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video capsule endoscopy (PillCam)

Indications: 1) small intestinal disorders a) celiac disease or other malabsorption b) Crohn's disease, (now gold standard) [4] c) small bowel tumors d) chronic abdominal pain e) small intestinal hemorrhage, obscure GI bleed - normal upper GI endoscopy & lower GI endoscopy - repeat gastrointestinal endoscopy recommended prior to capsule endoscopy [8,9] - identified source of 15/20 acute upper GI hemorrhages with negative upper GI endoscopy [10] 2) esophageal disorders a) Barrett's esophagus b) esophagitis, GERD c) esophageal varices 3) gastroparesis [8] * FDA approved for small bowel examination * as safe in elderly >= 80 years of age & with higher diagnostic yield than in adults 65-79 years of age [11] Contraindications: 1) intestinal stricture 2) swallowing disorder 3) cardiac pacemaker (esophagus) 4) achalasia, Zenker's diverticula, gastroparesis 5) psychiatric illness * NOT approved for colon cancer screening Procedure: outpatient procedure 1) the patient swallows a small capsule 2) the capsule contains a miniature camera that continuously photographs the gastrointestinal tract & transmits the images to a receiving unit worn by the patient 3) 8 hours of recording 4) 26 x 11 mm disposable capsule passed in the feces naturally, generally within 24 hours. Biodegradable capusles on the horizon. [4] 5) Videorecorder attached to patient, back & belt pack 6) Patient may eat (liquids) after 4 hours. 7) Data loaded into computer after a) 8 hours (intestine) b) 20 minutes (esophagus) Sensitivity 90%, Specificity 95% (intestinal indications) Advantages: 1) more sensitive for angiodysplasia, ulceration & intestinal tumors than contrast CT 2) no sedation 3) improves diagnostic yield for occult GI bleed [7] Disadvantages: 1) precise location of observed lesion is unclear 2) does not improve outcomes [7] Complications: - surgery to remove capsule (rare) Management: - push enteroscopy for upper GI bleed localized to the distal duodenum or proximal jejunum [8] Notes: Pillcam ESO for esophagus ($450) Sensitivity insufficient for use in colon cancer screening. Using traditional colonoscopy as the standard of comparison, capsule endoscopy had a sensitivity of: - 64% for detecting polyps 6 mm or larger - 73% for advanced adenomas 6 mm or larger - 74% for cancers. - sensitivities were higher with more thorough bowel preparation

General

capsule endoscopy

References

  1. Journal Watch 22(24):173, 2002 Costamanga G et al, Gastroenterology 123:999, 2002 PMID: 12360460 Faigel DO & Fennerty MB, Gastroenterology 123:1385, 2002
  2. Journal Watch 24(4):30, 2004 Hara AK et al, Radiology 230:260, 2004 PMID: 14617764
  3. Journal Watch 24(9):75, 2004 Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, De Franchis R. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology. 2004 Mar;126(3):643-53. PMID: 14988816
  4. Mann , Veterans Administration, Mather CA, Oct 2005
  5. Sturniolo GC et al, Small bowel exploration by wireless capsule endoscopy: Results from 314 procedures. Am J Med 2006; 119:341 PMID: 16564777
  6. Van Gossum A et al Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer N Eng J Med 2009, 361:264-270 July 16, 2009 PMID: 19605831 http://content.nejm.org/cgi/content/short/361/3/264
  7. Laine L et al. Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography. Gastroenterology 2010 May; 138:1673. PMID: 20138043
  8. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  9. ASGE Standards of Practice Committee, Fisher L, Lee Krinsky M, Anderson MA et al The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc. 2010 Sep;72(3):471-9. PMID: 20801285
  10. Schlag C et al. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2014 Nov 26 PMID: 25432532 http://www.giejournal.org/article/S0016-5107%2814%2902255-X/abstract
  11. Thurm T, Gluck N, Barak O, Deutsch L. Octa-nonagenarians can perform video capsule endoscopy safely and with a higher diagnostic yield than 65-79 year-old patients. J Am Geriatr Soc. 2022 Oct;70(10):2958-2966. Epub 2022 Jul 5. PMID: 35788980 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17953
  12. Enns RA, Hookey L, Armstrong D, Bernstein CN et al Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology. 2017 Feb;152(3):497-514. PMID: 28063287 Review.
  13. Brito HP, Ribeiro IB, de Moura DTH et al Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis. World J Gastrointest Endosc. 2018 Dec 16;10(12):400-421. PMID: 30631404 PMCID: PMC6323498 Free PMC article.
  14. http://www.PillCam.com http://www.PillCam.com/ESO