Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry

Lim

et al. 2020

Sci Rep

Self Cite

Three-dimensional (3D) reconstruction of capsule endoscopic images has been attempted for a long time to obtain more information on small bowel structures. Due to the limited hardware resources of capsule size and battery capacity, software approaches have been studied but have mainly exhibited inherent limitations. Recently, stereo camera-based capsule endoscopy, which can perform hardwareenabled 3D reconstruction, has been developed. We aimed to evaluate the feasibility of newly developed 3D capsule endoscopy in clinical practice. This study was a prospective, single-arm, feasibility study conducted at two university-affiliated hospitals in South Korea. Small bowel evaluation was performed using a newly developed 3D capsule endoscope for patients with obscure gastrointestinal bleeding, suspected or established Crohn's disease, small bowel tumors, and abdominal pain of unknown origin. We assessed the technical limitations, performance, and safety of the new capsule endoscope. Thirty-one patients (20 men and 11 women; mean age: 44.5 years) were enrolled. There was no technical defect preventing adequate visualization of the small bowel. The overall completion rate was 77.4%, the detection rate was 64.5%, and there was no capsule retention. All capsule endoscopic procedures were completed uneventfully. In conclusion, newly developed 3D capsule endoscopy was safe and feasible, showing similar performance as conventional capsule endoscopy. Newly added features of 3D reconstruction and size measurement are expected to be useful in the characterization of subepithelial tumours. Since its development in 2000, capsule endoscopy has played major roles in the evaluation of small bowel disease 1. However, current capsule endoscopy has many limitations, and continuous research and development have been performed to overcome these limirations 2,3. One of the major drawbacks is the inability of capsule endoscopy to measure the accurate size of the lesion. In addition, due to its passive movement and uncontrolled air insufflation, characterization of excavated or polypoid lesions is difficult in some cases (e.g., differentiation of mass and mucosal bulges) 4. To solve these problems, the three-dimensional (3D) reconstruction of the capsule image has been attempted but has shown limited utility so far 4,5. A typical 3D-imaging system requires multiple independent cameras to reconstruct three-dimensional structures. However, due to the limited hardware resources pertaining to capsule size and battery capacity, there has been no hardware-enabled 3D reconstruction to date. Instead, software approaches (e.g., Shape-form-Shading, SfS) have been used to reconstruct 3D small bowel structures 6,7. Software approaches have the fundamental limitation of estimating accurate and robust 3D information without newly added image information. Even though this tool has shown some usefulness in the interpretation of capsule images, it has had limited clinical significance due to its inherent limitations 4,5. Recently, IntroMedic Company (Seoul, ...

Section: Discussionsupporting

confidence: 89%

3D reconstruction of small bowel lesions using stereo camera-based capsule endoscopy

Lim

et al. 2020

Sci Rep

Self Cite

“…Most patients in whom capsule retention occurs are asymptomatic; however, some require surgical or enteroscopic capsule removal [4][5][6][7][8][9]. The clinical performance and complications of small bowel CE include completion rate, capsule retention rate, and indications [2,3]; these have also been described in Korea [10]. This study aimed to investigate the clinical performance and complications of small bowel CE based on 17-year data from a Korean Capsule Endoscopy Registry.…”

Section: Introductionmentioning

confidence: 99%

Changes in performance of small bowel capsule endoscopy based on nationwide data from a Korean Capsule Endoscopy Registry

Kim

Lim

Park

et al. 2020

Korean J Intern Med

Self Cite

Background/Aims: Capsule endoscopy (CE) is widely used for the diagnosis of small bowel diseases. The clinical performance and complications of small bowel CE, including completion rate, capsule retention rate, and indications, have been previously described in Korea. This study aimed at estimating the recent changes in clinical performance and complications of small bowel CE based on 17-year data from a Korean Capsule Endoscopy Registry. Methods: CE registry data from 35 hospitals were retrospectively analyzed. Clinical information, including completion rate, capsule retention rate, and indications, was collected and analyzed. In addition, the most recent 5-year data for CE examinations were compared with the previous 12-year data. Results: A total of 4,650 CE examinations were analyzed. The most common indication for CE was obscure gastrointestinal bleeding (OGIB). The overall incomplete examination rate was 16% and the capsule retention rate was 3%. Crohn's disease was a risk factor for capsule retention. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination. An indication other than OGIB was a risk factor for incomplete examination. A recent increasing trend of CE diagnosis of Crohn's disease was observed. The most recent 5-year incomplete examination rate for CE examinations decreased compared with that of the previous 12 years. Conclusions: The 17-year data suggested that CE is a useful and safe tool for diagnosing small bowel diseases. The incomplete examination rate of CE decreased with time, and OGIB was consistently the main indication for CE. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination.

“…According to the abovementioned definition, in both large population-based studies and in a recently published metaanalysis of 67 studies, the overall CR rate is approximately 2% (5)(6)(7)(8)(9)(10)(11)(12)(13). Recently, Iijima et al (14) evaluated the time-trend of CR rate, by comparing US, EU and Japan pre-marketing and post-marketing data.…”

Section: Preventing Crmentioning

confidence: 99%

“…In fact, the diagnosis of CR has relevant clinical implications (1). Although CR is usually asymptomatic, some cases of acute obstruction and perforation have been reported (6)(7)(8)(9)(10)(11)(12)(13)(52)(53)(54)(55)(56). Furthermore, if CR is readily diagnosed, some subgroups of patients can receive medical treatments (i.e., steroids in IBD patients) (7,57,58), which may favor capsule excretion in up to 20-30% of cases (7,57,58).…”

Section: Cr Diagnosismentioning

confidence: 99%

“…Interestingly, in the second group of patients, the index of suspicion must remain high regardless of the time elapsed between capsule ingestion and the onset of symptoms, as several cases in which acute obstruction has occurred several years after capsule ingestion are reported in the literature (54,61,62). Fortunately, patients with symptomatic CR are a small minority (less than 2% of all retentions) (7,8,(10)(11)(12). Because of clinical symptoms, these patients first undergo abdominal CT and eventually surgical intervention, which is mainly aimed at treating the cause of CR, along with capsule retrieval.…”

Section: Cr Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Capsule retention: prevention, diagnosis and management

Rondonotti¹

2017

Ann. Transl. Med.

Capsule retention (CR) has been defined as capsule remaining in the digestive tract for a minimum of two weeks. CR occurs approximately in 2% of all patients undergoing small bowel capsule endoscopy (CE). Prompt diagnosis of CR is important, as it has relevant clinical implications. CR should be suspected in (I) all asymptomatic patients who do not report capsule excretion within 15 days from capsule ingestion; and (II) patients with obstructive or perforation-related symptoms in which the capsule has not been excreted, regardless of the time between the onset of symptoms and capsule ingestion. Abdominal plain X-ray is the preferred test to confirm CR. An abdominal CT scan should be performed, on individual basis, if knowledge of the precise location of the retained capsule is necessary or whenever clinically indicated. Since CR is usually asymptomatic, an initial watchful monitoring is suggested. In inflammatory bowel disease (IBD) patients, a short course of medical therapy may allow capsule excretion. Nevertheless, in long-term CR, some cases of capsule fragmentation, acute obstruction and perforation have been described. Therefore, retrieval of the retained capsule is recommended if asymptomatic CR lasts for long time. A safe capsule retrieval is usually performed by endoscopy, whereas surgery remains a viable alternative if the first is unsuccessful or when clinically indicated. Either Patency Capsule (PC) or dedicated small bowel cross-sectional imaging techniques have been proposed to prevent CR. Both have pros and cons, but head-to-head comparative studies are lacking.