Diagnostic Yield Of Capsule Endoscopy Research Articles

A Prospective Multicenter Blinded Cohort Study Comparing Diagnostic Yield of Capsule Endoscopy (CE) Prior to Ileocolonoscopy (IC) Compared to Small Bowel Follow Through (SBFT) Prior to IC in Patients With Suspected Crohn's Disease (CD)

A Prospective Multicenter Blinded Cohort Study Comparing Diagnostic Yield of Capsule Endoscopy (CE) Prior to Ileocolonoscopy (IC) Compared to Small Bowel Follow Through (SBFT) Prior to IC in Patients With Suspected Crohn's Disease (CD)

A New and Improved Version of a Novel Algorithm of Automatic Lesion Detection and Its Impact on the Diagnostic Yield of Capsule Endoscopy in Patients With Small Bowel Gastrointestinal Bleeding

A New and Improved Version of a Novel Algorithm of Automatic Lesion Detection and Its Impact on the Diagnostic Yield of Capsule Endoscopy in Patients With Small Bowel Gastrointestinal Bleeding

Capsule endoscopy and double balloon enteroscopy for obscure gastrointestinal bleeding: Which is better?

See article in J. Gastroenterol. Hepatol. 2011; 26: 796–801.

Tu1591 Sensitivity Specificity and Diagnostic Yield of Capsule Endoscopy in Patients Undergoing Subsequent Double Balloon Enteroscopy

Tu1591 Sensitivity Specificity and Diagnostic Yield of Capsule Endoscopy in Patients Undergoing Subsequent Double Balloon Enteroscopy

302 Diagnostic Yield of Capsule Endoscopy vs. Colonoscopy in Patients With Melena and a Negative EGD

EGD is the first step in the evaluation of patients with melena. Although colonoscopy has traditionally been the next test in patients without a bleeding source on EGD, video capsule endoscopy (VCE) is being used with increasing frequency.

Can Capsule Endoscopy Be Used as a Diagnostic Tool in the Evaluation of Nonbleeding Indications in Daily Clinical Practice? A Prospective Study

Objective: To evaluate the diagnostic yield of capsule endoscopy (CE) and its impact on treatment and outcome in patients without bleeding indications. Subjects and Methods: One hundred and sixty-five nonbleeding patients were enrolled in the study. The most common indications for CE were chronic abdominal pain alone (33 patients) or combined with chronic diarrhea (31 patients) and chronic diarrhea alone (30 patients). Among the 165 patients, 129 underwent CE for evaluation of gastrointestinal symptoms and 36 for surveillance or disease staging. Results: CE findings were positive, suspicious and negative in 73 (44.2%), 13 (7.9%) and 79 (47.9%) of cases, respectively. The diagnostic yield was highest in patients with refractory celiac disease (10/10, 100%) and suspected Crohn’s disease (5/6, 83.3%), followed by patients with chronic abdominal pain and chronic diarrhea (13/31, 41.9%), established Crohn’s disease (2/6, 33.3%), chronic diarrhea alone (8/30, 26.7%), chronic abdominal pain alone (8/33, 24.2%) and other indications (3/13, 23.1%) (p < 0.005). The CE findings led to a change of medication in 74 (47.7%) patients, surgery in 15 (9.7%), administration of a strict gluten-free or other special diet in 13 (8.4%) and had other consequences in 11 (6.7%). Management was not modified in 42 (27.1%) patients. Among symptomatic patients (n = 129), 29 (22.5%) were lost to follow-up. The remaining 100 patients were followed up for 8.7 ± 4.0 months (range 2–19). Among the latter, resolution or improvement of symptoms was observed in 86 (86%) patients, no change in 11 (11%) and 3 (3%) died. All 86 patients who experienced resolution or improvement of their symptoms had a modification of their management after CE; only 7/11 patients whose symptoms did not change (63.6%) and 2/3 patients who died (66.7%) had a modification of management (p < 0.001). Conclusions: CE appears to be a useful tool in the evaluation of patients with nonbleeding indications. The outcome of most patients with negative findings was excellent.

