Yield Of Capsule Endoscopy In Patients Research Articles

Sa1630 Factors Predicting the Presence of Small Bowel Lesions in Patients With Obscure Gastrointestinal Bleeding

Capsule endoscopy (CE) is established as the first examination for the investigation of Obscure gastrointestinal bleeding (OGIB). However, clinical characteristics including comorbidity and meditation use that are relevant to the diagnostic yield of CE in patients with OGIB have been rarely reported. In addition, these reports did not consider type of OGIB (overt or occult). Therefore we conducted this study to define the predictive factors for the presence of small bowel lesions (vascular and erosive/ulcerated lesions) in patients with overt and occult OGIB.

Capsule endoscopy in adult celiac disease: a potential role in equivocal cases of celiac disease?

There have been limited studies evaluating capsule endoscopy (CE) in equivocal celiac disease (CD). To determine the role CE may have in equivocal CD cases, compared with patients with biopsy-proven and serology-proven CD who have persisting symptoms. Prospective cohort study. University hospital. A total of 62 patients with equivocal CD and 69 patients with nonresponsive CD. CE. Diagnostic yield of CE in equivocal cases and accuracy of mucosal abnormality detection in patients with nonresponsive CD. Equivocal cases (n = 62) were divided into two subgroups: group A (antibody-negative villous atrophy, n = 32) and group B (Marsh 1-2 changes, n = 30). In group A, CE secured a diagnosis of CD or Crohn's disease in 28% (9/32), significantly higher than the diagnostic yield in group B (7%; P = .044). In patients with CD with persisting symptoms, significant CE findings were identified in 12% (8/69), including 2 cases of enteropathy-associated lymphoma, 4 type 1 refractory disease cases, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly lower than the diagnostic yield of CE in antibody-negative villous atrophy (P = .048). Single center. There have been no previous reports systematically evaluating equivocal CD by using CE. The diagnostic yield of CE in patients with antibody-negative villous atrophy is better than that of CE in patients with CD with persisting symptoms. We advocate the use of CE in equivocal cases, particularly in patients with antibody-negative villous atrophy.

Diagnostic Yield of Capsule Endoscopy in Overt GI Bleeding Compared to Iron Deficiency Anemia

Purpose: Capsule endoscopy (CE) is an established technique for the identification of small bowel lesions in patients with obscure GI bleeding. It is also performed in the setting of iron deficiency anemia (IDA) when standard upper and lower endoscopy fail to reveal a source of blood loss. Studies have been conflicting regarding whether the diagnostic yield differs in those with obscure overt GI bleeding and those with IDA with or without occult bleeding. The aim of the study was to compare the diagnostic yield of CE in these two groups. We also sought to identify clinical factors associated with positive CE findings. Methods: A retrospective chart review was performed for all patients who had undergone CE for evaluation of overt GI bleeding or IDA at our center from May 2005 until March 2011. Only lesions felt to represent a definite or probable source of bleeding according to previously established guidelines were included in the diagnostic yield calculation. Variables in the two groups were compared using Chi-Square and two-sample T-test. Results: A total of 631 CE procedures done for obscure overt gastrointestinal bleeding (n=220) and IDA (n=411) were studied. Diagnostic yield was 56.4% in overt bleeding patients and 50.6% in IDA patients (p=0.168). Table 1 shows the identified lesions in the two groups. Patients with overt bleeding were more likely to have fresh blood (13.2% vs. 6.8%, p=0.008) and altered blood (3.6% vs. 0.5%, p=0.004) compared to IDA patients. 58.2% of patients with positive CE findings had prior transfusion requirement while 42.2% of patients with negative CE findings had transfusion requirement (p<0.001). Patients with positive CE findings were found to have lower hemoglobin (8.3 ± 2.2 vs. 9.0 ± 2.2 g/dL, p<0.001) and were older (66.2 ± 12.2 vs. 64.0 ± 13.6, p=0.034) compared to patients with negative CE findings.Table 1: . No Caption available.Conclusion: Diagnostic yield of CE in patients with obscure overt GI bleeding and patients with iron deficiency anemia was not significantly different making CE an important tool in the work-up of unexplained iron deficiency anemia. Patients with positive CE findings were more likely to have prior transfusion requirement, lower hemoglobin, and older age when compared to patients with negative CE findings.

