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Asteinza 1 , J. Loscos 1 , S. Madrid, Spain. Introduction: the capsule endoscopy CE , from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. Material and methods: retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique.
One took to end a descriptive and analytical analysis. Results: there was achieved a total of explorations in patients. The obscure gastrointestinal bleeding was the most frequent indication Angiodisplasia was the endoscopic lesion more frequently detected The global diagnostic yield as for the detection of injuries was Conclusions: the capsule endoscopy is a technique consolidated and as his potential is known, his indications are extended. The obscure gastrointestinal bleeding is the most frequent indication and the angiodisplasia the most identified injury. Once known his diagnostic yield, larger studies are needed that assess the influence of capsule endoscopy on clinical outcoumes.
Key words: Capsule endoscopy. Obscure digestive bleeding.
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Occult gastrointestinal bleeding. Iron deficiency anemia. Crohn's disease. Capsule endoscopy CE has become a first-rate diagnostic procedure for the study of small bowel SB -related diseases Since the technique was approved by the FDA August , its indications have varied as its potential diagnostic power and possible repercussions on subsequent therapeutic attitudes became known.
Nowadays the main indication of the CE is gastrointestinal bleeding of obscure origin OGB , either in the form of occult bleeding iron-deficiency anemia, positive occult blood in feces or manifest bleeding where blood is visible, although no cause has been identified even after upper and lower endoscopic examinations Another confirmed indication is Crohn's disease CD , although it may be primary contraindicated because of stenosis and it has the limitations of absence of histological confirmation and a difficult differential diagnosis with other conditions with similar characteristics 12, Other indications for CE are: SB tumors, predominant and generally discovered in the context of OGB, or suspected based on some imaging studies; gastrointestinal polyposis 14 , malabsorption and eventually abdominal pain or symptoms of irritable bowel syndrome after some study on diagnostic effectiveness 3.
In number of studies, CE has demonstrated better global results than other diagnostic methods, such as push enteroscopy, enteroclysis or conventional bowel follow-through, which also evaluate the SB 13, After approval by the European Agency in August , it began to be used in daily clinical practice at our hospital as a reference center. The aim of the present study is to report our experience with the CE since this procedure was implemented in our hospital, emphasizing its indications and diagnostic performance.
The following data were noted for each patient: age, sex, origin, reason for consultation, previous diagnostic procedures, endoscopic diagnosis, and incidents inherent to the technique. All examinations were carried out using the M2A Given Imaging capsule following certain preparatory rules, including: fasting for 12 hours; no iron consumption for 10 days prior to the examination; no fruits, starch, vegetables or bread for 3 days before the test, and liquids only the day before.
As a general rule, no specific oral preparation was necessary, and prokinetics were administered to patients with founded suspicions of delayed passage, including bedridden and diabetic subjects. In each case, weight, height and waist measurements were taken and fed into the computer and recorder. Guidelines followed for the examination were as follows:. Walk as much as possible and avoid sitting down for long periods or lying down. Fasting for 3 hours, after which, some liquids not dairy products may be taken. After 3 hours, a "light" snack may be taken with liquid.
If the capsule has not been expelled within 1 week, the doctor must be consulted without undergoing any magnetic resonance procedures in the meantime. All procedures were carried out with the written consent of the patient or legal representative where applicable, and the reading of studies was carried out by different doctors at the Endoscopy Department. The program used for both the descriptive and analytical statistical studies was SPSS, version A total of examinations were performed on patients.
Average patient age was In the 7. Regarding endoscopic diagnosis, angiodysplasia was the most commonly detected lesion When the reason for consultation was OGB in the form of occult bleeding, angiodysplasia was the most frequently detected lesion However, in In case of manifest bleeding, angiodysplasia was also the most commonly detected lesion On a pooled examination of OGB, angiodysplasia was the most frequently observed lesion [ It is important to report that when the reason for testing was OGB, blood was found in the gastrointestinal tract in In the case of abdominal pain-irritable bowel-type symptoms IBS , the examination was normal in 8 of them Eleven cases 2.
In 2 cases In Overall effectiveness with regard to the detection of lesions was There were 7 subjects 1. There were 2 cases 0. Finally, we performed this examination in 13 patients 3. No interference or malfunction was observed in any of these patients in either way between the capsule and the pacemaker.
CE is a first-rate procedure for the study of small-bowel diseases that has become increasingly consolidated. Its indications have increased as its potential diagnostic and subsequent repercussions have been demonstrated. Nowadays, OGB, either in the form of chronic anemia or in the form of manifest bleeding, continues to be the main indication for CE.
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In our study, OGB represented the Angiodysplasia was the most frequent finding in our study This percentage decreases when the study is carried out in younger patients. In our study, the diagnostic effectiveness of CE was Regarding diagnostic effectiveness, certain clarifications and caution with results should be done. In practically all published studies, reference is made to lesions found whatever their nature and relationship with problem of the patient. Thus, the existence of blood in the gastrointestinal lumen is considered a positive finding even when no source of the bleeding could be identified.
In this respect, it is essential to classify CE findings on the basis of the greater or lesser reliability with which the patient symptoms can be ascribed to these findings. The effectiveness of CE in OGB is clearly greater when bleeding is active when compared to occult bleeding In tests performed in our hospital, the percentage of examinations with no findings was more than 2-fold for occult OGB as compared to manifest OGB.
The same is the case with CD. In different studies CE has demonstrated one way or another that it is superior to other diagnostic procedures that also evaluate the SB -for instance, follow-through, enteroclysis, CT scans, and even push enteroscopy 7,8,12,13,15, CE is quite a safe procedure allowing a complete view of the SB in a large percentage In our patients, one case of acute abdominal pain occurred, but it has been published a study in which it took place in The evolution of endoscopy: wireless capsule cameras for the diagnosis of occult gastrointestinal bleeding and inflammatory bowel disease.
Surg Innov. Wireless capsule endoscopy. Waterman M, Eliakim R. Capsule enteroscopy of the small intestine. Abdom Imaging. Lewis BS.
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How to read wireless capsule endoscopic images: tips of the trade. Gastrointest Endosc Clin N Am. Gastrointes Endosc. European Society of Gastrointestinal Endoscopy ESGE : Recommendations on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Eliakim R. Video capsule endoscopy of the small bowel. Curr Opin Gastroenterol.
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Niv Y. Efficiency of bowel preparation for capsule endoscopy examina- tion: a meta-analysis. World J Gastroenterol. Safety, reliability and limitations of the given patency capsule in patients at risk of capsule retention: a 3- year technical review. Dig Dis Sci. Capsule Endoscopy Dr. References 1.