Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in sm all bowel diseases. Aim: The aim of this prospective study ...Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in sm all bowel diseases. Aim: The aim of this prospective study was to validate the g ain in information and therapeutic impact of WCE in patients with Crohn’ s disease. Methods: Fifty six consecutive patien ts with Crohn’ s disease underwent computed tomography (CT) enteroclysis, and i f stenoses < 10 mm were excluded, WCE was carried out. Results: In 15 patients ( 27% ), WCE could not be performed due to strictures detected by CT enteroclysis . From the other 41 patients, jejunal or ileal lesions were found in 25 patients by WCE compared with 12 by CT enteroclysis (p = 0.004). This gain in informatio n was mainly due to detection of small mucosal lesions such as villous denudatio n, aphthoid ulcerations, or erosions. Both methods were not significantly differ ent in the detection of lesions in the terminal/neoterminal ileum (WCE 24 patien ts, CT enteroclysis 20 patients). Therapy was changed due to WCE findings in 10 patients. Consecutively, all of them improved clinically. Conclusions: Capsule e ndoscopy improves the diagnosis of small bowel Crohn’ s disease. This may have significant therapeutic impact.展开更多
Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bo...Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bowel disease. However, the accuracy of radiography in this situation has often been questioned. The purpose of this prospective study was to investigate the feasibility and safety of the recently developed patency capsule, and its predictive value regarding the clinical relevance of radiographic small- bowel strictures. Patients and methods: 22 patients with suspected obstructive small- bowel disease and/or radiological evidence of small- bowel strictures underwent a patency capsule examination. Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome. Results: 13 patients passed an intact capsule without complaints, despite radiographically observed small- bowel stenosis; the subsequent video capsule examination was uneventful in all. In nine patients either intact passage was painful or the capsule disintegrated; in one of these, impaction of an intact capsule led to an ileus and emergency surgery. The type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery. There was a statistically significant correlation between outcome (surgery performed or recommended) and occurrence of painful capsule passage and disintegration (P≤ 0.05). Conclusions: Painless egestion of an intact patency capsule indicates safety of WCE. Patients without obstructive symptoms require neither small- bowel radiography nor a patency capsule study prior to WCE. Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small- bowel stricture and with a high probability of surgery.展开更多
文摘Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in sm all bowel diseases. Aim: The aim of this prospective study was to validate the g ain in information and therapeutic impact of WCE in patients with Crohn’ s disease. Methods: Fifty six consecutive patien ts with Crohn’ s disease underwent computed tomography (CT) enteroclysis, and i f stenoses < 10 mm were excluded, WCE was carried out. Results: In 15 patients ( 27% ), WCE could not be performed due to strictures detected by CT enteroclysis . From the other 41 patients, jejunal or ileal lesions were found in 25 patients by WCE compared with 12 by CT enteroclysis (p = 0.004). This gain in informatio n was mainly due to detection of small mucosal lesions such as villous denudatio n, aphthoid ulcerations, or erosions. Both methods were not significantly differ ent in the detection of lesions in the terminal/neoterminal ileum (WCE 24 patien ts, CT enteroclysis 20 patients). Therapy was changed due to WCE findings in 10 patients. Consecutively, all of them improved clinically. Conclusions: Capsule e ndoscopy improves the diagnosis of small bowel Crohn’ s disease. This may have significant therapeutic impact.
文摘Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bowel disease. However, the accuracy of radiography in this situation has often been questioned. The purpose of this prospective study was to investigate the feasibility and safety of the recently developed patency capsule, and its predictive value regarding the clinical relevance of radiographic small- bowel strictures. Patients and methods: 22 patients with suspected obstructive small- bowel disease and/or radiological evidence of small- bowel strictures underwent a patency capsule examination. Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome. Results: 13 patients passed an intact capsule without complaints, despite radiographically observed small- bowel stenosis; the subsequent video capsule examination was uneventful in all. In nine patients either intact passage was painful or the capsule disintegrated; in one of these, impaction of an intact capsule led to an ileus and emergency surgery. The type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery. There was a statistically significant correlation between outcome (surgery performed or recommended) and occurrence of painful capsule passage and disintegration (P≤ 0.05). Conclusions: Painless egestion of an intact patency capsule indicates safety of WCE. Patients without obstructive symptoms require neither small- bowel radiography nor a patency capsule study prior to WCE. Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small- bowel stricture and with a high probability of surgery.
