Video Capsule Endoscopy In Comparison To Radiological Examination In Detection Of Small Bowel Lesions

Abstract BACKGROUND Small bowel obscured its lesions as secrets which were difficult to diagnose before video capsule endoscopy as a new modality for investigation. Aim of the study Evaluation of video capsule endoscopy in comparison to radiological examination in detection of small bowel lesions. Patients and methods Fifty patients were recruited from Kafrawy Video Capsule Endoscopy Unit of Internal Medicine Department and endoscopy unit of Ain Shams University Hospital. The study included patients with occult or overt GIT bleeding, patients with unexplained microcytic iron deficiency anemia, patients with chronic diarrhea and abdominal pain, with normal upper GI endoscopy and colonoscopy. Exclusion of any patient younger than 18 years old, has intestinal stricture, achalasia, or dysphagia. All patients were studied biochemically with CBC and radiological by CT pelvis and abdomen with IV and oral positive contrast some of them were radiologically examined with CTE or CT mesenteric angiography. All patients were endoscopically examined by OGD, colonoscopy, VCE, and some of them were examined also with enteroscope. Results The study revealed that the detection rate of SB lesions with VCE was 84%. In the current study, (44%) of cases had AVMs, (72.73) % of them were above the age of forty five, and (27.27) % were below the age of forty five. All patients who were investigated with CT mesenteric angiography revealed negative results. In this study (20) % of patients had SB masses and polyps, (70) % of them were at age of forty five or more and only (30) % of them were below the age of forty five. All patients underwent CT pelvis and abdomen with IV and oral positive contrast, and we found that all patients had a negative results regarding the SB lesions. In comparison between CTE and VCE in detection of SB vascular lesions CTE did not detect SB vacular lesions. On the other hand, VCE detected the AVMs in the cases with negative CTE results. In this study one patient (2)% was diagnosed with hookworm infection. All patient underwent for OGD. We found that (20)% of patients had a significant gastric or duodenal lesions (proximal to the papilla) by VCE but missed by upper GI endoscopy. In our study the concomitant of VCE and enteroscope increase the detection of SB vascular lesions than isolated use of VCE only. Conclusion VCE has a high detection rate of SB lesions (84)%. CTE has a low significance in detection of SB vascular lesions and CT mesenteric angiography sensitivity relatively low. AVMs more common with increasing the age. PHE and SB ectopic varicies, were found to be common causes of GIT bleeding in CLD patient. There is a significant rate of missed gastric and duodenal (proximal to the papilla) lesions that the cause of GIT bleeding and unexplained iron deficiency anemia in OGD examination that were detected by VCE.

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Diagnostic yield of magnetically assisted capsule endoscopy versus gastroscopy in recurrent and refractory iron deficiency anemia

Endoscopy ◽

10.1055/a-0750-5682 ◽

2018 ◽

Vol 51 (05) ◽

pp. 409-418 ◽

Cited By ~ 10

Author(s):

Hey-Long Ching ◽

Melissa F. Hale ◽

Matthew Kurien ◽

Jennifer A. Campbell ◽

Stefania Chetcuti Zammit ◽

...

Keyword(s):

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Deficiency Anemia ◽

Gi Tract ◽

Upper Gi ◽

Upper Gi Tract ◽

Magnetically Assisted

Abstract Background Small-bowel capsule endoscopy is advocated and repeat upper gastrointestinal (GI) endoscopy should be considered for evaluation of recurrent or refractory iron deficiency anemia (IDA). A new device that allows magnetic steering of the capsule around the stomach (magnetically assisted capsule endoscopy [MACE]), followed by passive small-bowel examination might satisfy both requirements in a single procedure. Methods In this prospective cohort study, MACE and esophagogastroduodenoscopy (EGD) were performed in patients with recurrent or refractory IDA. Comparisons of total (upper GI and small bowel) and upper GI diagnostic yields, gastric mucosal visibility, and patient comfort scores were the primary end points. Results 49 patients were recruited (median age 64 years; 39 % male). Combined upper and small-bowel examination using the new capsule yielded more pathology than EGD alone (113 vs. 52; P < 0.001). In upper GI examination (proximal to the second part of the duodenum, D2), MACE identified more total lesions than EGD (88 vs. 52; P < 0.001). There was also a difference if only IDA-associated lesions (esophagitis, altered/fresh blood, angioectasia, ulcers, and villous atrophy) were included (20 vs. 10; P = 0.04). Pathology distal to D2 was identified in 17 patients (34.7 %). Median scores (0 – 10 for none – extreme) for pain (0 vs. 2), discomfort (0 vs. 3), and distress (0 vs. 4) were lower for MACE than for EGD (P < 0.001). Conclusion Combined examination of the upper GI tract and small bowel using the MACE capsule detected more pathology than EGD alone in patients with recurrent or refractory IDA. MACE also had a higher diagnostic yield than EGD in the upper GI tract and was better tolerated by patients.

