DBE is better and friendlier to the patient then traditional; Colonoscopy

[Guest guest]

In all academic hospitals in the Netherlands available from 1 january 2006

and probalby also in the UK and USA? is this new research method.

gr. kees

Gut. 2003 Aug;52(8):1122-6.

Wireless capsule endoscopy: a comparison with push enteroscopy in patients

with gastroscopy and colonoscopy negative gastrointestinal bleeding.

Mylonaki M, Fritscher-Ravens A, Swain P.

Department of Gastroenterology, Royal London Hospital, Whitechapel,

London, UK.

BACKGROUND: The development of wireless capsule endoscopy allows painless

imaging of the small intestine. Its clinical use is not yet defined. The

aim of this study was to compare the clinical efficacy and technical

performance of capsule endoscopy and push enteroscopy in a series of 50

patients with colonoscopy and gastroscopy negative gastrointestinal

bleeding.

METHODS: A wireless capsule endoscope was used containing a CMOS colour

video imager, transmitter, and batteries. Approximately 50,000 transmitted

images are received by eight abdominal aerials and stored on a portable

solid state recorder, which is carried on a belt. Push enteroscopy was

performed using a 240 cm Olympus video enteroscope.

RESULTS: Studies in 14 healthy volunteers gave information on normal

anatomical appearances and preparation. In 50 patients with

gastrointestinal bleeding and negative colonoscopy and gastroscopy, push

enteroscopy was compared with capsule endoscopy. A bleeding source was

discovered in the small intestine in 34 of 50 patients (68%). These

included angiodysplasia (16), focal fresh bleeding (eight), apthous

ulceration suggestive of Crohn's disease (three), tumour (two), Meckel's

diverticulum (two), ileal ulcer (one), jejunitis (one), and ulcer due to

intussusception (one). One additional intestinal diagnosis was made by

enteroscopy. The yield of push enteroscopy in evaluating obscure bleeding

was 32% (16/50). The capsule identified significantly more small

intestinal bleeding sources than push enteroscopy (p<0.05). Patients

preferred capsule endoscopy to push enteroscopy (p<0.001).

CONCLUSIONS: In this study capsule endoscopy was superior to push

enteroscopy in the diagnosis of recurrent bleeding in patients who had a

negative gastroscopy and colonoscopy. It was safe and well tolerated.

PMID: 12865269 [PubMed - indexed for MEDLINE]

Aliment Pharmacol Ther. 2004 Jul 15;20(2):189-94.

Wireless capsule endoscopy in patients with obscure gastrointestinal

bleeding: a comparative study with push enteroscopy.

Mata A, Bordas JM, Feu F, Gines A, Pellise M, Fernandez-Esparrach G,

Balaguer F, Pique JM, Llach J.

Digestive Endoscopy Unit, Gastroenterology Service, IMD, Hospital Clinic,

Barcelona, Spain.

BACKGROUND: The identification and treatment of lesions located in the

small intestine in obscure gastrointestinal bleeding is always a clinical

challenge. AIM: To examine prospectively the diagnostic precision and the

clinical efficacy of capsule endoscopy compared with push enteroscopy in

obscure gastrointestinal bleeding.

METHODS: Forty-two patients (22 men and 20 women) with obscure

gastrointestinal bleeding (overt bleeding in 26 cases and occult blood

loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy

and colonoscopy were analysed. All patients were instructed to receive the

capsule endoscopy and push enteroscopy was performed within the next 7

days. Both techniques were blindly performed by separate examiners. The

diagnostic yield for each technique was defined as the frequency of

detection of clinically relevant intestinal lesions carrying potential for

bleeding.

RESULTS: A bleeding site potentially related to gastrointestinal bleeding

or evidence of active bleeding was identified in a greater proportion of

patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%;

eight of 42) (P = 0.05). The most frequent capsule endoscopy findings

were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal

inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal

diagnoses were made by enteroscopy. In seven patients (22%), the results

obtained with capsule endoscopy led to a successful change in the

therapeutic approach.

CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases

the diagnosis yield in patients with obscure gastrointestinal bleeding,

and allows modification on therapy strategy in a remarkable proportion of

patients.

PMID: 15233699 [PubMed - indexed for MEDLINE]