Clinical relevance of small-bowel findings detected by wireless capsule endoscopy

Objective. Capsule endoscopy is becoming known as a valid tool for identifying sources of obscure gastrointestinal (GI) bleeding. Fewer data are available about its clinical value for other indications. Material and methods. Sixty patients ( 31 F, mean age 47 years, range 14 - 80 years) with no signs of overt GI bleeding were investigated by Given M2A video capsule for suspected small-bowel disease. The main clinical features were: iron deficient anemia ( 20), abdominal pain ( 12), chronic diarrhea ( 9), malabsorption and weight loss ( 7), Crohn's disease ( CD) ( 5), and familial adenomatous polyposis ( 3). Three patients underwent wireless endoscopy for suspected GI neoplasm and one for portal thrombosis. Results. Complete vision of the small bowel was achieved in 55 patients. No small-bowel lesions were identified in 17 patients, but 5 of them had gastric abnormalities. Small-bowel abnormality was found in 38 patients. Lesions compatible with CD were found in 14 patients, diffuse or patchy enteropathy in 7 and polyps in 6. Actively bleeding lesions were detected in 6 patients and potential bleeding sources in 5. Capsule endoscopy had an overall diagnostic yield of 62%. In particular, three small-bowel malignancies were detected and 9 patients received a better definition of their already-known pathology. However, further endoscopies were needed in 10 patients to obtain a diagnosis. One patient, diagnosed with ileal CD, underwent surgery, as the capsule remained trapped in a stricture. Conclusions. Wireless endoscopy effectively visualizes small-bowel abnormalities even though more accurate selection of the patients is needed in order to optimize its diagnostic efficacy.