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IMPACT OF SMALL BOWEL CAPSULE ENDOSCOPY IN IRON DEFICIENCY ANEMIA: INFLUENCE OF PATIENT’SAGE ON DIAGNOSTIC YIELD

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-61 ◽

2018 ◽

Vol 55 (3) ◽

pp. 242-246 ◽

Cited By ~ 2

Author(s):

Sofia XAVIER ◽

Joana MAGALHÃES ◽

Bruno ROSA ◽

Maria João MOREIRA ◽

José COTTER

Keyword(s):

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Vascular Lesions ◽

Deficiency Anemia ◽

Age Group ◽

Single Center Study ◽

Significant Pathology

ABSTRACT BACKGROUND: Iron deficiency anemia remains one of the main indications to perform small bowel capsule endoscopy. Literature suggests that diagnostic yield is influenced by patient’s age but with conflicting results regarding age cutoff. OBJECTIVE: We aimed to clarify the differences in diagnostic yield and incidence of specific findings according to age. METHODS: Retrospective single-center study including 118 patients performing small bowel capsule endoscopy in the study of iron deficiency anemia. Videos were reviewed and small bowel findings that may account for anemia were reported. Incomplete examinations were excluded. Findings were compared between patients ≤60 and >60 years. RESULTS: Patients had a mean age of 58 years old (SD ±17.9) with 69.5% females (n=82). The overall diagnostic yield was 49% (58/118), being higher among patients >60 years (36/60, diagnostic yield 60%) than those ≤60 years (20/58, diagnostic yield 34%), (P<0.01). Angioectasias were more frequent in patients >60 years (45% vs 9%, P<0.01). Patients ≤60 years presented more frequently significant inflammation (Lewis score >135 in 10.3% vs 1.7%, P<0.05) and other non-vascular lesions (24% vs 10%, P=0.04). CONCLUSION: In our cohort small bowel capsule endoscopy diagnosed clinically relevant findings in the setting of iron deficiency anemia in almost half the patients. Diagnostic yield was higher in patients older than 60 years (60%), with vascular lesions being more frequent in this age group. Despite the lower diagnostic yield in patients ≤60 years, significant pathology was also found in this age group, mainly of inflammatory type.

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Assessment of the Role of a Second Evaluation of Capsule Endoscopy Recordings to Improve Diagnostic Yield and Patient Management

GE Portuguese Journal of Gastroenterology ◽

10.1159/000516947 ◽

2021 ◽

pp. 1-5

Author(s):

Gerardo Blanco-Velasco ◽

Rolando Pinho ◽

Omar Michel Solórzano-Pineda ◽

Claudia Martínez-Camacho ◽

Luis Fernando García-Contreras ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Patient Management ◽

Interobserver Agreement ◽

Diagnostic Yield ◽

Vascular Lesions ◽

Deficiency Anemia ◽

Small Bowel Tumors ◽

Significant Pathology

Introduction: The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management. Methods: One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e., >50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation. Results: The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn’s disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% (p = 0.380), i.e., 6.3% for SBB, 4.4% for CD and 9.2% for other indications, resulting in a change in management of 4% of the patients. FNs in the first SBCE reading were found in 4% of the SBCEs. Discussion: A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients.

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Video Capsule Endoscopy in the Assessment of Portal Hypertensive Enteropathy

International Journal of Hepatology ◽

10.1155/2018/5109689 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Yasir Al-Azzawi ◽

Lidia Spaho ◽

Mohammed Mahmoud ◽

Joan Kheder ◽

Anne Foley ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Gastric Varices ◽

Video Capsule Endoscopy ◽

Vascular Lesions ◽

Common Finding ◽

Decompensated Cirrhosis ◽

Chronic Alcohol Abuse ◽

Compensated Cirrhosis ◽

Portal Hypertensive Enteropathy

Background. The features of the portal hypertension enteropathy (PHE) vary from mild mucosal changes to varices with or without bleeding. The prevalence and the development are not fully understood. Aim. Our aim is to examine the prevalence and the different manifestations of PHE using video capsule endoscopy (VCE). Methods. It is a single center retrospective study of patients with cirrhosis, who had VCE. Based on the published literature, we divided the PHE lesions into vascular lesions and mucosal lesions. Results. Of the 100 patients with cirrhosis that had a VCE study, the mean age was 62.82 years. Male gender was predominant (64%), while Caucasians represented 82% of the cohort. The most common etiology of cirrhosis was chronic alcohol abuse followed by chronic hepatitis C virus and nonalcoholic steatohepatitis. VCE detected small bowel lesions in 71% of the patients while the features of PHE were found in 65% from the total cohort. AVMs and inflammatory changes were the most common findings, followed by bleeding. More than 50% of the lesions were vascular in nature. The risk of finding PHE in decompensated cirrhosis is twice that in compensated cirrhosis. Forty-five patients had negative EGD exam for any active bleeding, esophageal varices, portal hypertensive gastropathy, or gastric varices. Of these, 69% had features of PHE in their VCE. Conclusions. VCE detected small bowel lesions in 71% of our cohort. There is a high prevalence of PHE in decompensated cirrhosis. Vascular lesions are the most common finding in the small bowel of this population.