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

Clinical Features of Patients With Negative Results From Traditional Diagnostic Work-up and Crohn??s Disease Findings From Capsule Endoscopy

Capsule endoscopy (CE) can detect Crohn's disease in patients with suggestive symptoms but with negative results from the traditional diagnostic work-up (ileocolonoscopy and small bowel follow-through). The objective of this study was to determine which clinical features predict the diagnosis of Crohn's disease by CE in this subgroup of patients. Twenty-three patients (7 men, 16 women; mean age: 40+/-15 y) with negative results from conventional imaging techniques were prospectively included in the study because of suspicion of Crohn's disease (long-standing abdominal pain and/or diarrhea and at least one of the following symptoms: anemia, weight loss, long-standing fever, perianal disease, extraintestinal manifestations typical of inflammatory bowel disease, elevated inflammatory parameters, or family history of inflammatory bowel disease). CE diagnosed Crohn's disease in 6 patients (26%). Crohn's disease diagnosis was more frequent in patients with a combination of anemia and elevated inflammatory parameters than in patients without this combination (57% vs. 12.5%; P=0.04). The only statistically significant association between an inflammatory parameter and Crohn's disease was an increased platelet count. CE is a useful tool for the diagnosis of subtle small bowel Crohn's disease. The diagnostic yield of CE in patients with suspicion of Crohn's disease but negative results from the traditional diagnostic work-up is significantly higher in patients with anemia and increased platelet count than in patients without this combination of clinical features.

Capsule Endoscopy (CE): Indications and Results from 100 Consecutive Patients in 2 Tertiary Hospitals in Switzerland

Aim: To determine the indications and diagnostic yield of CE in patients referred for CE in 2 tertiary centers in Switzerland. Furthermore we evaluated the safety of CE and the impact of bowel preparation on transit times. Methods: All 100 consecutive patients (pts) referred for CE from March 2002 until October 2003 were eligible. Diagnostic yield was defined as the percentage of examinations in which a pathologic finding explained the symptomatology of the patient or indication of CE. Transit times were calculated by the Rapid Reader Software. Results: All 100 pts were included. There were 54 men and 46 women. The mean age was 57 years (range 17 to 88 years). Indications for CE were inactive gastrointestinal bleeding or anemia in 65 pts, 5 pts with active GIB, 9 pts with polyposis syndromes, 4 pts with Crohn's disease, 5 pts with unexplained abdominal pain, 7 pts for work-ups of suspected pathologies on small bowel follow-throughs or CT scans and 5 pts with unexplained diarrhea. Pathologic findings were seen in 76% of examinations. However only in 44% were they deemed responsible for the symptoms of the patients. The most common incidental findings were lymphangiectasias. 62 pts had bowel preparation (2 liter phosphosoda) and 38 pts had not. Mean gastric transit time was 38 min in pts with preparation and 34 min in pts without preparation. Mean small bowel transit time was 217 min in pts with preparation and 244 min in pts without preparation. There were 5 capsule non-passages: in 2 pts the capsule did not reach the stomach, in 2 pts the capsule did not pass the pylorus and in 1 pt with Crohn's disease the capsule caused an obstruction and had to be removed surgically. Conclusions: CE provides a meaningful diagnostic yield in active and inactive GIB. The combined diagnostic yield is 44%. Other indications with a high diagnostic yield on CE are Crohn's disease and polyposis syndromes. Bowel preparation does not alter gastric transit time but does seem to decrease small bowel transit time. Overall complication rate in this series is comparable to other series. However the major part of capsule non-passages was in the esophagus and stomach and not in the small intestine.