The Study Of Capsule Endoscopy Application In Diagnosis Of Digestive Tract Diseases

Background and objective: The digestive tract can be divided into three parts: the upper, middle, and lower digestive tract. From the mouth to the duodenum is called the upper digestive tract, intestine is called the digestive tract, and colon is called lower digestive tract. Electronic gastroscopy and colonoscopy can realize visual observation of upper and lower digestive tract, while the middle digestive tract(intestinal) has the anatomical structure and special location, so the traditional examination technology is severely limited. Therefore, the small intestine is relatively blind area in the whole digestive tract in medical examination. Capsule endoscopy(Capsule Endoscopy CE) appears to achieve a comprehensive direct observation on small intestinal mucosa. Capsule endoscopy is a breakthrough in the diagnosis of small bowel disease. Although the domestic capsule endoscopy has accumulated certain clinical data, but in a variety of populations and disease stratification results is not perfect and there is no consistent. Through analyzing the clinical data of 1415 cases of capsule endoscopy,(1)we discuss the application value of capsule endoscopy in digestive tract diseases diagnosis,(2) Comparison the efficacy of endoscopic capsule and common gastrointestinal endoscope in upper abdominal pain and chronic diarrhea patients, summary of capsule endoscopy in clinical practice experience.Methods: 1. Included crowdThe examination clinical data of 1415 cases ocapsule endoscopy(domestic OMOM, JS-ME- II) in 2007 August to 2014 January in General Hospital of Beijing Military digestive endoscopy center was retrospective analysised. 884 cases of male, 531 cases of female; age range from 5 to 91 years old, the average age was 49.34 years old. 2. Capsule endoscopy examination group According the symptom before examination and other examinations, cases were divided into the following four groups:(1)Obscure gastrointestinal bleeding, namely the repeated episodes of bloody or black stool or fecal occult blood remains positive, and the upper, lower gastrointestinal endoscopy showed no positive discovery.(2)Patients with chronic abdominal pain and diarrhea: Chronic abdominal pain is a subjective symptom of the patient, and the duration, intensity, position of abdominal pain are also different, the time should be more than six months in clinical, and should exclude organic disease after the relevant examination. Chronic diarrhea is a clinical on more than three months, daily stool frequency was more than usual amount of defecation frequency, or greater than 200 grams.(3)Clinical suspicion of intestinal inflammatory bowel disease, intestinal obstruction and intestinal stenosis should be excepted according to clinical manifestations, laboratory examination and X-ray examination;(4)people who do physical examination with no symptoms. 3. Intestinal cleanness evaluation Capsule endoscopy image definition: According to the bubble in stomach, small intestine cavity, endoscopic doctor divided influence of gastric, small intestinal mucosa observation into three levels: The best: no bubbles and mucus in Intraluminal, endoscopic doctor can clearly observe the intestinal mucosa and intestinal cavity. The general: A small amount of bubbles and mucus, endoscopic doctor can basically observe the intestinal mucosa and intestinal cavity. Poor: A lot of bubbles and mucus, endoscopic doctor basically do not see the bowel mucosa and intestinal cavity. 4. Lesion judgment and classification All capsule endoscopy patients were reviewed by the endoscopist with unified fulltime, and the capsule endoscopy diagnosis report should be issued. The lesion is divided into: the unity of inflammatory lesions, vascular disease, tumor, eminence lesion etc. Single lesions found in the same patient of capsule endoscopy, such as erosion or ulcershould be marked one point, and summury the total number of lesions; If the lesion is continuous or diffuse should be recorded as one point. 5. Abdominal pain and chronic diarrhea patients who examined capsule endoscopy, endoscopy and colonoscopy the same time should be included. Electronic gastroscopy and colonoscopy were examined by the full-time endoscopists who have done endoscope more than 5000 cases and professional technicians. 6. Statistical method SPSS13.0 statistical software for statistical analysis is be used according to the type of data. Count data is compared with the t test. Measurement data expressed with rate(%). Chi square test was used for statistical analysis, if the P value is less than 0.05, there is a significant difference.Results:(1)The study included 1415 capsule endoscopy, 1401 cases achieved excellent or good level in intestinal cleanness99%(1401/1415). The average of access photo number is 48622 + 6117. A total of 1311 cases of capsule endoscopy were through the ileocecal valve(92.7%,1311/1415). 