Negative capsule endoscopy for obscure gastrointestinal bleeding is closely associated with the use of low-dose aspirin

Objective. Capsule endoscopy (CE) is used widely for determining the cause of obscure gastrointestinal bleeding (OGIB). However, negative findings still arise from CE examination. The aim of this study was to determine the factors associated with negative findings on CE in patients with OGIB. Material and methods. A total of 134 patients who underwent CE for overt (n = 104) or occult (n = 30) OGIB between October 2007 and April 2010 were included. The clinical backgrounds of the patients (age; sex; the use of anti-coagulant, anti-platelet drugs or NSAIDs; comorbidity and the timing of CE examination after bleeding) were noted. Results. The overall diagnostic yield of CE in detecting the relevant findings was 50% (n = 67). Multivariate analysis revealed that the use of anti-platelet drug and the timing of CE (≥16 days) were predictive factors for negative findings on CE (odds ratio 2.69 [1.01–7.21], p = 0.048 and odds ratio 2.32 [1.01–5.33], p = 0.047, respectively). Among the patients with the use of low-dose aspirin (LDA, n = 28) as anti-platelet drug, cessation of it before CE was the only predictive factor for negative findings on CE (odds ratio 12.0 [1.72–83.5], p = 0.012). Conclusion. In the patients with OGIB, the use of LDA and the cessation of it before CE made it difficult to detect the cause of bleeding by CE. This might indicate that the source of OGIB related to LDA heals immediately after cessation of the drugs or is a very small lesion that could not be detected by CE.

Diagnostic Yield and Clinical Impact of Capsule Endoscopy in Obscure Gastrointestinal Bleeding during Routine Clinical Practice: A Single-Center Experience

Objective: This study assessed the diagnostic yield of capsule endoscopy (CE) and its impact on patients with obscure gastrointestinal bleeding (OGIB). Subjects and Methods: Between May 2007 and May 2009, 63 patients with OGIB (overt bleeding: 25, and occult blood loss with chronic ferropenic anemia: 38) and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic tests, CE findings, therapeutic interventions, medical treatment and clinical outcomes following CE were evaluated. Results: The overall diagnostic yield was 44.44% of patients and included findings of angiectasia in 11 (17.46%) patients, nonsteroidal anti-inflammatory drugs enteropathy in 6 (9.52%) patients, celiac disease in 3 (4.76%) patients, tumors in 2 (3.17%) patients, and a variety of other diagnoses ranging from varices to ulcers (due to congenital afibrinogenemia and amyloidosis). The diagnostic yield was notably higher in overt bleeders (15/25, 60%) compared to occult bleeders (13/38, 34.21%; p = 0.044), and in patients with overt bleeding who had CE within the first 10 days (14/16, 87.5%) after the bleeding episode in comparison to overt bleeders who underwent CE >10 days after the bleeding episode (2/16, 11.1%; p < 0.0001). During follow-up (11.8 ± 7 months), CE findings led to specific therapy that resolved the underlying disease or improved the clinical condition in 45 of 63 patients, thus having a positive clinical impact of 71.43%. Conclusion: CE has a high diagnostic yield and a positive influence on clinical management in a significant proportion of patients with OGIB. These data further support the role of CE in routine clinical practice.

Capsule endoscopy performed across the pediatric age range: indications, incomplete studies, and utility in management of inflammatory bowel disease

