Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps

Abstract

BackgroundFamilial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps.Method20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history.ResultsWithin the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum.ConclusionCE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12608000616370

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

“…89 Diagnostic test and cohort studies in patients with FAP or PJS have shown that CE has a better diagnostic yield than endoscopy for the detection of small-bowel polyps, whereas endoscopy was superior for the detection of duodenal polyps. 87,90,91 CE has been shown to detect more and smaller jejunal-ileal polyps than other imaging modalities including radiography and MRE, 88,[91][92][93] and had similar detection rates to device-assisted enteroscopy 94 in patients with FAP or PJS.…”

First clinical trial of a newly developed capsule endoscope with panoramic side view for small bowel: A pilot study

“…25 Capsocam SV1 technology combines high frame frequency, multiple cameras with side views, and long operation time for an excellent and qualified examination of the small bowel. Regarding obscure small bowel bleeding [26][27][28] and familial adenomatous polyposis, 4,29 Capsocam SV1 could enhance the diagnostic value of capsule endoscopy 30 also when compared with double balloon endoscopy. [31][32][33][34][35][36] The newly described low detection rate of small bowel lesions as a consequence of disappointing physician performance 36 may be overcome with the use of Capsocam SV1 imaging.…”

Genetic risks and familial associations of small bowel carcinoma

“…Polyps that were smaller than 5 mm were exclusively seen with capsule endoscopy. However, location of the detected polyps and determination of their exact sizes was more accurate by MRI [76,77] . Drawback for VCU include capsule retention, missed polyps < 1 cm, especially duodenal polyps (due to rapid transit) [73,78] .…”