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      Capsula endoscópica y enteroscopia asistida por balones en pacientes con sospecha de enfermedad de intestino delgado métodos complementarios

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          Abstract

          Introducción: El desarrollo reciente de la cápsula endoscópica (CE) y la enteroscopia asistida por balones (EAPB) ha cambiado el algoritmo diagnóstico de la patología del intestino delgado. La combinación de ambos métodos parece ser una herramienta útil. Objetivo: Mostrar la experiencia con el uso combinado de CE y EAPB en pacientes con sospecha de enfermedades del intestino delgado. Pacientes y métodos: 34 pacientes a quienes se les realizó CE y EAPB. El endoscopista conocía el resultado de la CE. Equipos: CE M2A, PillCam SB (Given Imaging), videoenteroscopios doble balón Fujinon EN-450P5, EN-450T5, enteroscopio balón único Olympus SIG Q-180. Se registraron datos demográficos, indicaciones, segmentos evaluados, hallazgos y complicaciones. Resultados: 34 pacientes (19 mujeres, 15 hombres), edad promedio: 57,67 años. Principales indicaciones: sangrado digestivo oscuro evidente 67,64 %, anemia 11,76%, enfermedad de Crohn 5,88%. La EAPB se realizó por vía anterógrada en 25 pacientes, retrógrada en 4 y combinada en 5. Se detectaron lesiones con CE en 85,29% pacientes, con EAEAPB en 67,64% y con ambos métodos en 52,9%. En 11 pacientes se detectaron lesiones por CE y la EAPB fue normal. En 2 pacientes hubo hallazgos en la EAPB no vistos por la cápsula. Hallazgos mas frecuentes: CE: angioectasias 11, tumor subepitelial ulcerado 2, presencia de sangre 4, úlceras 3. EAPB: angioectasias 9, tumor subepitelial ulcerado 1, ulceras 3, divertículo de Meckel, 1. Terapéutica endoscópica en 13 pacientes y cirugía en 4 con sangrado digestivo Conclusiones: CE y EBU combinadas permiten mejorar el diagnóstico y orientar la conducta terapéutica en pacientes con sospecha de patología del intestino delgado.

          Translated abstract

          Introduction: The recent development of capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE) has changed the diagnostic algorithm of small bowel pathology. The combination of both methods seems to be a useful tool. Objective: To show the experience with the combined use of CE and BAE in patients with suspected small bowel diseases.Patients and methods: 34 patients who underwent CE and BAE. The endoscopist knew the outcome of the CE. We used the CE M2A, Pillcam (Given Imaging), double balloon videoenteroscopy Fujinon EN-450P5, EN-450T5, single balloon enteroscopy GIS Olympus Q-180. Demographic data, indications, segments evaluated, findings and complications were recorded. Results: 34 patients (19 women, 15 men), average age: 57.67 years. Main indications: evident obscure gastrointestinal bleeding 67.64%, anemia 11, 76%, Crohn’s disease 5.88%. Anterograde BAE was performed in 25 patients, retrograde in 4 and combined in 5 patients. CE lesions were detected in 85.29% patients with BAE in 67.64% and 52.9% in both methods. In 11 patients lesions were detected by CE and the BAE was normal. In 2 patients there were findings in the BAE, not seen by the capsule. Most common finding: CE: 11 angiodysplasia, 2 subepithelial ulcerated tumor, 4 blood presence, 3 ulcers. BAE: 9 angiodysplasia, 1 subepithelial ulcerated tumor, 3 ulcers, 1 Meckel diverticulum. Therapeutic endoscopy was performed in 13 patients and surgery in 4 patients with digestive bleeding. Conclusions: Combined CE and BAE allow improving the diagnostic and orientate the therapeutic behavior in patients with suspected small bowel pathology.

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          Most cited references34

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          Wireless capsule endoscopy.

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            A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.

            Due to its superior ability to examine the entire small bowel mucosa, capsule endoscopy (CE) has broadened the diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGIB). Published studies have revealed a numerically superior performance of CE in determining a source of OGIB compared with other modalities, but due to small sample sizes, the overall magnitude of benefit is unknown. Additionally, the types of lesions more likely to be found by CE versus alternate modalities are also unknown. The aim of this study was to evaluate the yield of small bowel findings with CE in patients with OGIB compared to other modalities using meta-analysis. We performed a recursive literature search of prospective studies comparing the yield of CE to other modalities in patients with OGIB. Data on yield and types of lesions identified among various modalities were extracted, pooled, and analyzed. Incremental yield (IY) (yield of CE-yield of comparative modality) and 95% confidence intervals (95% CI) of CE over comparative modalities were calculated. A total of 14 studies (n = 396) compared the yield of CE with push enteroscopy for OGIB. The yield for CE and push enteroscopy was 63% and 28%, respectively (IY = 35%, p or=30% with an NNT of 3, primarily due to visualization of additional vascular and inflammatory lesions by CE.
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              Total enteroscopy with a nonsurgical steerable double-balloon method

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                September 2010
                : 64
                : 3
                : 200-205
                Article
                S0016-35032010000300010
                29ee1cd7-d93c-4f5b-8ca4-c24487e4bb8b

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                CE, Capsule endoscopy,BAE, Balloon-assisted enteroscopy,complementary methods,(CE) Capsula Endoscópica,EAPB Enteroscopia asistida por balones,Métodos complementarios

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