Capsule endoscopy (CE) is used increasingly to evaluate the small bowel in children. An upper GI series is recommended before CE to evaluate the risk of obstruction. Despite normal findings on an upper GI series, CE may still be incomplete. Although large adult studies have demonstrated the safety and diagnostic yield of CE, similar pediatric studies have not been available. To identify factors associated with incomplete studies and the diagnostic yield in pediatric patients. Retrospective review of consecutive CE studies from February 2005 through June 2008. Large tertiary children's hospital. A total of 123 CE studies in 117 patients; median age 12.9 years (range 0.8-22.4 years). Demographic information, indication, placement technique, pre-CE imaging results, and cecal completion status were recorded. Risk factors were analyzed with bivariate and multivariate regression analysis. There were 27 (22%) incomplete studies; of these, there were normal pre-CE radiologic study findings in 12 (44%), and findings requiring medical, endoscopic, or operative intervention in 6. Of the 117 patients, CE produced a new diagnosis in 21 (18%). Abnormal findings on previous imaging (odds ratio [OR] 3.0; 95% CI, 1.2-8.0), endoscopic placement (OR 3.1; 95% CI, 1.1-8.4), and female sex (OR 3.3; 95% CI, 1.2-9.4) were associated with incomplete studies. Retrospective, incomplete follow-up. CE may be performed in children as small as 11.5 kg, with 18% yield in all studies, and 28% in pediatric known inflammatory bowel disease. Capsule retention requiring retrieval did not pose life-threatening risk in our series, and CE may be used to identify disease-associated small-bowel stenosis.

W1639: Diagnostic Yield of Capsule Endoscopy for Gastric Diseases

Three different types of capsule endoscopy (CE) have been invented, capsule endoscopy for esophagus (Pillcam-ESO), small intestine (Pillcam-SB), and colon (Pillcam-COLON). CE is the least invasive procedure for investigation of the digestive tract, implying that CE should be suitable for mass screening. In Japan, screening endoscopy for gastric cancer is very common among normal asymptomatic subjects, because of the high incidence of gastric cancer. However, capsule endoscopy for the stomach is not available, yet. In the present study, we aimed to recon a baseline diagnostic yield of capsule endoscopy for gastric diseases.

PWE-035 Diagnostic yield of capsule endoscopy in small bowel Crohn's disease: an experience from a district general hospital

Introduction The small bowel is a common site for Crohn9s disease but remains relatively inaccessible endoscopically for the majority of its part. There has been variable success in diagnosing active Crohn9s disease by conventional radiological imaging methods.1 The British Society of Gastroenterology (BSG) guidelines on small bowel capsule endoscopy (CE) recommend that CE should be considered in patients with a high suspicion of small bowel Crohn9s disease undetected by conventional means.2 Methods We carried out a retrospective audit of all patients referred for CE in our hospital between 2005 and 2009 with suspected small bowel Crohn9s disease undetected by conventional means to evaluate the diagnostic yield of CE and its impact on management. Results Small bowel Crohn9s disease was suspected in patients with symptoms of abdominal pain or diarrhoea and weight loss, positive family history of inflammatory bowel disease, extra-intestinal manifestations or investigational findings including iron deficiency anaemia (IDA), raised CRP/ESR or hypoalbuminaemia. All patients presenting with symptoms of abdominal pain had small bowel radiology before proceeding to CE in line with BSG guidelines.4 202 patients underwent CE during the study period of which 34 (16.8%) patients were referred to exclude small bowel Crohn9s disease. 19 (56%) patients were females. A diagnosis of Crohn9s disease was made in 13 (38%) patients on CE based on the findings of erosions, aphthous ulcers etc. 13 (38%) patients had a normal examination, 2 (6%) had NSAID induced ulcers, 1 (3%) was diagnosed with coeliac disease, 1 (3%) had erosive gastropathy, 2 (6%) had discrete aphthous ulcers of query significance and 2 (6%) had limited views due to poor bowel preparation for which a repeat CE examination was requested. CE changed management in 19 (56%) patients and included the following – 12 patients with Crohn9s disease were managed conservatively while one had surgery, NSAIDs were stopped in two, proton pump inhibitor was started in one, gluten free diet was initiated in one and two patients underwent repeat endoscopic examination which excluded Crohn9s disease. Conclusion In our selected cohort, small bowel Crohn9s disease was diagnosed in 38% of patients that was undetectable by conventional means. This figure is slightly lower than that mentioned in the literature (43–71%).3 Other significant diagnoses were obtained in 12% of cases (NSAID induced ulcers, coeliac disease and erosive gastropathy) and were managed conservatively with good outcome.

