Diagnostic Yield Of Capsule Endoscopy Research Articles

The role of capsule endoscopy in obscure gastrointestinal bleeding

Abstract Background and study aim Obscure gastrointestinal bleeding is mostly recurrent and originates in the small bowel, which can be only partially examined by conventional endoscopy. Capsule endoscopy has revolutionized the evaluation of obscure gastrointestinal bleeding (OGIB). The diagnostic yield of capsule endoscopy in OGIB was a main concern of many studies. The aim of this study is to assess the diagnostic yield of capsule endoscopy in cases of OGIB. Capsule-related complications and degree of inter-observer variation will be recorded as well. Patients and methods 54 consecutive patients suffering from OGIB, whether occult or overt, were subjected to capsule examination and data analysis. Results The majority (74.1%) presented with obscure overt bleeding. Examination was complete in 68.4%. The commonest lesions were angiodysplasias (17.5%). Examinations were negative for lesions in 35.1% and hampered by limitations in 19.3%. The capsule diagnostic yield was 56.1%, while capsule retention occurred in 3.5%. The inter-observer agreement for the cause of bleeding was 91.2%. Conclusions Capsule endoscopy proved helpful in solving the mystery of OGIB. It succeeded in diagnosing the cause of bleeding and directing further management with good compliance, high proportion of inter-observer agreement and low incidence of complications.

The diagnostic yield of capsule endoscopy in patients with iron deficiency anemia and a negative endoscopic workup

Background: Capsule endoscopy (CE) is now a well established method for investigating the small bowel (SB). However, its yield in detecting significant findings in patients with iron deficiency anemia (IDA) who have undergone a negative endoscopic workup is not well investigated.

Nouvelles explorations endoscopiques dans les MICI

Capsule endoscopy and single and double balloons enteroscopy are new techniques developed over the past few years and enabling the exploration of the quasitotality of the small bowel. In Crohn’s disease, capsule endoscopy provides superior diagnosis yield for small bowel study, up to 60% differential performance between the two techniques. Capsule endoscopy seems to have a better yield compared to computerized enterography enteroclysis although it is close to magnetic resonance enteroclysis. The diagnostic yield of capsule endoscopy is considered to be higher in the case of a known Crohn’s disease but this result is pending confirmation. Single-balloon and double-balloon enteroscopy are of tremendous importance in this context, playing a complementary role to capsule endoscopy, though a much more invasive technique.

The Diagnostic Yield of Capsule Endoscopy in Patients with Iron Deficiency Anemia and a Negative Endoscopic Workup

Background: Capsule endoscopy (CE) is now a well established method for investigating the small bowel (SB). However, its yield in detecting significant findings in patients with iron deficiency anemia (IDA) who have undergone a negative endoscopic workup is not well investigated. Methods: Between May 2002 and July 2008 a total of 240 CE procedures for IDA were performed. Clinical information, documentation of IDA and prior negative endoscopic workup were collected prospectively at our institution. The PillCam SB video capsule (Givenimaging Ltd.) was used. Capsule images were interpreted by two experienced gastroenterologists (2). A bivariant analysis was used to determine whether CE findings were associated with each of the demographic and clinical variables for patients with anemia (n=240). Results: The majority of the 240 patients (67%) had normal findings and no source for IDA could be identified. The total number of IDA patients with findings that could explain SB bleeding was 80 (33%), some patients had more than one finding. Findings that were felt not likely to be a source IDA were found in 23 patients (9.6%). The number of units transfused had no correlation with a positive or negative finding (p=0.923). Use of NSAIDs came close to being statistically significant for positive findings (p=0.073). Prior findings on endoscopy had no influence on CE findings (p=0.104 and p=0.070). Age and gender were also not predictive. Using a multivariant analysis, the only significant predictive factor for findings in CE were transfusion requirements, the odds ratio was 3.3 (p<0.001) and 95% CI 1.72 to 6.37. Conclusions: Findings that could explain blood loss from the SB were found in 33% of 240 IDA patients. An active site of SB bleeding was found in 5% of patients. Only one (0.42%) small bowel tumor was identified. The best positive predictor for findings on CE is a history of a prior blood transfusion. The majority of patients with IDA (67%) referred for CE did not have a finding that could account for SB bleeding.

