Small bowel exploration by wireless capsule endoscopy: Results from 314 procedures

Objectives: To assess the diagnostic efficiency of capsule endoscopy in a large group of patients with different indications, to weigh the reliability of the procedure for excluding small bowel lesions, and to identify factors associated with the likelihood of obtaining a definitive diagnosis. Methods: Three hundred four consecutive patients (141 female, mean age 55 years, range 12-91 years) underwent capsule endoscopy in two different Gastroenterology Units, for a total of 314 procedures, and were followed-up for a median period of 15 months. Referrals were obscure occult/ overt gastrointestinal bleeding (203 patients), suspected small bowel disease (74), gastrointestinal polyposis (18), suspected/previous intestinal or endocrine malignancies (13), previously diagnosed intestinal lymphangectasia (3), and vascular abnormalities (3). Results: Adequate visualization of the small bowel was obtained in 96% of patients, although the capsule did not visualize cecum in 20% of cases. Non-natural excretion of the capsule was observed in 4 patients, all of whom underwent laparotomy for intestinal stenosis. Diagnostic yields were 58% for obscure gastrointestinal bleeding and 31% for patients with suspected small bowel disease. Capsule endoscopy was able to rule out small bowel disease in 14% of patients, and a definitive diagnosis was achieved in 65% of patients. The only parameter associated with the likelihood of reaching a conclusive diagnosis was the indication to the procedure (overall chi-square 13.5, P=.004). Conclusions: Capsule endoscopy represents a reliable tool for verifying the state of the small bowel. Accurate selection of indications and critical evaluation of the results are essential to fully exploit this procedure. (C) 2006 Elsevier Inc. All rights reserved.