PTU-013 Do we over estimate the risks of capsule endoscopy in suspected or established small bowel Crohn's disease? A comparison with completion rates and complications observed in the setting of obscure gastrointestinal bleeding

Introduction The advent of capsule endoscopy (CE) has presented new opportunities to assess and manage small bowel (SB) conditions. In obscure GI bleeding (OGIB) CE is the preferred method to examine the SB, with proven safety and efficacy. In Crohn9s disease (CD) its role has been harder to establish in part due to fear of capsule retention. The British Society of Gastroenterology (BSG) guidelines propose radiological studies of the SB in the first instance, reserving CE for those in whom strictures have been excluded and findings are equivocal. However a recent meta-analysis highlighted superior diagnostic yield for CE compared with standard radiological imaging techniques,1 and SB studies are known to lack specificity in terms of excluding strictures.2 Although safety concerns are limiting the use of CE in this field, there is little evidence comparing CE complications in CD with those in established uses of CE such as investigation of OGIB. Methods Individuals with suspected/established CD, or OGIB who had undergone CE following a standard prep regime (1 picolax±10 mg metoclopramide), were identified from a dedicated CE database established in 2006. Suspected CD was defined by the criteria in the BSG guidelines, OGIB by evidence of melaena, haematochezia, or drop in haemoglobin >2 g/dl and positive faecal occult blood test. A retrospective study design was employed. Key demographics were recorded. Studies were considered complete if the capsule was seen to pass into the caecum. Complications were recorded. Rates of completion and complication were compared between the two groups. Results 102 patients were identified. 53 (52%) had suspected/established CD, mean age 39±15 years. 16 (30%) had established CD, and in six of these CE was performed to establish recurrence post resection. 49 (48%) underwent CE for OGIB, mean age 59±13 years. Complete visualisation of the SB was achieved in 94% (50/53) of the CD group and 93% (46/49) of the OGIB group (no statistical difference). Of note completion rates were significantly lower in suspected compared to established CD; 92% (34/37) vs 100% (16/16), (p Conclusion CE is safe in both suspected and established CD with completion rates comparable to that in OGIB. Concerns regarding risk of retention may have been overestimated. Its use in regular clinical practice is likely to increase.

Completion rate and diagnostic yield of small-bowel capsule endoscopy: 1 vs. 2 frames per second

Currently, the default frame rate for capsule endoscopy is usually set at 2 frames per second (fps). We postulated that setting the frame rate at 1 fps for the whole procedure would save battery life and increase the completion rate without compromising the diagnostic yield. The aim of this study was to compare the completion rates and diagnostic yield of capsule endoscopy performed with frame rates of 1 fps and 2 fps. The OMOM capsule endoscopy system was used. The procedure was performed according to the manufacturer's instructions, and the frame rate was set at 1 fps in one group and at 2 fps in the other group for the whole procedure. The completion rate, total operating time, and diagnostic yield in the two groups were measured and compared. A total of 107 patients were randomized to either the 1 fps group (n = 54) or the 2 fps group (control, n = 53). There was no significant difference in sex, age, indications, and gastric transit time between the two groups. The mean total operating time was significantly longer in the 1 fps group than in the 2 fps group (758 +/- 79 minutes vs. 456 +/- 67 minutes, P < 0.001). The completion rate and diagnostic yield were significantly higher in the 1 fps group than in the 2 fps group (96.2 % vs. 70.6 %, P < 0.001; 40.7 % vs. 18.9 %, P = 0.013, respectively). Setting the frame rate of the capsule endoscope at 1 fps for the whole procedure increases the completion rate by prolonging the capsule's total operating time; the diagnostic yield does seem to be at least as high as with 2 fps.

