181

R Enns, K Pluta, L Halparin, J Amar, JS Whittaker, H Chaun

Division of Gastroenterology, Department of Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia

BACKGROUND: Capsule endoscopy refers to a novel diagnostic method of imaging the gastrointestinal tract using a wireless capsule which transmits images to a data recorder while the device traverses the small intestine.

OBJECTIVE: We reviewed our experience with capsule endoscopy to determine the indications, outcomes and management of positive findings.

METHODS: Patients are prepared for capsule endoscopy with a single dose of phosphasoda. Following an 8 hour fast, a sensor array system is applied to the abdomen, the capsule is swallowed and the images transmitted to a data recorder worn on the patient’s side. Typically, the battery life of the capsule is 8 hours, following which the data recorder is returned, downloaded to a computer workstation and reviewed.

For obscure bleeding,

RESULTS: To date, 192 capsule studies have been performed in 175 patients. The indications included obscure bleeding (144) (74 Overt, 69 occult), anemia (10), evaluation of IBD (11), screening for polyps (8), pain (14), and abnormal radiological imaging (4). In the setting of obscure bleeding a definitive source of bleeding was discovered in 72 (50%). This included angiodysplasia (46), mitotic lesions (9), ulcers (17). A probable source of bleeding was found in another 9 capsule studies. One patient with anemia was diagnosed with celiac disease. Of 4 patients with abnormal radiological imaging, WCE demonstrated lesions in 1. Twenty-six patients with obscure bleeding underwent laparotomy with curative surgical resection. Two capsules (one patient) became lodged in a previously unrecognized stricture proximal to a ‘j-pouch’ and required endoscopic removal. Although several other capsules were lodged and removed surgically (with the diseased segment), no capsule has caused obstruction.

CONCLUSION: The yield of capsule endoscopy in carefully selected patients with obscure bleeding approximates 50%. The yield in other conditions is less clear. Further studies into cost-effectiveness are required to determine how/if these studies truly affect patient management.

NEXT ABSTRACT >