Endoscopy 2006; 38(5): 498-502
DOI: 10.1055/s-2006-925340
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

The Yield of Capsule Endoscopy in Patients with Abdominal Pain or Diarrhea

L.  C.  Fry1 , E.  J.  Carey1 , A.  D.  Shiff1 , R.  I.  Heigh1 , V.  K.  Sharma1 , J.  K.  Post1 , J.  G.  Hentz2 , D.  E.  Fleischer1 , J.  A.  Leighton1
  • 1Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
  • 2Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona, USA
Further Information

Publication History

Submitted 23 December 2005

Accepted after revision 25 January 2006

Publication Date:
09 May 2006 (online)

Background and Study Aims: Capsule endoscopy, proven effective for evaluation of obscure gastrointestinal bleeding and suspected Crohn’s disease, is increasingly used to investigate other small-intestine disorders, but its yield for other indications is not well known. We sought to evaluate its yield and findings for abdominal pain or diarrhea.
Patients and Methods: Medical records of patients with abdominal pain or diarrhea (> 6 weeks’ duration) who underwent capsule endoscopy between August 2001 and June 2004 were retrospectively reviewed for demographic data, indications, findings, diagnoses, complications, and radiologic studies. All patients had previous endoscopic or radiologic examinations (colonoscopy, enteroscopy, upper endoscopy, small-bowel series, computed tomography enterography, or computed tomography) demonstrating no abnormalities sufficient for diagnosis.
Results: 64 patients (26 men; 38 women; mean age, 43 years; age range, 19 - 83 years) who met study criteria had 68 capsule endoscopy studies. Indications were abdominal pain (35 patients), diarrhea (14), or both (15). Complete small-bowel visualization with identification of the cecum was achieved in 81 %; yield of positive findings was 9 % (6 patients). By indications, the yield was 6 % for abdominal pain, 14 % for diarrhea, and 13 % for both. Diagnoses included Crohn’s disease (3), enteropathy induced by nonsteroidal anti-inflammatory drugs (2), and submucosal tumor (1). Capsule retention occurred in two patients, requiring surgical removal.
Conclusions: Capsule endoscopy had a low yield for evaluation of abdominal pain or diarrhea and cannot be recommended as a first-line test without further study. Nonetheless, it facilitated diagnosis in 9 % of patients with negative endoscopic and radiologic examinations.

References

  • 1 Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy.  Nature. 2000;  405 417
  • 2 Ginsberg G G, Barkun A N, Bosco J J. et al . Wireless capsule endoscopy: August 2002.  Gastrointest Endosc. 2002;  56 621-624
  • 3 Liangpunsakul S, Chadalawada V, Rex D K. et al . Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis.  Am J Gastroenterol. 2003;  98 1295-1298
  • 4 Hara A K, Leighton J A, Sharma V K, Fleischer D E. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.  Radiology. 2004;  230 260-265. Epub 2003 Nov 14
  • 5 Eliakim R, Fischer D, Suissa A. et al . Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease.  Eur J Gastroenterol Hepatol. 2003;  15 363-367
  • 6 Voderholzer W A, Ortner M, Rogalla P. et al . Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis.  Endoscopy. 2003;  35 1009-1014
  • 7 Heigh R I, Leighton J A, Hara A. et al . Diagnosing small bowel (SB) Crohn’s disease (CD): video capsule endoscopy (VCE) and CT enterography (CTE) lead the way: small bowel follow through (SBFT) less helpful [abstract].  Gastroenterology. 2003;  124 (Suppl 1) A37
  • 8 Eliakim R. Wireless capsule video endoscopy: three years of experience.  World J Gastroenterol. 2004;  10 1238-1239
  • 9 Lewis B S, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study.  Gastrointest Endosc. 2002;  56 349-353
  • 10 Herrerias J M, Caunedo A, Rodriguez-Tellez M. et al . Capsule endoscopy in patients with suspected Crohn’s disease and negative endoscopy.  Endoscopy. 2003;  35 564-568
  • 11 Pennazio M, Santucci R, Rondonotti E. et al . Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases.  Gastroenterology. 2004;  126 643-653
  • 12 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 385-389
  • 13 Fireman Z, Mahajna E, Broide E. et al . Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy.  Gut. 2003;  52 390-392
  • 14 Triester S L, Leighton J A, Leontiadis G I. et al . A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2005;  100 2407-2418
  • 15 Dubcenco E, Jeejeebhoy K N, Petroniene R. et al . Capsule endoscopy findings in patients with established and suspected small-bowel Crohn’s disease: correlation with radiologic, endoscopic, and histologic findings.  Gastrointest Endosc. 2005;  62 538-544
  • 16 Bardan E, Nadler M, Chowers Y. et al . Capsule endoscopy for the evaluation of patients with chronic abdominal pain.  Endoscopy. 2003;  35 688-689
  • 17 Mele C, Infantolino A, Conn M. et al . The diagnostic yield of wireless capsule endoscopy in patients with unexplained abdominal pain [abstract].  Am J Gastroenterol. 2003;  98 S298
  • 18 Kornbluth A, Colombel J F, Leighton J A, Loftus E, ICCE . ICCE consensus for inflammatory bowel disease.  Endoscopy. 2005;  37 1051-1054
  • 19 Yousfi M M, de Petris G, Leighton J A. et al . Diaphragm disease after use of nonsteroidal anti-inflammatory agents: first report of diagnosis with capsule endoscopy.  J Clin Gastroenterol. 2004;  38 686-691
  • 20 Culliford A, Daly J, Diamond B. et al . The value of wireless capsule endoscopy in patients with complicated celiac disease.  Gastrointest Endosc. 2005;  62 55-61
  • 21 Mata A, Llach J, Castells A. et al . A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes.  Gastrointest Endosc. 2005;  61 721-725
  • 22 Sriram P V, Rao G V, Reddy D N. Wireless capsule endoscopy: experience in a tropical country.  J Gastroenterol Hepatol. 2004;  19 63-67
  • 23 Kalantzis N, Papanikolaou I S, Giannakoulopoulou E. et al . Capsule endoscopy: the cumulative experience from its use in 193 patients with suspected small bowel disease.  Hepatogastroenterology. 2005;  52 414-419
  • 24 Keuchel M, Hagenmüller F. Video capsule endoscopy in the work-up of abdominal pain.  Gastrointest Endosc Clin N Am. 2004;  14 195-205
  • 25 Lankisch P G, Gaetke T, Gerzmann J, Becher R. The role of enteroclysis in the diagnosis of unexplained gastrointestinal symptoms: a prospective assessment.  Z Gastroenterol. 1998;  36 281-286
  • 26 Landi B, Tkoub M, Gaudric M. et al . Diagnostic yield of push-type enteroscopy in relation to indication.  Gut. 1998;  42 421-425

J. A. Leighton, M. D.

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