104 cases has not reached colon due to lead to the capsule endoscopy quality and battery life reasons. Capsule endoscopy retented in the bowel because it’s disease in 4 cases;(2) Capsule endoscopy operation time: the retention time of capsule endoscopy in esophageal is 0 ~ 18 min, the average is about 1min. The retention time of capsule endoscopy in stomach is 1 ~ 246 min, the average is about 58 min. The retention time of capsule endoscopy in intestianl is 30~320min, the average is about 260 min. 3. The detection results of capsule endoscopy: 3.1 A total of 1415 patient underwented capsule endoscopy. 1161 lesions were found in in 1110 cases, the positive rate was 78.45%(1110/1415). Among them, the upper gastrointestinal tract lesions was accounted for 39.3%(456/1161), small intestinal lesions were accounted for 46.3%(537/1161), and colorectal lesions was accounted for 14.5%(168/1161). The number of vascular abnormalities was 310, erosive lesions was 464, ulcerative lesions was 150, tumors was 75, polypoid lesions was 123, intestinal parasitic diseases was 24, not clear was 18, inflammatory bowel disease was 7; diverticulum was 2. 3.2 The capsule test results in four classifications of people according to the clinical etiology check people as follows:(1) Unexplained gastrointestinal hemorrhage in 265 cases, among the 169 cases of usual small intestinal lesions, the most common detection sequence were small intestinal vascular malformation in 49.1%(83/169), intestinal inflammatory lesions in 34.3%(58/169), and intestinal parasitic diseases in 5.3%(9/169),Not clear cause 11.2%(19/169);(2) Chronic abdominal pain and diarrhea in 632 cases, among the 208 cases of usual small intestinal lesions, the most common detection sequence were small intestinal vascular malformation in 54.3%(113/208), intestinal inflammatory lesions in 30.8%(64/208), intestinal parasitic diseases in 8.7%(18/208),Not clear cause 6.2%(13/208);(3) Suspected small intestinal inflammatory bowel In 41 patients, among the 20 cases of usual small intestinal lesions, the most common detection sequence were intestinal inflammatory lesions in 35%(7/20), small intestinal vascular malformation in 25%(5/20); intestinal polyps in 20%(4/20),Not clear cause 11.2%(21/41);(4) Asymptomatic patients in 477 cases, among the 140 cases of usual small intestinal lesions, the most common detection sequence were small intestinal vascular malformation in 73.6%(103/140), intestinal inflammatory lesions in 20%(28/140), and intestinal parasitic diseases in 1.4%(2/140), Not clear cause 5%(7/140). 4. Comparison of capsule endoscopy and gastrointestinal endoscopy:(1) In 293 patients with upper abdominal pain, capsule endoscopic found 50 patients with reflux esophagitis(17.1%), 37 cases of bile reflux gastritis(12.6%), 32 cases of gastric ulcer(10.9%); while the gastroscope examination found 68 cases of reflux esophagitis(23.2%), 63 cases of bile reflux gastritis(21.5%), 42 cases of gastric ulcer(14.3%);(2) In 198 patients with chronic diarrhea, capsule endoscopic found 61 cases with colon polyps(30.8%), 22 cases of melanosis coli(11.1%), 7 cases of blind ulcer back(7.1%); while the colonoscopy detected colon polyps in 71 cases(35.9%), 23 cases of melanosis coli(11.6%), 2 cases of blind ulcer(2%), Although capsule endoscopy can’t inspection on the whole colon, but because of its sensitivity, and the total detection rate of colonoscopy is similar with capsule endoscopy(49% vs 54%,χ2=1.01, P>0.05). the total detection rate of chronic diarrhea by capsule endoscopy was higher than colonoscopy with statistical significance(62.6% vs 13.1%, χ2=103.07,P<0.01).Conclusion:(1)The positive rate of capsule endoscopy was 78.45%(1110/1415), and the small intestinal lesions was accounted for 46.3%(537/1161). The Capsule endoscopy retention rate was 0.03%(4/1415). Capsule endoscopy is safe and feasible examzation.(2) Capsule endoscopy had higher diagnostic value in obscure gastrointestinal bleeding, and the most common cause of bleeding in vascular malformation. In 140 cases of symptomatic group, the most common disease detected was small intestinal vascular malformation in 73.6%(103/140), intestinal inflammatory lesions in 20%(28/140). Capsule endoscopy has a good application prospect for routine screening for asymptomatic patients.(3) In the upper abdominal pain, disease detected by capsule endoscopy in the top three were reflux esophagitis, gastritis with bile reflux and gastric ulcer. In the upper gastrointestinal diseases, the total detection rate of capsule endoscopy was lower than gastroscope, At present, the capsule endoscope can not completely replace the traditional electronicgastroscope.(4) In chronic diarrhea patients, the total positive rate of capsule endoscopy and colonoscopy for colorectal lesions showed no difference. The total detection rate of capsule endoscopy in small intestinal lesions was significantly higher than that of colonoscopy with statistical significance. In patients with chronic diarrhea, capsule endoscopy may be used preferably.