Utilidad de la cápsula endoscópica como método diagnóstico en el estudio de patología de intestino delgado

Wireless capsule endoscopy (CE) is a relatively new method to evaluate the small intestine.To evaluate the indications of CE in our center and assess whether specific indications are associated with best results during CE studies.Retrospective analysis of 69 patients aged 9 to 85 years (36 males) subjected to a CE at our institution between April 2004 and October 2007.The most common indications for CE were overt gastrointestinal bleeding in 43.5% of patients, iron deficiency anemia in 39.1 %, suspicion of a small bowel tumor in 4.3%, chronic diarrhea in 4.3% and abdominal pain in 2.9%. CE was normal in 23.2% and was able to find lesions in 76.8% of the studies. Gastrointestinal bleeding, followed by iron deficiency anemia were the indications associated with the higher rates of positive findings during CE.Gastrointestinal bleeding and iron deficiency anemia were the indications that obtained the best diagnostic yield for CE.

High diagnostic and clinical impact of small-bowel capsule endoscopy in patients with hereditary hemorrhagic telangiectasia with overt digestive bleeding and/or severe anemia

Patients with hereditary hemorrhagic telangiectasia (HHT) often present with recurrent anemia because of epistaxis or GI bleeding in relation to telangiectases mostly located in the stomach or small bowel. Capsule endoscopy is considered a major diagnostic tool for small-bowel diseases, but the impact of capsule endoscopy imaging on patient management in HHT is poorly understood. To clarify the contribution of capsule endoscopy in selected patients with HHT. Prospective, descriptive study. Multicenter, two university hospital tertiary-care centers, from January 2003 to June 2007. This study involved 30 patients with HHT and severe anemia (hemoglobin <9 g/dL; normal: 11-15 g/dL) and minimal epistaxis or moderate anemia but overt GI bleeding. Capsule endoscopy investigation. Clinical characteristics and capsule endoscopy results and their clinical consequences. Capsule endoscopy detected gastric and small-bowel telangiectases in 14 (46.7%) and 26 (86.7%) cases, respectively. Active bleeding was present in 36.7% of cases. Diffuse telangiectases were detected in 42.3% without correlation with age, sex, or type of HHT mutation. Further investigations were carried out as a consequence of the capsule endoscopy results in 67% of cases. Treatment, consisting mostly of endoscopic argon plasma coagulation, was scheduled in 46.7% of patients. Our population was essentially composed of patients with the ALK1 mutation. This study shows that there is a high diagnostic yield for capsule endoscopy in selected patients with HHT. Capsule endoscopy makes possible precise mapping of lesions and has a considerable impact on the management of these selected patients by using a predefined algorithm: a limited number of accessible lesions is suitable for endoscopic treatment, whereas innumerable diffuse lesions require a medical approach. We suggest that capsule endoscopy could be a first-line, noninvasive, digestive tract examination in selected patients with HHT.

Can we improve the diagnostic yield of small bowel videocapsule endoscopy?

Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination's diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy's diagnostic yield sometime in the near future.

Wireless Capsule Endoscopy in Enteropathy Induced by Nonsteroidal Anti-inflammatory Drugs in Pigs

The aim of this study is to evaluate the diagnostic yield of capsule endoscopy in nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy in pigs. Indomethacin (400 mg/day) was administrated orally for 10 days to eight female pigs weighing 36.3+/-2.4 kg. Afterwards, capsule endoscopy was performed, using the EndoCapsule system (Olympus Optical Co., Tokyo, Japan). The following morning, pharmacological euthanasia and immediate autopsy were performed. Small bowel injury compatible with NSAID-induced enteropathy was observed in 7/8 animals. The most common lesions were red spots and erosions. Ulcers and small intestinal bleeding were identified sporadically. Sensitivity and specificity of capsule endoscopy were 83.3% and 95.8%, respectively. Our results indicate that wireless capsule endoscopy is a highly accurate noninvasive method for evaluation of experimental NSAID-induced enteropathy.

