Capsule Endoscopy of the Upper Gastrointestinal Tract – The Need for a Second Endoscopy

Peter, Shajan; Heuss, Ludwig T.; Beglinger, Christoph; Degen, Lukas

doi:10.1159/000089959

Cited by 11 publications

(14 citation statements)

References 49 publications

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“…So we propose that performing a second EGD might have prevented the need for WCE in these cases. Although the prevalence of gastric and duodenal lesions in our local population diagnosed with OGIB is slightly superior to other series, the results are similar enough to make them consistent with present literature references (10,11,41,42). In our country other studies with WCE have shown gastro-duodenal lesions in 3.4-9% of subjects (43,44).…”

Section: Discussionsupporting

confidence: 89%

“…Although some published algorithms even suggest a repeat upper endoscopy before submitting the patient for WCE to complete the study of the small bowel (7), some authors postulate that the final decision should rely either on the preferences of the endoscopist performing the first EGD (8) or according to the findings of WCE once completed (9). This latter statement has been supported by results from some retrospective studies published in the last few years (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Velayos¹,

Tejada

Fernández³

et al. 2009

Rev. esp. enferm. dig.

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Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease.Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy.Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study.Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases.Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes.A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Velayos¹,

Tejada

Fernández³

et al. 2009

Rev. esp. enferm. dig.

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“…Other theories relate to the procedure itself, in terms of the quality of colon preparation, complete examination rates or endoscopists experience (29). In this clinical scenario, the usual recommendation is to repeat the endoscopic procedure, especially if signs or symptoms persist, if there is a suspicion of missed lesions or poor colon cleansing, or when the cecum is not reached (9,(29)(30)(31).…”

Section: Sbce Has Been Developed To Examine the Sb In A Simple And Nomentioning

confidence: 99%

“…It has not been demonstrated that a second-look colonoscopy enhances the diagnostic yield and thus SB exploration should be performed (9,(29)(30)(31). It is important to ensure that SBCE examines the entire SB.…”

Section: Sbce Has Been Developed To Examine the Sb In A Simple And Nomentioning

confidence: 99%

Colonic lesions in patients undergoing small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact

et al. 2017

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Background: Nowadays, capsule endoscopy is the first-line procedure to assess the small bowel. During small bowel procedures, other segments of the gastrointestinal tract may be visualized. The aim of the current study was to evaluate the incidence of colonic abnormalities in patients undergoing small bowel capsule and its impact on patient management.Patients and methods: This study is a retrospective analysis of data from 526 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between 2008 and 2011. Patients with incomplete procedures were excluded from the analysis. Patient baseline characteristics, colonic lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed.Results: Four hundred and sixty four patients were finally included in the analysis. Two hundred and ninety three patients were male (57.3%) and the mean age was 61.3 ± 20.03 years (18-86). Obscure gastrointestinal bleeding (59%) and inflammatory bowel disease (19%) were the main indications for the procedure. Colonic abnormalities were detected by capsule endoscopy in 47 (9%) of 464 patients. The most common types of missed lesions were vascular lesions (34%) and colonic ulcers (32%). This information had a clinical or diagnostic impact of 7.55% and a therapeutic impact of 6.03%.Conclusion: All images of the colon should be evaluated during small bowel capsule endoscopy as they may provide relevant information that may result in changes in patient management.

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“…We should be in the "optimal diagnostic time" to most adequately address the dilemma posed by the authors: a second UDE procedure before SBCE? The answer to this question should be guided by patient status and the estimated quality of the initial UDE exam (18), in terms of whether any limitations occurred.…”

Section: Editorialmentioning

confidence: 99%

Capsule endoscopy: are we making the most of all its benefits?

Pérez-Cuadrado-Martínez

2009

Rev. esp. enferm. dig.

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Since small-bowel (SB) endoscopic exploration beyond Treitz's angle (usually the farthest point reached by upper digestive endoscopy (UDE) with a gastroscope) was introduced, upper digestive tract (UDT) lesions overlooked by UDE were reported, diagnosed "de novo" initially by oral push enteroscopy (OPE) (2), and subsequently by small-bowel capsule endoscopy (SBCE) (3) and then double-balloon enteroscopy (DBE). All these endoscopic explorations went through segments already examined by prior UDEs that had yielded negative results even when performed by the same clinician. Why is this?In this issue Benito Velayos and colleagues (4) study this, and report their retrospective UDT findings following diagnosis with SBCE after a single negative UDE procedure. They specifically refer to obscure gastrointestinal bleeding (OGIB). In a substantial 17% of patients the authors diagnosed UDT conditions significant enough to indicate a second UDE, with a high impact on patient management changes.Consistency in so-called "stable" mucosal lesions such as polyps is easier with endoscopy as compared to changing conditions such as digestive bleeding, where the time factor has proven critical for diagnostic effectiveness. In the natural history of hemorrhage CE may document initial bleeding findings (often not revealing the underlying cause, made invisible by blood itself), the responsible lesion, or finally a scarred or healed lesion with no pathological findings whatsoever. The dominant lesion, the true origin of bleeding, must be differentiated from simple findings. Angiodysplasia, the "princeps" lesion in OGIB, may also be a clinically non-significant finding, particularly if small in size and no bleeding is seen to originate in it. This is probably the case with the finding by the authors of gastro-duodenal angiodysplasia using SBCE in a patient where an initial UDE provided no diagnosis and a second UDE procedure finally found gastric cancer.Our concern is intrinsically complex when the lesion also is vascular in nature -despite attempts at nomenclature standardization for these lesions, a single endoscopic exam may provide various diagnostic interpretations regarding characterization, whereas a second exploration, even by the same clinician, may set the record straight.OGIB has been recently defined by the 2007 world consensus meeting in Berlin (5) as any gastrointestinal bleeding event whose cause remains unknown after UDE and colonoscopy with ileoscopy. Bleeding should be located in the SB if its origin in the UDT and colon was effectively excluded, which has given rise to a new emerging concept: mid gastrointestinal bleeding (MGIB) (6), with particular characteristics versus the traditional lower gastrointestinal bleeding (LGIB) beyond Treitz's angle. In MGIB the origin of bleeding lies within the SB, between the papilla of Vater and Bahuin's valve, and this condition has a special behavior regarding severity, transfusional requirements, stays, and overall cost, even if it only represents Capsule endoscopy -are we making t...

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Capsule Endoscopy of the Upper Gastrointestinal Tract – The Need for a Second Endoscopy

Cited by 11 publications

References 49 publications

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Colonic lesions in patients undergoing small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact

Capsule endoscopy: are we making the most of all its benefits?

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