Evaluation of capsule endoscopy in the diagnosis of small bowel disease

To evaluate the clinical utility of capsule endoscopy in diagnosing small bowel disease. A retrospective review of 155 cases undergone capsule endoscopy examinations from September 2002 to March 2007 in our hospital were performed. Gastric and small bowel transit time, patient tolerability, number of complete and incomplete examinations, and examination findings were evaluated. A total of 155 cases were reviewed, and 159 times of capsule endoscopy examination were finished. Of the 155 patients, 97 suffered from obscure gastrointestinal bleeding, 42 abdominal pain, 6 abdominal discomfort, 4 diarrhea, and 6 body check. The capsule endoscopy examination for the entire small bowel were finished in 93.1%(148/159)cases. All the patients had no discomfortable feeling during the examinations. The capsule endoscopy remained in the stomach for an average of 65.5 min(1 to 335 min). The mean transit time in the small bowel was 282.2 min(45 to 524 min). The diagnostic yield of capsule endoscopy was 78.6%(125/159). Vasculopathy was present in 43.4% patients, enteritis in 28.3%, submucous knot in 10.1%, diverticulum of small intestine in 8.2%, and small intestine tumor in 5.7%. Other findings consisted of polyposis of small intestine, foreign objects and parasite. The diagnostic yield of obscure gastrointestinal bleeding by capsule endoscopy was 89.7%, and of abdominal pain was 73.8%. Capsule endoscopy is safe and well tolerated. Capsule endoscopy is a valuable diagnostic tool in the evaluation of occult small bowel disease, especially for obscure gastrointestinal bleeding.

Diagnostic yield of capsule endoscopy in elderly patients with obscure GI bleeding

Diagnostic yield of capsule endoscopy in elderly patients with obscure GI bleeding

P051 - Prospective study of contrast-enhanced small bowel sonography (CES) in patients with Crohn's disease (CD) operated of an ileal stenosis. Preliminary results

P051 - Prospective study of contrast-enhanced small bowel sonography (CES) in patients with Crohn's disease (CD) operated of an ileal stenosis. Preliminary results

The Effect of Metoclopramide in Capsule Enteroscopy

Clinical utility of prokinetics in capsule endoscopy (CE) is not clearly established. The objective of this prospective, randomized, single-blind, controlled trial was to determine if metoclopramide is useful in CE by increasing the rate of complete enteroscopy. Ninety-five patients referred for CE were randomized to no metoclopramide (group B, n = 48) or 10 mg metoclopramide (group A, n = 47). Complete enteroscopy was possible in 38 patients of group A (80.9%) and 37 of group B (77.1%) (P = 0.422) with two cases of gastric retention in group B (4.2%; P = 0.253). Median gastric transit time was 26 min (1-211) in group A and 28 min (4-200) in group B (P = 0.511). Mean small bowel transit time, calculated after excluding 20 patients with incomplete enteroscopy, was similar in both groups (221.2 +/- 89 min vs. 256 +/- 82.2 min; P = 0.083). There were also no differences in the total number of findings (group A 4.5 +/- 4.7; group B 4.7 +/- 3.7, P = 0.815). Administration of 10 mg metoclopramide orally 15 min before capsule ingestion did not significantly increase the rate of total enteroscopies and had no effect on transit times. It also did not modify CE diagnostic yield.

Single-center experience of 309 consecutive patients withobscure gastrointestinal bleeding

To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE findings. Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common finding in the entire cohort, these accounted for 30% of clinically significant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleeding group, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

Effect of small bowel preparation with simethicone on capsule endoscopy

Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate

Bowel preparation for capsule endoscopy (CE) has not been standardized. This study aimed to compare CE images between patients prepared by simethicone and those prepared by magnesium citrate. Retrospective analysis of case series of our hospital from 2004 to 2007. Single center. CE images of 75 patients receiving bowel preparation either by 200 mg of simethicone (n=39) or by 34 g of magnesium citrate (n=36) were retrospectively investigated. Grades of fluid transparency and mucosal invisibility by air bubbles and food residue were compared between the 2 preparations. Capsule transit time, frequency of positive findings, and interobserver variations between 2 observers were also investigated. Image quality and diagnostic yield of CE. Fluid transparency in the first and the third time segments of the small intestine was better in patients prepared by magnesium citrate than in those prepared by simethicone (P= .001 and P= .03, respectively). On the other hand, mucosal invisibility was not different in any part of the small intestine between the 2 groups. Neither gastric transit time nor small-bowel transit time was different between the 2 groups. The diagnostic yield of CE correlated significantly with fluid transparency (P= .04), but it did not correlate with mucosal invisibility. Single-center retrospective study. Magnesium citrate seems to be a recommended preparation for CE compared with simethicone. The fluid transparency, rather than the mucosal invisibility, may be a factor associated with the diagnostic yield of CE.

Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease

To compare results of capsule endoscopy with those of barium enteroclysis or CT enteroclysis. Retrospective review of hospital records revealed 65 patients who had an enteroclysis and small bowel capsule endoscopy. The diagnostic yield of capsule endoscopy was compared with the enteroclysis using Fisher's exact test. The main indications were obscure gastrointestinal bleeding (n = 37) and suspected Crohn disease (n = 17). Radiologic studies included CT enteroclysis (n = 30), and fluoroscopic barium enteroclysis with carbon dioxide (n = 18) or with methylcellulose (n = 17). Capsule endoscopy had a higher diagnostic yield (8/17) compared to barium-methylcellulose cellulose enteroclysis (1/17) (P = 0.02). The diagnostic yield of capsule endoscopy was not significantly different compared with barium-carbon dioxide (12/18 vs. 10/18) enteroclysis or with CT enteroclysis (9/30 vs. 8/30). Vascular lesions were better assessed with capsule endoscopy. However, the CT enteroclysis found more lesions in patients with chronic abdominal pain. Barium-carbon dioxide enteroclysis and CT enteroclysis have similar diagnostic yields for small bowel disease compared to capsule endoscopy. Barium methylcellulose has an inferior diagnostic yield.

Rebleeding rate after interventional therapy directed by capsule endoscopy in patients with obscure gastrointestinal bleeding

BackgroundThe precise role of capsule endoscopy in the diagnostic algorithm of obscure gastrointestinal bleeding has yet to be determined. Despite the higher diagnostic yield of capsule endoscopy, the actual impact on clinical outcome remains poorly defined. The aim of this study was to evaluate the follow-up results of patients with obscure gastrointestinal bleeding to determine which management strategies after capsule endoscopy reduced rebleeding.MethodsAll patients in whom the cause of obscure gastrointestinal bleeding was investigated between May 2004 and March 2007 were studied retrospectively. We evaluated the clinical outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy using the rebleeding rate as the primary outcome.ResultsSeventy-seven patients with obscure gastrointestinal bleeding underwent capsule endoscopy. Capsule endoscopy identified clinically significant findings that were thought to be the sources of obscure gastrointestinal bleeding in 58.4% of the patients. The overall rebleeding rate was 36.4%. The rebleeding rate was significantly higher among patients with insignificant findings than among those with significant findings (p = 0.036). Among the patients in whom capsule endoscopy produced significant findings, the rebleeding rate of the patients who underwent therapeutic interventions was significantly lower than that in those who did not undergo intervention (9.5% vs 40.0%, p = 0.046).ConclusionFollow-up and further aggressive interventions are necessary for patients with obscure gastrointestinal bleeding and significant capsule endoscopy findings to reduce the chance of rebleeding.

Diagnostic Yield of Capsule Endoscopy in Elderly Patients with Obscure GI Bleeding and Predictive Factors of Rebleeding: A Prospective Multicenter Study of the ANGH Group

Introduction: Capsule endoscopy (CE) is widely used to investigate obscure GI bleeding (OGIB) from small bowel origin. Aims: The aim of this prospective multicenter study was 1) to determine the findings and the diagnostic yield of CE in overt and occult OGIB in elderly patients and 2) to identify predictive factors associated with rebleeding. Methods: patients older than 70 years who had a previous negative endoscopic evaluation (at least one upper endoscopy and one colonoscopy) for OGIB and a rebleeding were eligible for inclusion. Rebleeding was defined as a drop in hemoglobin level from the high one of 2 g/dL or more, or by a new overt bleeding. A multivariate analysis was performed to identify predictors of lesions and to determine factors associated with rebleeding. Six French hospitals participated in this prospective multicenter study from January 2006 to April 2007. Results: 76 patients (42 women and 34 men, 76.6 ± 9 yrs) were included; 47 had an occult and 29 an overt OGIB. 73% of patients had one or more severe comorbidity. 40% of patients were taking one or more drug-induced GI lesion [NSAIDs (n = 2); aspirin (n = 12); vitamin K antagonist (n = 11), clopidrogel (n = 10)]. Visualization of the entire small bowel was achieved in 90%. No complication related to CE occurred. A lesion was identified in 49 (63%) cases, angiodysplasias were observed in 73% of cases. The yield (define by OGIB related to lesion) of CE was 58%, resulting in a potential specific treatment in 82%. The yield of CE for occult OGIB was 55% vs. 65% for overt OGIB (p = 0.7). Predictive factors of small bowel lesions were (OR [IC], p): male sex (6.7 [1.5-30]; 0,014) and cardiac disease (8.2 [1.7-39], 0.008). A specific treatment was possible in 40 (82%) of cases. 48 (63%) patients were followed up during a median period of 461 days (96-636 days). A rebleeding was observed in 11 (23%) cases. A trend towards but not significant, because of small sample size, to rebleeding was observed in case of 1) overt OGIB (36% vs. 18%), 2) identified lesion (27% vs. 14%) and 3) untreated lesion (42% vs. 18%). Conclusion: the diagnostic yield of CE is high in elderly patients with OGIB allowing an appropriate treatment in most of cases. Predictors of GI lesion identified by CE were male sex and a past history of cardiac disease. A rebleeding was observed in 11 (23%) patients, but this small sample size do not allowed to clearly identified factors of relapse.

