video capsule endoscopy (PillCam)
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Indications
- small intestinal disorders
- celiac disease or other malabsorption
- Crohn's disease, (now gold standard)[4]
- small bowel tumors
- chronic abdominal pain
- small intestinal hemorrhage, obscure GI bleed
- normal upper GI endoscopy & lower GI endoscopy
- repeat gastrointestinal endoscopy recommended prior to capsule endoscopy[8][9]
- identified source of 15/20 acute upper GI hemorrhages with negative upper GI endoscopy[10]
- esophageal disorders
- gastroparesis[8]
* FDA approved for small bowel examination
* as safe in elderly >= 80 years of age & with higher diagnostic yield than in adults 65-79 years of age[11]
Contraindications
- intestinal stricture
- swallowing disorder
- cardiac pacemaker (esophagus)
- achalasia, Zenker's diverticula, gastroparesis
- psychiatric illness
* NOT approved for colon cancer screening
Advantages
- more sensitive for angiodysplasia, ulceration & intestinal tumors than contrast CT
- no sedation
- improves diagnostic yield for occult GI bleed[7]
Disadvantages
- precise location of observed lesion is unclear
- does not improve outcomes[7]
Procedure
outpatient procedure
- the patient swallows a small capsule
- the capsule contains a miniature camera that continuously photographs the gastrointestinal tract & transmits the images to a receiving unit worn by the patient
- 8 hours of recording
- 26 x 11 mm disposable capsule passed in the feces naturally, generally within 24 hours. Biodegradable capusles on the horizon.[4]
- Videorecorder attached to patient, back & belt pack
- Patient may eat (liquids) after 4 hours.
- Data loaded into computer after
Sensitivity 90%, Specificity 95% (intestinal indications)
Complications
- surgery to remove capsule (rare)
Management
- push enteroscopy for upper GI bleed localized to the distal duodenum or proximal jejunum[8]
Notes
Pillcam ESO for esophagus ($450)
Sensitivity insufficient for use in colon cancer screening.
Using traditional colonoscopy as the standard of comparison, capsule endoscopy had a sensitivity of:
- 64% for detecting polyps 6 mm or larger
- 73% for advanced adenomas 6 mm or larger
- 74% for cancers.
- sensitivities were higher with more thorough bowel preparation
More general terms
References
- ↑ Journal Watch 22(24):173, 2002 Costamanga G et al, Gastroenterology 123:999, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12360460 Faigel DO & Fennerty MB, Gastroenterology 123:1385, 2002
- ↑ Journal Watch 24(4):30, 2004 Hara AK et al, Radiology 230:260, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14617764
- ↑ Journal Watch 24(9):75, 2004 Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, De Franchis R. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology. 2004 Mar;126(3):643-53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14988816
- ↑ 4.0 4.1 4.2 Mann , Veterans Administration, Mather CA, Oct 2005
- ↑ Sturniolo GC et al, Small bowel exploration by wireless capsule endoscopy: Results from 314 procedures. Am J Med 2006; 119:341 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16564777
- ↑ Van Gossum A et al Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer N Eng J Med 2009, 361:264-270 July 16, 2009 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19605831 <Internet> http://content.nejm.org/cgi/content/short/361/3/264
- ↑ 7.0 7.1 7.2 Laine L et al. Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography. Gastroenterology 2010 May; 138:1673. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20138043
- ↑ 8.0 8.1 8.2 8.3 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
- ↑ 9.0 9.1 ASGE Standards of Practice Committee, Fisher L, Lee Krinsky M, Anderson MA et al The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc. 2010 Sep;72(3):471-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20801285
- ↑ 10.0 10.1 Schlag C et al. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2014 Nov 26 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25432532 <Internet> http://www.giejournal.org/article/S0016-5107%2814%2902255-X/abstract
- ↑ 11.0 11.1 Thurm T, Gluck N, Barak O, Deutsch L. Octa-nonagenarians can perform video capsule endoscopy safely and with a higher diagnostic yield than 65-79 year-old patients. J Am Geriatr Soc. 2022 Oct;70(10):2958-2966. Epub 2022 Jul 5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35788980 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17953
- ↑ Enns RA, Hookey L, Armstrong D, Bernstein CN et al Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology. 2017 Feb;152(3):497-514. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28063287 Review.
- ↑ Brito HP, Ribeiro IB, de Moura DTH et al Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis. World J Gastrointest Endosc. 2018 Dec 16;10(12):400-421. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30631404 PMCID: PMC6323498 Free PMC article.
- ↑ <Internet> http://www.PillCam.com http://www.PillCam.com/ESO