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      Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry

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          Abstract

          Background/Aims

          Capsule endoscopy (CE) is widely used. However, CE has limitations including incomplete examination, inadequate bowel preparation, and retention. The aim of this study was to estimate the indications for and detection, completion, and retention rates of small intestine CE based on the 10-year data from the Korean Capsule Endoscopy Registry.

          Methods

          Twenty-four hospitals participated in this study. Clinical information, such as reasons for CE, method and quality of bowel preparation, and incomplete examination and capsule retention rates, was collected and analyzed.

          Results

          A total of 2,914 CEs were registered. The most common reason for CE was obscure gastrointestinal bleeding (59%). Significant lesions were detected in 66% of cases. Positive CE diagnosis occurred in 63% of cases. The preparation method did not significantly affect the quality of bowel preparation for CE. The overall incomplete rate was 33%, and was high in the elderly and those with poor bowel preparation. Capsule retention was 3% and high in patients with small bowel tumors and Crohn's disease and in children under 10 years of age.

          Conclusions

          CE is a valuable technique; while the overall detection rate is high, incompletion and retention rates are also relatively high. CE should be carefully considered in the elderly and children less than 10 years of age, as well as in patients with small bowel tumors and Crohn's disease.

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          Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review.

          Zhuan Liao, Rui Gao, Can Xu … (2010)
          Capsule endoscopy (CE) has been widely used in clinical practice. To provide systematically pooled results on the indications and detection, completion, and retention rates of small-bowel CE. A systematic review. We searched the PubMed database (2000-2008) for original articles relevant to small-bowel CE for the evaluation of patients with small-bowel signs and symptoms. Data on the total number of capsule procedures, the distribution of different indications for the procedures, the percentages of procedures with positive detection (detection rate), complete examination (completion rate), or capsule retention (retention rate) were extracted and/or calculated, respectively. In addition, the detection, completion, and retention rates were also extracted and/or calculated in relation to indications such as obscure GI bleeding (OGIB), definite or suspected Crohn's disease (CD), and neoplastic lesions. A total of 227 English-language original articles involving 22,840 procedures were included. OGIB was the most common indication (66.0%), followed by the indication of only clinical symptoms reported (10.6%), and definite or suspected CD (10.4%). The pooled detection rates were 59.4%; 60.5%, 55.3%, and 55.9%, respectively, for overall, OGIB, CD, and neoplastic lesions. Angiodysplasia was the most common reason (50.0%) for OGIB. The pooled completion rate was 83.5%, with the rates being 83.6%, 85.4%, and 84.2%, respectively, for the 3 indications. The pooled retention rates were 1.4%, 1.2%, 2.6%, and 2.1%, respectively, for overall and the 3 indications. Inclusion and exclusion criteria were loosely defined. The pooled detection, completion, and retention rates are acceptable for total procedures. OGIB is the most common indication for small-bowel CE, with a high detection rate and low retention rate. In addition, angiodysplasia is the most common finding in patients with OGIB. A relatively high retention rate is associated with definite or suspected CD and neoplasms.
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            The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.

