[Role of capsule endoscopy in patients with obscure digestive bleeding]

Effectiveness and safety of capsule endoscopy in the diagnosis of small bowel diseases

GOALS

To assess the effectiveness, safety, and clinical use of capsule endoscopy (CE) in the diagnosis of small bowel diseases.

STUDY

Systematic review carried out in the main electronic databases, including MEDLINE, EMBASE, and COCHRANE. Papers were selected independently by the 2 researchers and the quality was determined using a purpose-designed scale.

RESULTS

A total of 9 systematic reviews and 28 original papers were included [11 assessed obscure gastrointestinal bleeding, 9 Crohn's disease (CD), and 4 hereditary polyposis syndromes]. The diagnostic yield of CE for the diagnosis of obscure gastrointestinal bleeding ranged from 39% to 77%. The diagnostic yield of push enteroscopy was lower than 40% in all but 1 study. CE detected suggestive findings in 19% to 71% of patients with suspected CD, whereas radiologic techniques did so in only 0% to 37% of the cases. In patients with suspected recurrence, detection with these techniques was 58% to 81% and 19% to 67%, respectively. Endoscopic capsule detected a greater number of polyps in patients with polyposis syndromes but other techniques allowed for better localization.

CONCLUSIONS

Although CE occupies a preferential place in the diagnosis of gastrointestinal bleeding and CD; there is insufficient evidence to establish whether it could be used as a first line diagnostic test. The evidence is insufficient to ascertain this technique's usefulness in small bowel disorders other than obscure bleeding or CD.

Intermittent bowel obstruction due to a retained wireless capsule endoscope in a patient with a small bowel carcinoid tumour

A 43-year-old man with a history of metastatic carcinoid disease is presented. The patient had symptoms of chronic intermittent abdominal pain two years after undergoing a wireless capsule endoscopy procedure. Radiological examinations revealed a retained capsule endoscope, and the patient underwent exploratory laparotomy with capsule retrieval. To the authors' knowledge, this is the first case presentation of chronic, partial small bowel obstruction caused by unrecognized retention of a capsule endoscope.