specifically the ileal pouch. Therefore, regular surveillance of the small intestine beyond EGD, including the use of a side-viewing duodenoscope and limited ileoscopy, are not generally recommended.1Burt R.W. Colon cancer screening.Gastroenterology. 2000; 119: 837-853Abstract Full Text Full Text PDF PubMed Scopus (318) Google ScholarThe major implication from my study is that VCE clearly cannot substitute for standard endoscopy as a surveillance method for polyps in the duodenum and ileum, but it can detect polyps throughout the small intestine. As Dray et al infer, this last conclusion has dubious applicability to the FAP population. In my article, I likewise acknowledge the questionable clinical impact of VCE on small-bowel surveillance in FAP. However, I believe my results are applicable to other polyposis disorders in which small intestinal surveillance is recommended, such as Peutz-Jeghers syndrome (PJS).1Burt R.W. Colon cancer screening.Gastroenterology. 2000; 119: 837-853Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar Only a few VCE studies have included patients with PJS, likely because of the rarity of this disorder.2Caspari R. von Falkenhausen M. Krautmacher C. et al.Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers' syndrome.Endoscopy. 2004; 36: 1054-1059Crossref PubMed Scopus (196) Google Scholar, 3Soares J. Lopes L. Vilas Boas G. et al.Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives.Endoscopy. 2004; 36: 1060-1066Crossref PubMed Scopus (100) Google Scholar, 4Brown G. Fraser C. Schofield G. et al.Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps.Endoscopy. 2006; 38: 385-390Crossref PubMed Scopus (91) Google Scholar, 5Schulmann K. Hollerbach S. Kraus K. et al.Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.Am J Gastroenterol. 2005; 100: 27-37Crossref PubMed Scopus (216) Google Scholar Therefore, VCE may serve an adjunctive role, and a comparative trial with double-balloon enteroscopy would be helpful to clarify their utility. I appreciate the comments by Dray et al regarding video capsule endoscopy (VCE) for the diagnosis of small-bowel polyps in patients with familial adenomatous polyposis (FAP), and I agree that such patients rarely develop cancers in regions of the small intestine other than the duodenum and terminal ileum, specifically the ileal pouch. Therefore, regular surveillance of the small intestine beyond EGD, including the use of a side-viewing duodenoscope and limited ileoscopy, are not generally recommended.1Burt R.W. Colon cancer screening.Gastroenterology. 2000; 119: 837-853Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar The major implication from my study is that VCE clearly cannot substitute for standard endoscopy as a surveillance method for polyps in the duodenum and ileum, but it can detect polyps throughout the small intestine. As Dray et al infer, this last conclusion has dubious applicability to the FAP population. In my article, I likewise acknowledge the questionable clinical impact of VCE on small-bowel surveillance in FAP. However, I believe my results are applicable to other polyposis disorders in which small intestinal surveillance is recommended, such as Peutz-Jeghers syndrome (PJS).1Burt R.W. Colon cancer screening.Gastroenterology. 2000; 119: 837-853Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar Only a few VCE studies have included patients with PJS, likely because of the rarity of this disorder.2Caspari R. von Falkenhausen M. Krautmacher C. et al.Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers' syndrome.Endoscopy. 2004; 36: 1054-1059Crossref PubMed Scopus (196) Google Scholar, 3Soares J. Lopes L. Vilas Boas G. et al.Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives.Endoscopy. 2004; 36: 1060-1066Crossref PubMed Scopus (100) Google Scholar, 4Brown G. Fraser C. Schofield G. et al.Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps.Endoscopy. 2006; 38: 385-390Crossref PubMed Scopus (91) Google Scholar, 5Schulmann K. Hollerbach S. Kraus K. et al.Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.Am J Gastroenterol. 2005; 100: 27-37Crossref PubMed Scopus (216) Google Scholar Therefore, VCE may serve an adjunctive role, and a comparative trial with double-balloon enteroscopy would be helpful to clarify their utility. Is there any need for video capsule endoscopy evaluation in postduodenal small-bowel polyps detection in familial adenomatous polyposis?Gastrointestinal EndoscopyVol. 66Issue 3PreviewTo the Editor: Full-Text PDF