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K Go¹, K Pluta², R Enns²

¹Department of Medicine, University of Toronto, Toronto, Ontario; ²Division of Gastroenterology, Department of Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia

BACKGROUND: Capsule endoscopy (CE) is a new method of assessing the GI tract primarily designed to image the small intestine. The primary indication is for obscure gastrointestinal bleeding. Although yields of over 50% have been documented with CE, some of these lesions are within reach of a standard endoscope and therefore, the true benefit of CE may be overestimated.

OBJECTIVE: We evaluated our CE studies to determine how many of the positive results could have been diagnosed with standard endoscopic methods.

METHODS: All CE performed between 12/01 and 10/03 were evaluated. CE was performed in standard fashion with an overnight fast. All patients had previously had at least one upper endoscopy, one colonoscopy and small bowel barium study. All positive studies were noted; the site of the lesion estimated. In sites of controversy, consensus opinion was used to determine if the lesion was within reach of the endoscope. Lesions were classified as within reach of a colonoscope (C), endoscope (E) or enteroscope (En). For the purposes of this study an enteroscope was considered a ‘standard endoscope.’

RESULTS: A total of 165 CE were reviewed. Of these 83 demonstrated lesions that were felt to be definitely positive on CE. Of these 83 CE at total of 27 (33%) were felt likely to have been reached by standard endoscopy (7), enteroscopy (12) or colonoscopy (8). In 4 of these cases, the lesions had been seen at endoscopy and the capsule study was performed to exclude other lesions. In the other cases, the site of disease was not recognized.

CONCLUSION: In over one-third of cases where CE has been definitively positive, the lesion found was within reach of a standard endoscope.

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