Research Report
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World J Gastroenterol. Apr 14, 2014; 20(14): 4025-4029
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.4025
Non-small-bowel abnormalities identified during small bowel capsule endoscopy
Reinier A Hoedemaker, Jessie Westerhof, Rinse K Weersma, Jan J Koornstra
Reinier A Hoedemaker, Jessie Westerhof, Rinse K Weersma, Jan J Koornstra, Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
Author contributions: Hoedemaker RA and Westerhof J acquired the data, performed statistical analysis and wrote the manuscript; Weersma RK and Koornstra JJ were responsible for the study concept and design, and were involved in editing the manuscript.
Correspondence to: Jan J Koornstra, MD, PhD, Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. j.j.koornstra@umcg.nl
Telephone: +31-50-3613354 Fax: +31-50-3619306
Received: August 30, 2012
Revised: April 20, 2013
Accepted: May 18, 2013
Published online: April 14, 2014
Processing time: 591 Days and 19.4 Hours
Abstract

AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed.

METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as bleeding from the digestive tract that persists or recurs without an obvious etiology after a normal gastroduodenoscopy and colonoscopy. Nevertheless, capsule endoscopy sometimes reveals findings outside the small bowel, i.e., within reach of conventional endoscopes. In this retrospective single center study, 595 patients undergoing capsule endoscopy between 2003 and 2009 were studied. The incidence of non-small bowel abnormalities was defined as visible abnormalities detected by capsule endoscopy that are located within reach of conventional endoscopes.

RESULTS: In 595 patients, referred for obscure gastrointestinal bleeding or for suspected Crohn’s disease, abnormalities were found in 306 (51.4%). Of these 306 patients, 85 (27.7%) had abnormalities within reach of conventional endoscopes; 63 had abnormalities apparently overlooked at previous conventional endoscopies, 10 patients had not undergone upper and lower endoscopy prior to capsule endoscopy and 12 had abnormalities that were already known prior to capsule endoscopy. The most common type of missed lesions were vascular lesions (n = 47). Non-small-bowel abnormalities were located in the stomach (n = 15), proximal small bowel (n = 22), terminal ileum (n = 21), colon (n = 19) or at other or multiple locations (n = 8). Ten patients with abnormal findings in the terminal ileum had not undergone examination of the ileum during colonoscopy.

CONCLUSION: A significant proportion of patients undergoing small bowel capsule endoscopy had lesions within reach of conventional endoscopes, indicating that capsule endoscopy was unnecessarily performed.

Keywords: Capsule endoscopy; Small bowel; Findings; Colon; Stomach

Core tip: Capsule endoscopy (CE) is a technique to detect small bowel pathology which sometimes reveals non-small bowel abnormalities (NSBAs). There are no data on the incidence of NSBAs in capsule endoscopy. In this study, 595 capsule endoscopy procedures were included. Abnormalities were found in 306 (51.4%) of cases. Of these 306 patients, 85 (27.7%) had abnormalities within reach of conventional endoscopes. The fact that a significant proportion of patients referred for small bowel CE had lesions within the reach of conventional endoscopes indicates that CE was unnecessarily performed and emphasizes the importance of critical selection of patients for capsule endoscopy.