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Small bowel I
PTU-142 Small bowel capsule endoscopy: a review of 232 studies undertaken at a single centre
  1. A M Verma,
  2. R Ramiah,
  3. D Legge,
  4. A Dixon
  1. Gastroenterology, Kettering General Hospital, Kettering, UK

Abstract

Introduction Capsule endoscopy (CE) is the modality of choice for investigating small bowel pathology. It is non-invasive, tolerated, safe and reliable. The BSG have issued guidance on the use of CE for patients with obscure gastrointestinal bleeding (OGB) and for patients with a high suspicion of small bowel Crohn's disease undetected by conventional means, in Kettering General Hospital (KGH) CE has been used extensively for this as MR enteroclysis is not available. KGH introduced a CE service in 2008. In 3+ years, 232 studies have been reported. KGH uses Diagmed/Given PillCam 2 CE. Patients take two sachets of Klean prep prior to their study. Patients do not undergo patency capsule testing. Patients take the capsule and using a laptop computer, a real time image is visualised, ensuring the capsule has passed into the small bowel. Patients are sent home and keep the recording belt and box on for 12–15 h. If capsule does not pass into small bowel patients are given a pro-kinetic and if that fails they undergo a gastroscopy to introduce the capsule into the distal duodenum (rarely required).

Methods Demographic data, indications, quality of bowel preparation and diagnosis is recorded in a database. This has been analysed using Mircrosoft Excel.

Results Overall: 232 studies, mean age = 54.93 years, median = 57.31 years. 114 males, mean age= 57.83 years, median = 60.80 years. 118 females, mean age = 52.07, median = 52.5 years. Yield of pathology = 100 studies (43.10%). 3 capsules retained (1.72%)—2 strictures, 1 trapped in diverticulum. Obscure GI bleeding/anaemia as an indication: 174 studies, yield = 72 studies (41.38%). Diagnoses: angioectasia 13, erosions/ulcers 11 (gastric 3), Crohn's disease 6, tumours 6, active bleeding 5, polyps 5, stenosis/stricture = 5. Other indications: 58 studies: ?Crohn's disease 46 (yield = 22/47.83%), known Crohn's 6, abnormal imaging = 3, other = 3.

Conclusion This series of CE studies reveals a yield of 43.10% with a low capsule retention rate of 1.73%. As these patients have had multiple investigations (endoscopies/cross sectional imaging) it suggests that in patients with suspected small bowel pathology, CE is very useful (with a high yield) and safe. For OGB the yield is 41.38% with common diagnoses being angioectasia, ulcers/erosions. Occasionally active bleeding, polyps and tumours are seen. This confirms the importance of CE in investigating OGB. For suspected Crohns's disease the yield is high (47.83%). This confirms that as long as patients don't have symptoms of sub-acute small bowel obstruction, CE is a very useful diagnostic modality for small bowel Crohn's disease.

Competing interests None declared.

Reference 1. Sidhu R, Sanders DS, Morris AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut 2008;57:125–36.

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