Limited ability of capsule endoscopy to detect normally positioned duodenal papilla

Background: The current power of capsule endoscopy (CE) to diagnose patients with obscure GI bleeding is 42% to 74.4%. Objective: The aim of this study was to evaluate the diagnostic power of CE through its ability to detect duodenal papilla. Design and Patients: A total of 112 consecutive CEs were retrospectively reviewed. All patients had undergone esophagogastroduodenoscopy and had their normal duodenal papilla confirmed. Setting and Interventions: The CE findings were reviewed separately at a rate of 15 images/second by 2 experienced and competent capsule readers. Main Outcome Measurements: The CE detection rate of duodenal papilla was calculated. in addition, the number of frames showing duodenal papilla was counted. Results: Among the total CEs, 2 cases were excluded because the capsule could not traverse the second portion of duodenum. The most common indication was obscure GI bleeding. CE only detected duodenal papilla in 48 cases (43.6%). The mean number of frames of the visualizing duodenal papilla was 3.5 +/- 2.5 (range 1-13). Limitations: Choosing duodenal papilla as the reference may not be optimal because its position is difficult to identify. Conclusions: Our study conveys an important message on the present power of CE; we should carefully review CE findings at a slower review rate to raise the detection ability of the current-powered CE, when it is passing through several "difficult to identify" locations such as second portion of the duodenum. In addition, to raise the power of CE, technologic improvements of CE, such as an extracoporeal-controllable device or a multiside viewing capsule, are needed.