W1304 Are Patients with Chronic Iron-Deficiency Anaemia Different from Those with Occult Gastrointestinal Bleeding? Clinical Characteristics and Diagnostic Yield of Capsule Endoscopy

W1304 Are Patients with Chronic Iron-Deficiency Anaemia Different from Those with Occult Gastrointestinal Bleeding? Clinical Characteristics and Diagnostic Yield of Capsule Endoscopy

Double-Balloon Enteroscopy and Capsule Endoscopy Have Comparable Diagnostic Yield in Small-Bowel Disease: A Meta-Analysis

The aim of this study was to compare the diagnostic yield of capsule endoscopy (CE) with double-balloon enteroscopy (DBE) in small-bowel (SB) disease using meta-analysis. We performed a search of studies comparing CE with DBE in SB disease. Data on diagnostic yield of CE and DBE were extracted, pooled, and analyzed. The weighted incremental yield (IY(W)) (yield of CE--yield of DBE) of CE over DBE and 95% confidence intervals (95% CIs) for pooled data were calculated using a fixed-effect model (FEM) for analyses without, and a random-effect model (REM) for analyses with, significant heterogeneity. Eleven studies compared CE and DBE; the pooled overall yield for CE and DBE was 60% (n = 397) and 57% (n = 360), respectively (IY(W), 3%; 95% CI, -4% to 10%; P = .42; FEM). Ten studies reported vascular findings; the pooled yield for CE and DBE was 24% (n = 371) and 24% (n = 364), respectively (IY(W), 0%; 95% CI, -5% to 6%; P = .88; REM). Nine studies reported inflammatory findings; the pooled yield for CE and DBE was 18% (n = 343) and 16% (n = 336), respectively (IY(W), 0%; 95% CI, -5% to 6%; P = .89; FEM). Nine studies reported polyps/tumors; the pooled yield for CE and DBE was 11% (n = 343) and 11% (n = 336), respectively (IY(W), -1%; 95% CI, -5% to 4%; P = .76; FEM). CE and DBE have comparable diagnostic yield in SB disease, including obscure gastrointestinal bleeding. CE should be the initial diagnostic test because of its noninvasive quality, tolerance, ability to view the entire SB, and for determining the initial route of DBE. Because of its therapeutic capabilities, DBE may be indicated in patients with a positive finding on CE requiring a biopsy or therapeutic intervention, if suspicion for a SB lesion is high despite a negative CE, and in patients with active bleeding.

Wireless Capsule Endoscopy: Indications, Limitations, and Future Challenges

Wireless capsule endoscopy is one of the recent inventions that has made an impact in the diagnostic work-up of gastrointestinal diseases, mainly in small intestinal pathology, the part of the gut that cannot be totally visualized by upper and lower gastrointestinal endoscopy. Since the first report documenting the use of capsule endoscopy, many adult clinical trials have taken place. Although the Food and Drug Administration approved the use of the capsule in children (ages 10-18 years) in October 2003, few small clinical trials exploring the diagnostic yield of capsule endoscopy in pediatric populations have been published.

