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DOI: 10.1055/s-2005-921176
Outcome of Capsule Endoscopy in Determining Indication and Route for Push-and-Pull Enteroscopy
Publikationsverlauf
Submitted 25 June 2005
Accepted after revision 24 October 2005
Publikationsdatum:
23. Januar 2006 (online)
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Background and Study Aim: Video capsule endoscopy and push-and-pull enteroscopy (PPE), both allow a complete examination of the small bowel in patients with suspected intestinal disorders. Due to the invasiveness of PPE, indications should probably be selective. The aim of the present prospective study was to evaluate the outcome of an approach whereby capsule endoscopy was used to select patients in whom PPE was indicated.
Patients and Methods: 164 patients were included (90 men; age 54 ± 18 years) with various indications for small-bowel investigation, such as obscure bleeding (n = 88), suspected Crohn’s (n = 14) or celiac (n = 12) disease, or known or strongly suspected localized diseases such as neoplasms (n = 18) for biopsy. Four patients with a suspected intestinal stenosis underwent PPE without prior capsule endoscopy. In the remaining 160 patients, who had a capsule endoscopy, PPE was selected if there were lesions requiring biopsy or angiodysplasias to be treated by argon plasma coagulation (APC). Regarding the insertion route, an anal PPE was indicated if the capsule transit time from ingestion to arrival at the lesion was ≥ 75 % of the total time from ingestion to arrival at the cecum. After gut cleansing, PPE was performed with general anesthesia, and the small bowel was examined until the lesion was reached or the scope could not be advanced further. If the suspected lesion had not been reached, a second procedure was performed through the alternative route, under the same conditions.
Results: The diagnostic yield of capsule endoscopy was 75 %. According to the indications, 47 PPE procedures were performed in 42 patients, including 33 through the oral route, 4 through the anal route and 5 combined ones. Indications were: suspicion of intestinal tumor (n = 13), celiac disease with chronic bleeding (n = 4), suspicion of Crohn’s disease (n = 3), treatment of significant arteriovenous malformations (AVMs) (n = 10), diffuse enteropathies (n = 3), nonsteroidal anti-inflammatory drug (NSAID)-related conditions (n = 2), and obscure digestive bleeding (n = 3). Lesions detected by capsule endoscopy were reached by PPE in all but two cases. The positive predictive value (PPV) of capsule endoscopy to make a correct indication for PPE was 94.7 % and the negative predictive value (NPV) was 98.3 %. The PPV and NPV of a time index of > 0.75 to start via the anal route were 94.7 % and 96.7 %. No complications were observed and all patients were discharged the day after the procedure. Follow-up at 9 months showed that capsule endoscopy followed by PPE had positively influenced the management of 90.5 % of the patients.
Conclusions: The use of capsule endoscopy as a filter for PPE results in effective management of patients with various intestinal diseases. Capsule endoscopy can also direct the choice of route of PPE; a time index of > 0.75 appears to reliably indicate an anal route so that a double procedure is required in only about 12 % of cases.
References
- 1 Waye J D. Small bowel endoscopy. Endoscopy. 1992; 24 68-72
- 2 Krevsky B. Enteroscopy: exploring the final frontier. Gastroenterology. 1991; 100 838-839
- 3 Moch A, Herlinger H, Kochman M L. et al . Enteroclysis in the evaluation of obscure gastrointestinal bleeding. AJR Am J Roentgenol. 1994; 163 1381-1384
- 4 Orjollet-Lecoanet C, Menard Y, Martins A. et al . CT enteroclysis for detection of small bowel tumors. J Radiol. 2000; 81 618-627
- 5 Umschaden H W, Szolar D, Gasser J. et al . Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology. 2000; 215 717-725
- 6 Meron G D. The development of the swallowable video capsule (M2A). Gastrointest Endosc. 2000; 52 817-819
- 7 Saurin J C, Delvaux M, Gaudin J L. et al . Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push enteroscopy. Endoscopy. 2003; 35 576-584
- 8 Ell C, Remke S, May A, Helou L. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy. 2002; 34 685-689
- 9 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
- 10 Caspari R, von Falkenhausen M, Krautmacher C. et al . Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers syndrome. Endoscopy. 2004; 36 1054-1059
- 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 Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months. Endoscopy. 2004; 36 1067-1073
- 13 Saurin J C, Delvaux M, Vahedi K. et al . Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy. 2005; 37 318-323
- 14 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a non-surgical steerable double-balloon method. Gastrointest Endosc. 2001; 53 216-220
- 15 Yamamoto H, Yano T, Kita H. et al . New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003; 125 1556-1557
- 16 American Gastroenterological Association . Medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000; 118 197-200
- 17 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
- 18 Van Gossum A, Hittelet A, Schmit A. et al . A prospective comparative study of push and wireless-capsule enteroscopy in patients with obscure digestive bleeding. Acta Gastroenterol Belg. 2003; 66 199-205
- 19 Schmit A, Gay F, Adler M. et al . Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias. Dig Dis Sci. 1996; 41 2348-2352
- 20 Shiba M, Higuchi K, Kameda N. et al . Wireless capsule endoscopy and double balloon enteroscopy in Japanese patients with obscure gastrointestinal bleeding [abstract]. Gastrointest. Endosc. 2005; 61 AB182
- 21 Nakamura M, Niwa Y, Ohmiya N. et al . A preliminary comparison of capsule endoscopy and double balloon enteroscopy in patients with suspected small bowel bleeding [abstract]. Gastrointest. Endosc. 2005; 61 AB176
- 22 Fireman Z, Mahajna E, Broide E. et al . Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut. 2003; 52 390-392
- 23 Fireman Z, Eliakim R, Adler S, Scapa E. Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel. Eur J Gastroenterol Hepatol. 2004; 16 927-931
- 24 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004; 2 1010-1016
- 25 Delvaux M, Gay G. Video capsule endoscopy: facts and perspectives. Best Clin Pract Res. 2005; In press
- 26 Mosca S, Morace F, Secondulfo M. How can we measure insertion depth during the enteroscopic push procedure?. Endoscopy. 2001; 33 1082-1083
- 27 May A, Nachbar L, Schneider M. et al . Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer. Endoscopy. 2005; 37 66-70
- 28 Kita H, Yamamoto H, Nakamura T. et al . Bleeding polyp in the mid-intestine identified by capsule endoscopy and treated by double balloon endoscopy. Gastrointest. Endosc. 2005; 61 628-629
M. Delvaux, M. D. Ph. D.
Deparment of Internal Medicine and Digestive Pathology · Hôpitaux de Brabois Adultes · Tour Drouet · CHU de Nancy
54511 Vandoeuvre les Nancy · France
Fax: +33-383154012
eMail: m.delvaux@chu-nancy.fr