Capsule endoscopy is safe and effective after small-bowel resection.
ABSTRACT Because capsule endoscopy is a relatively new technique, the indications, the contraindications, and the complications of the procedure have not been fully delineated. The present study was undertaken to determine the utility and the safety of capsule endoscopy in patients who have undergone small-bowel resection.
Ten patients (mean age 48.5 [8.4] years) were included in the study. Eight had undergone surgical resection for Crohn's disease and two for malignancy. Indications for capsule endoscopy included suspected relapse of Crohn's disease or of malignancy, with a negative conventional evaluation that included barium contrast radiography, upper endoscopy, colonoscopy, US, CT, and push enteroscopy. Capsule endoscopy was performed in the standard fashion.
No side effects were observed in any patient. Natural excretion of the capsule was reported at a mean of 72 hours. In 7 patients (70%), capsule endoscopy revealed recurrence of disease in the small bowel: one recurrent malignancy, 6 recurrent Crohn's disease. The information gained was helpful with respect to further treatment for all of these patients.
Capsule endoscopy is safe and effective in the evaluation of patients who have undergone surgical resection of the small bowel for benign or malignant disease.
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ABSTRACT: Capsule endoscopy (CE) was found to be an effective tool in diagnosis of small bowel pathology. This review will focus on its role in Crohn's disease. Its role in patients with suspected Crohn's disease (CD) is described. CE has an established role for diagnosing CD when other tests are negative, though it is not a first line investigative tool in these patients. Over diagnosis is of concern. Its use in established CD remains an open question. It can provide exact mapping of small bowel disease before surgery, and might have impact on the treatment of the disease. It may have role in monitoring mucosal healing, which is becoming a target of therapy, and may help establish the exact diagnosis in a limited group of patients with indeterminate colitis. Retention of CE might occur. It is of low rate in patients with suspected CD and higher in patients with known CD but clinical obstruction is extremely rare. Economic considerations are a limit to a wider application of the CE.Journal of Crohn s and Colitis 06/2008; 2(2):107-13. · 3.39 Impact Factor
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ABSTRACT: Jejunal diverticulosis is an uncommon disease and usually asymptomatic. It can be complicated not only by diverticulitis, but by hemorrhage, perforation, intussusception, volvulus, malabsorption and even small bowel obstruction due to enteroliths formed and expelled from these diverticula. We describe a case of an occult bleeding jejunal diverticulum, casually discovered in a patient that was taken to surgery for a Dieulafoy's lesion after unsuccessful endoscopic treatment. We performed a gastric resection together with an ileocecal resection.Macroscopic and microscopic examinations confirmed the gastric Dieulafoy's lesion and demonstrated the presence of another source of occult bleeding in asymptomatic jejunal diverticulum. The current case emphasizes that some gastrointestinal bleeding lesions, although rare, can be multiple and result in potentially life-threatening bleeding. The clinician must be mindful to the possibility of multisite lesions and to the correlation between results of the investigations and clinical condition of the bleeding patient.BMC Surgery 11/2012; 12 Suppl 1:S29. · 1.97 Impact Factor
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ABSTRACT: Anemia is the most common hematologic abnormality in older populations. Furthermore, iron deficiency anemia is common and merits investigation and treatment, as it usually results from chronic occult bleeding from the gastrointestinal tract. In view of a wide use of capsule endoscopy as a diagnostic procedure for occult gastrointestinal bleeding and of the growth of aging population, we performed a literature review about the feasibility of capsule endoscopy in the elderly. We conducted a literature search in the PubMed database in July 2012, and all English-language publications on capsule endoscopy in elderly patients since 2005 were retrieved. The potential original articles mainly focused on obscure gastrointestinal bleeding were all identified and full texts were obtained and reviewed for further hand data retrieving. We retrieved only six papers based on different primary end-points. Four were retrospective non randomized studies and two were prospective non randomized studies. In the end 65, 70, 80 and 85 years were used as an age cut-off. All studies evaluate the diagnostic yield of capsule endoscopy in iron deficiency anemia. Only three studies assess the feasibility of capsule examination of the elderly. Iron deficiency anemia in the elderly with or without obscure gastrointestinal bleeding is the major indication for capsule endoscopy after a negative esophago-gastro-duodenoscopy and colonoscopy. It is safe and effective to identify a small bowel pathology without a great discomfort for the elderly. Inability to swallow the capsule, battery failure before capsule reaches the cecum, and capsule retention are some of the important problems associated with capsule endoscopy in elderly as well as in younger patients.BMC Surgery 11/2012; 12 Suppl 1:S30. · 1.97 Impact Factor