Capsule Endoscopy: Is it Really Helpful in the Diagnosis of Small Bowel Diseases?
Objective: To determine the diagnostic yield and safety of capsule endoscopy for small bowel diseases. Introduction: The small bowel evaluation for any pathology has always been a difficult task because both upper GI endoscopy and colonoscopy could not access this area and other radiological tools like barium studies and CT enteroclysis were less sensitive with associated risk of radiation exposure. Only Push enteroscopy could evaluate the small bowel effectively but was laborious and invasive. Capsule endoscopy was introduced in year 2000 and was accepted with great enthusiasm all over the world3. Now, during the past few years it has also been used for the diagnosis of acute gastrointestinal bleeding in emergency departments and results are quite encouraging 5,6. The procedure was introduced at Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in year 2009. Since then, it has been regularly used for investigation of small bowel abnormalities. Methods: Video Capsule Endoscopy (VCE) using GIVEN Imaging system was performed on 60 patients having various indications like obscure GI bleeding, undiagnosed iron deficiency anemia, abdominal pain and malabsorption. This was a retrospective analytic study carried out at the Department of Gastroenterology-Hepatology
Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan from February 2009 to June 2014. Statistical Analysis was done using SPSS version 22. Results: Out of 60 patients, 41 (68.33%) were male, 19 (31.67%) were female. Mean age was 52 years with minimum 11 years and maximum of 85 years. No lesion was found on examination in 8.33% (n=5) patients while presence of blood in the gut resulted in poor visualization in 3.33% (n=2) patients. In remaining 88.34% (n=53) patients, the procedure detected various intestinal lesions. Our study detected presence of Angioectasias in 30.0% (n=18), visible vessels in 6.67% (n=4), strictures in 5.0% (n=3), small bowel ulcers in 10.0% (n=6), edema and erosions in 8.33% (n=5), loss of villi in 11.68% (n=7), intestinal worms in 3.33% (n=2), mass lesions in 8.33% (n=5) and Angioectasia with ulcers in 5.0% (n=3) of patients. The diagnosis in 3 patients was further verified by surgical operation, while enteroscopy was done in 2 patients for confirmation. Capsule impaction occurred in 2 patients. All images of Video Capsule Endoscopy (VCE) were of good quality. Conclusion: Capsule endoscopy is a safe and effective procedure with a good diagnostic yield and can be used routinely for the diagnosis of small bowel diseases.