            Melanie Mayer, S Remke, L Helou … (2002)
            In chronic gastrointestinal bleeding (CGB), bleeding sites located in the small bowel are difficult to detect with conventional radiological or scintigraphic techniques. Push enteroscopy (PE) is at present considered to be the most effective diagnostic procedure. The aim of this prospective trial was to compare the efficacy of wireless capsule endoscopy (CE) with PE. Between April and October 2001, 65 patients with CGB were referred to our unit. Complete conventional diagnostic work-up (including small-bowel enteroclysis, angiography, and scintigraphy), as well as PE and CE, were performed in 32 patients. On average, the patients had been suffering from CGB for 29 +/- 24 months (6 - 126); the lowest hemoglobin level varied between 3.0 and 9.9 g/dl (mean 5.9 +/- 1.4); 17 +/- 18 blood units (0 - 60) were transfused. Each patient underwent 6 +/- 7 (range 1 - 38) hospitalizations, with a mean of 14 +/- 9 diagnostic procedures before CE was used. Conventional diagnostic procedures revealed relevant pathological findings in five of the 32 patients (16 %). Definite bleeding sites diagnosed by PE in nine patients (28 %) included angiodysplasia (seven patients), small-bowel cancer (one patient) and lymphoma (one patient). CE detected the definite source in 21 of the 32 patients (66 %) ( P < 0.001). Definite bleeding sources included angiodysplasia (17 patients), malignant stenoses (two patients) and inflammatory small-bowel disease (two patients). Questionable bleeding sources were seen on PE in three additional patients (9 %), and using CE in a further seven patients (22 %). Both CE and PE were safe and were not associated with any morbidity. In the present trial in patients with CGB, wireless CE had the highest diagnostic yield and was significantly superior to PE. CE can help reduce the number of diagnostic procedures and could become the initial diagnostic choice in patients with CGB and negative upper and lower gastrointestinal endoscopy.
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              Complications, limitations, and failures of capsule endoscopy: a review of 733 cases.

              Roberto De Masi, Marco Pennazio, Juan Manuel Herrerías … (2005)
              Although a variety of technical and clinical problems of capsule endoscopy have been reported, their incidence and clinical importance are unknown. The objective was to evaluate the incidence and the type of such events. This was a retrospective analysis of 733 consecutive examinations at 4 large referral centers. The main outcome measurements were that the problems were classified as "technical," i.e., related to the functioning of the equipment, and "clinical," i.e., related to patient characteristics. For each type of event, the causes and the impact on the ability to reach a diagnosis were examined. A total of 183 problems were recorded in 174 patients (23.7%): one problem occurred in 165 patients, two in 9 patients. In 8.46% of patients, technical limitations or failures, or clinical complications prevented or hampered diagnosis. Technical problems (e.g., gaps in the recordings, short duration of capsule batteries, failure of downloading) occurred in the early phase of capsule use in 8.6% of examinations and prevented or hampered diagnosis in 2.9%. Clinical problems (difficulty/inability to swallow the capsule, incomplete small-bowel examination) occurred in 16.4% of examinations and hampered or prevented diagnosis in 6.4%. Capsule retention that required surgical or endoscopic retrieval occurred in 1.9% of cases. Technical problems were rare and hampered or prevented the diagnosis in a very small number of cases. The majority of clinical failures were related to an incomplete small-bowel examination.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Endosc
                Journal ID (iso-abbrev): Clin Endosc
                Journal ID (publisher-id): CE
                Title: Clinical Endoscopy
                Publisher: The Korean Society of Gastrointestinal Endoscopy
                ISSN (Print): 2234-2400
                ISSN (Electronic): 2234-2443
                Publication date (Print): September 2015
                Publication date (Electronic): 30 September 2015
                Volume: 48
                Issue: 5
                Pages: 399-404
                Affiliations
                [1 ]Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea.
                [2 ]Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
                [3 ]Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
                [4 ]Department of Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
                [5 ]Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [6 ]Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
                [7 ]Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
                [8 ]Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea.
                [9 ]Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
                [10 ]Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea.
                [11 ]Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
                [12 ]Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [13 ]Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
                [14 ]Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
                [15 ]Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.
                [16 ]Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
                Author notes
                Correspondence: Oh Young Lee. Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2290-8343, Fax: +82-2-2298-9183, leeoy@ 123456hanyang.ac.kr
                Article
                DOI: 10.5946/ce.2015.48.5.399
                PMC ID: 4604278
                PubMed ID: 26473123
                SO-VID: 1b796aae-f216-43dd-bfff-a4a44c2d17e3
                Copyright © Copyright © 2015 Korean Society of Gastrointestinal Endoscopy
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 August 2014
                Date revision received : 15 September 2014
                Date accepted : 23 September 2014
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: capsule endoscopy,completion,intestine, small,preparation,retention
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: capsule endoscopy, completion, intestine, small, preparation, retention

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