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Unsuspected Small-Bowel Crohn’s Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2018/9416483 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Che-Yung Chao ◽

Carl Frederic Duchatellier ◽

Ernest G. Seidman

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Elderly Patients ◽

Capsule Endoscopy ◽

The Elderly ◽

Fecal Calprotectin ◽

Tertiary Hospital ◽

Video Capsule Endoscopy ◽

Deficiency Anemia

Background. Video capsule endoscopy (VCE) is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn’s disease (CD) in elderly patients. Methods. Retrospective review of VCE performed in elderly patients (≥70 y) at a tertiary hospital (2010–2015). All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS) > 790 (moderate-to-severe inflammation). Those with lower LS (350–790) required histological confirmation. Known IBD cases were excluded. Results. 197 VCE were performed (mean age 78; range 70–93). Main indications were iron deficiency anemia (IDA), occult GI bleeding (OGIB), chronic abdominal pain, or diarrhea. Eight (4.1%) were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP) was elevated in 7/8 (mean 580 μg/g). Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval. Conclusions. VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

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The Spectrum of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia Detected by Video Capsule Endoscopy

Medicina ◽

10.3390/medicina55030059 ◽

2019 ◽

Vol 55 (3) ◽

pp. 59 ◽

Cited By ~ 2

Author(s):

Antonella Contaldo ◽

Giuseppe Losurdo ◽

Francesca Albano ◽

Andrea Iannone ◽

Michele Barone ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Univariate Analysis ◽

Video Capsule Endoscopy ◽

Deficiency Anemia ◽

Occult Bleeding

Background and objectives: Video-capsule endoscopy (VCE) has shown a large range (38–83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors in inpatients with both of the above reported conditions. Methods: We selected inpatients with IDA (hemoglobin <12 g/dL in women, <13 g/dL in men) and obscure-occult bleeding. We excluded VCE indications other than IDA. Complete medical histories and laboratory tests were collected. All subjects underwent PillCam SB2/SB3. The VCE feature Lewis score was calculated when appropriate. We used the t-test and Fisher’s exact test for continuous and categorical variables, respectively, in univariate analysis. For multivariate analysis, we used binomial logistic regression. Results: We retrieved 109 patients (female:male ratio of 53:56; age 63.4 ± 18.9 years). Eighty patients (73.4%) showed ≥1 small bowel lesions. The Lewis score was calculated in 41 patients: 13 (31.7%) showed a mild (<135) and 28 (68.3%) a moderate-severe (135–790 and >790, respectively) score. In univariate analysis, the small bowel transit time (6.2 ± 2.9 versus 5.2 ± 2.1 h; p = 0.049) and non-steroidal anti-inflammatory drug use for at least two weeks (17.5% versus 0%; p = 0.01) were significantly higher in subjects with injuries. These associations were not confirmed at multivariate analysis. The severity of a lesion directly correlated with proton pump inhibitor (PPI) use and duration (not confirmed in multivariate analysis). VCE can reveal the source of obscure-occult bleeding in a high percentage of unexplained IDAs. A wide spectrum of endoscopic pictures may be found. Known as well as supposed risk factors for small bowel lesions may be detected.

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Negative Video Capsule Endoscopy Had a High Negative Predictive Value for Small Bowel Lesions, but Diagnostic Capability May Be Lower in Young Patients with Overt Bleeding

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8825123 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Sipawath Khamplod ◽

Julajak Limsrivilai ◽

Uayporn Kaosombatwattana ◽

Nonthalee Pausawasdi ◽

Phunchai Charatcharoenwitthaya ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Young Patients ◽

Video Capsule Endoscopy ◽

Management Decision ◽

Negative Results ◽

Decision Methods ◽

Cumulative Rate ◽

High Negative Predictive Value

Background. Patients with potential small bowel bleeding (PSBB) who have negative results of video capsule endoscopy (VCE), clinical course, rate of rebleeding, and missed lesions with their predictors are essential for further management decision. Methods. This retrospective study included patients presenting with PSBB who had negative VCE findings between January 2008 and December 2016. All patients had to have at least two years of follow-up data to be included. Patients with <2 years of follow-up in their medical record were interviewed by telephone to determine if any unrecorded rebleeding episodes occurred. Results. One hundred forty-two patients were included. The mean age was 60.9 years, and 52.8% were male. Eighty-one patients presented with overt bleeding. The median duration of follow-up was 5.08 years. During the follow-up period, 30 patients experienced rebleeding. The cumulative rate of rebleeding at 1, 2, and 5 years was 10.0%, 14.3%, and 22.4%, respectively. Multivariate analysis showed nonsteroidal anti-inflammatory drugs (NSAIDs) and presentation of overt bleeding to be independent predictors of rebleeding. There were only nine small bowel lesions (6.3%) missed by VCE. These nine patients, compared with others, were significantly younger and tended to present with overt bleeding. Conclusion. Rebleeding was not uncommon in PSBB after negative VCE; however, the rate of missing small bowel lesions was low. Nonetheless, further investigations may be considered in young patients who present with overt bleeding.

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