Capsule endoscopy for the detection of oesophageal mucosal disorders: a comparison of two different ingestion protocols

Objective. To assess the accuracy of a new ingestion protocol for capsule endoscopy (CE) in evaluating patients with gastro-oesophageal reflux disease (GORD). Methods. Oesophago-gastroduodenoscopy (OGD) was performed 1 week prior to CE. The first 28 subjects swallowed the capsule following the original ingestion protocol (OIP) and the subsequent 30 subjects following a simplified ingestion protocol (SIP). CE videos were reviewed by two independent investigators who were blinded to the OGD findings. Results. Of 48 patients included, 24 were diagnosed with reflux oesophagitis (67% male, mean age 49.5±13 years) and 24 with Barrett oesophagus (BO) (88% male, 55.6±10 years) by OGD. In addition, 10 asymptomatic healthy controls (50% male, 45.8±7.1 years) were included. Oesophageal transit time was faster in patients using the SIP compared to the OIP (126±26 s versus 214±33; p=0.04). Complete evaluation of the Z-line was possible in 19/28 (68%) of the OIPs compared to 28/30 (93%) of the SIPs (p=0.04). Sensitivity for detecting any oesophageal abnormality was higher in the SIP group than in the OIP group (97% versus 89%; p=0.11). Overall, CE detected oesophagitis in 22/24 patients (sensitivity, 92%; specificity, 88%) and BO in 23/24 patients (sensitivity, 96%; specificity, 91%). Furthermore, 41/44 (93%) preferred CE over OGD and experienced less discomfort and pain during CE. Conclusion. CE is an accurate method for detecting mucosal oesophageal abnormalities. The new ingestion protocol improves the visualization of the Z-line, which is likely to increase the diagnostic yield of CE.

Diagnostic yield of capsule endoscopy in ulcerative colitis and inflammatory bowel disease of unclassified type (IBDU)

Capsule endoscopy is increasingly reported as an important diagnostic procedure in patients with known or suspected Crohn's disease, but its clinical utility in patients with ulcerative colitis or unclassified type inflammatory bowel disease (IBDU) is unclear. The aim of our study was to determine the diagnostic yield of capsule endoscopy for small-bowel disease in patients with ulcerative colitis and IBDU. All data from patients with a history of ulcerative colitis or IBDU who underwent capsule endoscopy between October 2001 and August 2005 were analyzed for procedure indications and findings. Images were reviewed by an experienced capsule endoscopist. The finding of multiple ulcerations (three or more) on capsule endoscopy was classified as diagnostic of small-bowel Crohn's disease. 120 patients had undergone 122 capsule endoscopy procedures. Overall, 19 of 120 patients (15.8 %) had capsule endoscopy findings consistent with the diagnosis of Crohn's disease. The proportion of patients with small-bowel disease was significantly higher among patients with a history of colectomy (7 of 21 patients, 33 %) compared with those without colectomy (12/99, 12 %) ( P = 0.04). Among patients with positive findings on capsule endoscopy, 18 had also previously undergone a small-bowel follow-through study and only one showed findings consistent with Crohn's disease. Many patients with a diagnosis of ulcerative colitis and atypical features or IBDU may have small-bowel findings on capsule endoscopy that are consistent with Crohn's disease. Capsule endoscopy should be considered in ulcerative colitis patients with atypical clinical features particularly after colectomy.

Esophageal capsule endoscopy in patients with suspected esophageal disease: double blinded comparison with esophagogastroduodenoscopy and assessment of interobserver variability

The study aim was to compare the diagnostic yield of capsule endoscopy and esophagogastroduodenoscopy (EGD) in patients with suspected esophageal disease. Secondary aims were to assess interobserver variability of capsule endoscopy readings and safety. In total, 98 patients (53 men, 53 +/- 13 years) with an indication for EGD were included. The patient population was artificially enriched to include two thirds of patients with abnormal esophageal findings at EGD, which was followed by capsule endoscopy. Capsule recordings were blindly read by three endoscopists, one from the center that recruited the patient and two from the other center. Study outcomes were the findings described on EGD and capsule endoscopy, agreement between EGD and capsule endoscopy for findings, quality of the capsule recording, and interobserver agreement for capsule endoscopy quality and findings. EGD was normal in 34 patients and showed esophageal findings in 62 (esophagitis 28, hiatus hernia 21, varices 21, Barrett's esophagus 11, others 7). Average esophageal transit time of the capsule was 361 +/- 393 seconds. Capsule endoscopy was normal in 36 patients but detected esophagitis in 23, hiatus hernia in 0, varices in 23, Barrett's esophagus in 18, and others in 4. The positive predictive value of capsule endoscopy was 80.0 % and the negative predictive value was 61.1 %. Overall agreement per patient was moderate between EGD and capsule endoscopy for the per-patient (kappa = 0.42) and per-findings (kappa = 0.40) analyses. Interobserver agreement between capsule endoscopy readings was moderate for findings (kappa = 0.39) and quality assessment (kappa = 0.24). No adverse event was observed after either EGD or capsule endoscopy. In this study, despite artificial prevalence enrichment, capsule endoscopy showed a moderate sensitivity and specificity in the detection of esophageal diseases.