Introduction Capsule endoscopy (CE) is a useful tool to assess the small bowel (SB). The 2008 British Society of Gastroenterology (BSG) guidelines detailed the use of CE in occult gastrointestinal bleeding (OGIB) and suspected SB Crohn's disease (CD).1 At present, CE is not available in all district general hospitals (DGH). Our aim was to ascertain the indications for referral and evaluate the diagnostic yield of this test in a multiracial North West London DGH.
Methods We conducted a retrospective analysis of all CE undertaken from April 2009 to December 2011. 136 patients [60 male (44.1%) and 76 female (55.9%); mean age 53.1] were included in this study. Data were collected on patient demographics, previous diagnostic investigations, indications and findings of CE.
Results See Abstract PWE-203 table 1 below. Patients referred for OGIB had negative bidirectional endoscopies. Patients with abdominal pain had imaging to exclude strictures. There were no cases of capsule retention. CE in OGIB revealed the main diagnoses were SB telangiectasia (9/68; 13.2%), non-specific SB inflammation and ulceration (9/68; 13.2%) and erosive gastritis (7/68; 10.3%). Two cases each of portal hypertensive gastropathy, CD, coeliac disease and polypoid lesions were diagnosed (total 11.8%) and one case of angiodysplasia and lipoma (2/68; 3%). Suboptimal views were obtained in 8/68 (11.8%) while CE was normal in 25 patients (36.8%). In the suspected CD group, 14 patients (14/57; 24.6%) were diagnosed with CD (at least 3 SB apthous ulcers and erosions). Non-specific inflammation (5/57; 8.8%) and erosive gastritis (5/57; 8.8%) were also found. Suboptimal views affected five cases and 25 patients (43.9%) had normal CE. One case each of coeliac disease, radiation enteritis and intestinal lymphangiectasia were also diagnosed. One case of SB lymphoma was diagnosed as a complication of coeliac disease. Subgroup analysis according to ethnicity in suspected CD revealed 29 Caucasian (50.9%), 26 Asian (45.6%) and 2 (3.5%) patients of African descent. CD was diagnosed in 8 Caucasians and 6 Asians.
Conclusion In our cohort, diagnostic yield for CD was less than other studies (24.56% vs 43–71%).1 This may reflect the prevalence of CD in an Asian minority area.2 SB telangiectasia and ulceration were the main sources of OGIB. CE is a safe and useful technique to evaluate the SB and we recommend its use in the DGH setting.
Competing interests None declared.
References 1. Sidhu R, Sanders DS, Morris AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut 2008;57:125–36.
2. Yang SK, Loftus EV, Sandborn WJ. Epidemiology of IBD in Asia. Infl Bow Dis 2001;7:260–70.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.