[Video capsule endoscopy--preliminary experience in university hospital setting].

BACKGROUND

The use of video capsule endoscopy (VCE) started in late 2001 when it was approved by the Food and Drug Administration (FDA). Since then, we are able to visualize small bowel mucosa with a minimally invasive technique, very comfortable for patients, with very few complications and without the need of hospitalization. At Dubrava University Hospital, we have been using VCE since October 2006, and by February 2008 we examined 30 patients.

OBJECTIVE

The aim of the study was to present our preliminary results in the use of VCE during a period of one year and five months. We also report indications and contraindications for VCE, and patient preparation.

METHODS

In this retrospective study we reviewed records on 30 patients that had undergone VCE at Dubrava University Hospital, Zagreb, Croatia, between October 2006 and February 2008. The indications for VCE were restricted to the investigation of obscure gastrointestinal bleeding (OGIB) (n = 10), iron deficiency anemia (n = 2), suspected Crohn's disease (n = 1), assessment of known small bowel Crohn's disease (n = 5), unexplained diarrhea (n = 6), chronic abdominal pain (n = 3), suspected ganglioneurinoma (n = 1) and suspected polyposis syndrome (n = 2). To be eligible for VCE, patients had to have previously undergone usual diagnostic methods of upper endoscopy, colonoscopy and small bowel follow-through, without discovering the cause of their symptoms. Before swallowing the capsule, patients were instructed not to eat anything the day before VCE and to drink 4 L of liquids, and additional 2 L magnesium sulfate. In all patients we used Olympus EndoCapsule Software (Tokyo, Japan). Results were interpreted by one specialist, gastroenterologist.

RESULTS

Definitive diagnosis was made in 15 patients. Suspect findings were noted in 2 patients, whereas no diagnosis could be established in 13 patients. According to our experience, VCE is a promising new method that has a high diagnostic yield in patients with OGIB and known Crohn's disease. Use of VCE enabled definitive diagnosis to be made in 6 of 10 patients with OGIB after all previously used diagnostic methods had failed to reveal any pathological finding. In the group of OGIB patients, angiodysplasia was the most common findings (4 of 10 patients). In the group of patients with Crohn's disease, progression of the disease to neotherminal ileum was recorded in 3 of 5 patients. Our experience also confirmed the VCE to be a very safe method; capsule retention was recorded in only one patient.

CONCLUSIONS

Although VCE enabled us to visualize the small bowel mucosa and therefore helped us establish the diagnosis in cases where other diagnostic methods had failed, it still has some important limitations, the major one being the impossibility to take biopsies and to perform any therapeutic procedures. However, it has a high diagnostic yield in cases of OGIB and Crohn's disease, is very comfortable for patients, and has a low incidence of complications (capsule retention). When making definitive diagnosis, one should always consider patient's history and physical examination findings as well as other possible causes of small bowel mucosal impairment.

CONCLUSIONS

VCE is a promising new technique that has a high diagnostic yield in patients with OGIB and Crohn's disease. However, more studies need to be done to establish definitive indications, cost-effectiveness and the best way of patient preparation for VCE.