Study Of The Capsule Endoscopy In Diagnosis Of Small Bowel Disease

IntroductionThe length of the small intestine is about 5-7meters which occupy 2/3 of the total gastrointestinal tract, the small intestine is considered to be the most difficult part of the intestine tract just because of the complex ansa intestinalis tied by mesenterium and the far from the mouth and anus.Conventional endoscopic techniques are limited by its length for the small bowel examination and complex, multiple, looped configurations. Radiographic techniques are insensitive to the superficial leisions and the small bleeding sites.The wireless capsule endoscopy is a new noninvasive techniques for direct visualization of the whole small bowel with high diagnostic yield, safety and minimal discomfort.Object and MethodWe prospectively analyze 64 patients that underwent capsule endoscopy in The First Hospital Of Jilin University. According to their symptoms, the patients are divided into three groups as obscure gastrointestinal bleeding group(18,11 men, 7 women, mean age 47.7years), abdominal pain group(33, 25 men, 8 women, mean age 52.8years), diarrhea group (13,7men, 6women, mean age 55.3years). Evaluation criterial include (1)succeed in CE means capsule reaching terminal ileum or disclosing lesions before reaching terminal ileum (2)Faliure in CE means capsule not reaching terminal ileum and not detecting any lesion or stopped by all kinds of reasons(3)Positive finding means lesions disclosed by CE(4)Diagnostic yield means the lesions detected by CE can explain the source of the symptoms. (5) The OMOM capsule system consists of three parts, intelligence capsule, data recorder and workstation. Patients are required to have a fluid diet for dinner and observed a fasting period after 18 o'clock the day before CE examination, all patients take polyethylene glycol for intestine cleaning. Drinking and eating are forbidden within 2 hours after swallowing the capsule. During the whole examination period, patients are allowed to walk anywhere freely except for place with strong magnetic field. The indicating light should be checked by the patients to make sure the system are working. The recorder will be taken off from the patients 8 hours later, and the data stored in the recorder be downloaded into the workstation, the endoscopic doctor give a diagnostic according to the image captured by the capsule. The capsule is for one-time use and will be excreted naturally.1,The overall resultsAll patients swallowed the capsule easily, 1 failed the examination, 63 reached the terminal ileum, bowel preparation were good with sharp visibility of the mucosa except for 9 patients. Delayed excretion of the capsule occurred in 2 patients. There are positive findings in 47 patients, of which 19 were diagnosed. Total success yield in CE examination is 98.4% (63/64), positive finding yield is 73.4% (47/64), diagnostic yield is 29.7% (19/64), delayed excretion yield of CE is 3% (2/64). 2,Results in OGB groupAll 18 patients swallowed the capsule easily, bowel preparation were good with sharp visibility of the mucosa except for 2 patients owning to fresh bleeding. 16 patients excreted the capsule in 1 day to 2 weeks, delayed excretion of the capsule occurred in 2 patients. Success yield in CE examination is 100% (18/18), positive finding yield is 77.7% (14/18), diagnostic yield is 61.1% (11/18), delayed excretion yield of CE is 11% (2/18).3,Results in abdominal pain groupAll 33 patients swallowed the capsule easily, the capsule reached the terminal ileum in 32 patiens, failure of the CE examimation occurred in 1 patient. Bowel preparation were good with clear visibility of the mucosa except for 7 patients. All patients excreted the capsule in 1 day to 9 days. Positive findings are detected in 21 patients, including intestinal ulcers, diverticulum, polyp, submucosal intumesce, roundworm, lymphangiectasia, nonspecific enteritis, 4 patients were diagnosed. Success yield in CE examination is 96.9% (32/33), positive finding yield is 63.6% (21/33), diagnostic yield is 12.1% (4/33), delayed excretion yield of CE is 0%.4,Results in diarrhea groupThe capsule reached ileal valve within 133-439m in all 13 patients. All patients excreted the capsule within 10 days . Bowel preparation were good with clear visibility of the mucosa except for 2 patients.Positive findings are detected in 12 patients, including polyp, submucosal intumesce, roundworm and nonspecific lesions (mucosa hyperemia, erosion, tubercle and sinus venosus). 4 patients were diagnosed.Success yield in CE examination is 100%, positive finding yield is 92.3%(12/13), diagnostic yield is30.7%(4/13), delayed excretion yield of CE is 0%. Conclusion1,Capsule endoscopy is an noninvasive and safe examination for direct visualization of the small bowel,with high detecting and diagnostic yield, which is strongly recommended as the first choice in diagnosing OGB bleeding.2,The diagnostic values of the CE in abdominal pain and diarrhea are remained to be studied.3,Capsule endoscopy are safe and well tolerated in old patients, can be used as the first choice in old people with cardiac insufficiency or bad general body state...