Video Capsule Endoscopy in Diabetic Patients and its Effect on the Gastric and Small Bowel Transit Time

Purpose: Video capsule Endoscopy (VCE) is one of the most complex procedures in digestive endoscopy. Delayed gastric emptying in diabetic patients has been cited as a possible reason for incomplete small bowel examination during a VCE. Since this relationship is not yet clearly established we decided to investigate it further. Methods: Case records of 412 consecutive (May 03 - Mar 07) VCE performed at a community based hospital were reviewed retrospectively. 51(12.4%) patients did not meet the inclusion criteria and were excluded. The Gastric transit time (GTT) and the Small Bowel Transit Time (SBTT) of diabetic patients (n=90, 24.9%) were compared with non-diabetic using a SPSS students version 16 (Spss Inc, Chicago). Results are expressed as mean ± SD. T-test was used for statistical analysis, p≤0.05 being significant. Results: 361 adult patients (male = 159, Age = 65 ± 16.2 years) were included in the study. The caecum was visualised in 83/91 (91%) diabetics and 241/270 (89%) in non-diabetics (p=0.59). In our experience there was no significant difference in the GTT (33.4, 1- 240 min vs. 35.52, 1- 264 min, p=0.67) and the SBTT (229.53, 38- 455 min vs. 245.15, 37-424 min, p= 0.12) between the diabetic and the non-diabetic groups respectively. Conclusion: The diagnostic yield of capsule endoscopy is affected by several factors which are not yet completely understood. GTT and SBTT are not affected statistically in patients with diabetes when compared with nondiabetics. This study highlights the need to perform prospective multi-institutional randomized control trials to further explore this relationship.

Wireless Capsule Endoscopy in Israeli Defense Force: Two Years of Experience

Evaluate outcome and diagnostic yield of capsule endoscopy (CE) in soldiers with suspected small bowel disease, in comparison to traditional diagnostic procedures. 27 consecutive soldiers who underwent CE between June 2002 and February 2004 were enrolled. Results of CE were compared to standard techniques. CE was normal in 16 patients (59.3%). Findings could not explain any signs or symptoms were observed in 11.1%. Definite diagnosis of Crohn's disease was obtained in 11.1%. Patients (62.5%) with a triad of symptoms (abdominal pain, changed bowel habits, and gastrointestinal bleeding) versus 15.8% without that triad, had either diagnostic or suspicious CE (p = 0.015). Diagnostic yield of CE was higher in gastrointestinal bleeding (25%) in comparison to suspected Crohn's disease (15.8%). Three out of 6 patients (50%) with suggestive findings of Crohn's disease in the preliminary workup were diagnosed as definite Crohn's by capsule endoscopy. CE allowed the physician to conclude workup in 71% patients. CE should be used when obscure gastrointestinal bleeding or Crohn's disease is suspected without a conclusive diagnosis. Furthermore, when a triad of symptoms exists CE should be considered as first line examination.

Impact of Capsule Endoscopy Findings on Patient Outcomes

There is limited data on the impact of capsule endoscopy (CE) findings on patient outcomes. The aim of our study is to evaluate the impact of CE findings on further diagnostic work-up, treatment, and symptom resolution. A retrospective chart review of patients who underwent CE at a single tertiary care center over a 3-year period was performed. CE findings were classified as positive, suspicious, or negative. Therapeutic interventions were medical, endoscopic, surgical, other, or none. Symptoms were considered resolved when the patient had cessation of symptoms for at least 6 months post-CE. A total of 193 patients were studied. The overall diagnostic yield of CE was 37%. There were 97 (50%) patients who had further diagnostic testing following CE; (40 with positive, 22 with suspicious, 35 with negative CE findings). There were 76% patients who received treatment post-CE (59% with positive, 43% with suspicious, 49% with negative CE findings). Overall symptom resolution was seen in 71% of patients (59% with positive, 68% with suspicious, 70% with negative CE findings). There was no statistically significant difference in diagnostic work-up, treatment, and symptom resolution between patients with positive, suspicious, and negative findings. Patients with obscure overt GI bleeding were less likely to have further diagnostic work-up (P = 0.001), and had the highest rate of symptom resolution as compared to other indications (P < 0.001). There is no significant difference in outcomes amongst patients with positive, suspicious, and negative CE findings. Patients with obscure overt GI bleeding had more favorable outcomes as compared to other indications.