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Nutrition/Coeliac/Small bowel free papers 063–076

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M. Mylonaki, A. Fritscher-Ravens, P. Swain.Department of Gastroenterology, Royal London Hospital, Whitechapel, London E1 1BB, UK

Background: The development of wireless capsule endoscopy allows painless imaging of the gastrointestinal tract. The clinical utility and performance characteristics of this examination are unknown.

Aim: To assess the clinical efficacy and technical performance of wireless capsule endoscopy in a series of 55 patients.

Methods: A wireless capsule endoscope measuring 11 x 27 mm was used. It contained a light source, CMOS imager, colour television transmitter and silver oxide batteries encapsulated in a strong plastic container with a transparent optical dome window. The 50,000 transmitted images are received via an array of 8 aerials and stored on a portable solid-state recorder, which is carried on a belt.

Results: In a subset of 38 patients push-enteroscopy was compared with capsule endoscopy. A bleeding source was discovered in the small intestine in 21 of 38 patients (55%). These included angiodysplasia (11), fresh blood (5), ileal ulcer (1) tumour (2), Meckel's diverticulum (1) vasculitis (1). Active intestinal bleeding was seen in 3. No additional intestinal diagnoses were made by enteroscopy. The yield of push-enteroscopy in evaluating obscure bleeding was 30% (12/38). The capsule found significantly more intestinal bleeding abnormalities than push enteroscopy (p<0.05). A source of bleeding was identified beyond the reach of the push enteroscope in 9/21 (42%). Therapy was altered in 50% and in 3 patients, who had required more than 100 units of blood, directed surgery cured (2) or markedly reduced (1) the bleeding. Patients always preferred capsule endoscopy to push-enteroscopy (p<0.001). There were no complications. Preparation with picolax improved images in patients on iron or with blood in the intestine. 7 patients had no push-enteroscopy. Studies in volunteers (7) and patients with chronic abdominal pain (3) were mostly normal – erosions in …

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