Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval
Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. Gastrointestinal endoscopy
(Impact Factor: 5.37).
03/2010; 71(3):535-41. DOI: 10.1016/j.gie.2009.10.029
Capsule retention in the small bowel is a known complication of small-bowel video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval.
To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval.
Retrospective analysis of all video capsule studies was performed at our center, and evaluation of the outcome of DBE was the first method used to retrieve entrapped video capsules.
Tertiary referral center.
A total of 904 patients who underwent small-bowel video capsule endoscopy.
Capsule retrieval by DBE.
The number of patients in whom capsule retention occurred and the number of patients in whom an entrapped capsule could be retrieved by using DBE.
Capsule retention occurred in 8 patients (incidence 0.88%; 95% CI, 0.41%-1.80%) and caused acute small-bowel obstruction in 6 patients. All retained capsules were successfully removed during DBE. Five patients underwent elective surgery to treat the underlying cause of capsule retention. One patient required emergency surgery because of multiple small-bowel perforations.
In our series, the incidence of capsule retention was low. DBE is a reliable method for removing retained capsules and might prevent unnecessary surgery. If surgery is required, preoperative capsule retrieval allows preoperative diagnosis, adequate staging in case of malignancy, and optimal surgical planning.
Available from: Susumu Saigusa
- "Although there were many reports of capsule retention of long duration [4, 12, 13], we think that the retained CE should be retrieved if spontaneous or pharmaceutical manipulation, the rates of spontaneous or pharmaceutical-manipulated passage of retained capsules have been reported to vary from 15 to 65.6% [3, 14], is ineffective to egest it because there are several reports of retained capsule causing intestinal obstruction and perforation [5, 6, 8, 9]. Surgical retrieval is often required secondary to an underlying pathologic process causing a stricture or obstruction although double-balloon endoscopy has been reported as one of the effective approaches for the retrieval of retained CE [15, 16]. We removed the retained CE by laparoscopy-assisted surgery. "
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ABSTRACT: A 50-year-old man with anemia was referred to our hospital to undergo capsule endoscopy (CE), which revealed small intestinal ulcers. After 5 months of CE, he returned because of recurrent anemia without abdominal symptoms. Abdominal X-ray and computed tomography showed capsule retention in the small intestine at the pelvic cavity. The capsule remained at the same place for 7 days. We performed capsule retrieval by laparoscopy-assisted surgery with resection of the involved small intestine, including an ileal stricture. Resected specimen showed double ulcers with different morphologies, an ulcer scar with stricture, and a wide ulcer at the proximal side of the others. Each ulcer had different histopathological findings such as the degree of fibrosis and monocyte infiltration. These differences led us to consider that the proximal ulcer may have been secondarily induced by capsule retention. Our experience indicated that careful follow-up and the cooperation between medical institutions after CE examination should be undertaken for patients with incomplete examination, unknown excretion of the capsule, and/or ulcerative lesions despite the lack of abdominal symptoms. Additionally, a retained CE remaining over long periods and at the same place in the small intestine may lead to secondary ulceration.
Available from: PubMed Central
- "Several case reports have shown that a balloon-assisted endoscope can reach the deep small bowel and can be utilized to retrieve the retained capsule in patients not requiring emergency intervention.9,18-21 However, the retained capsule cannot always be removed using BAE. "
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ABSTRACT: Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.
Available from: Roy L J van Wanrooij
- "Other diagnostic tools which might be helpful in the diagnostic work-up of RCD patients include videocapsule enteroscopy (VCE), MR enteroclysis, and double balloon enteroscopy (DBE) which all allow visualization of intestinal lesions. VCE is useful in determining the extent of lesions and is less invasive than other endoscopic techniques [16, 25]. Comparison of VCE with MR enteroclysis indicates that both modalities are complementary in diagnostic accuracy in the analysis of small-bowel disease . "
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ABSTRACT: A small subset of coeliac disease (CD) patients experiences persisting or recurring symptoms despite strict adherence to a gluten-free diet (GFD). When other causes of villous atrophy have been excluded, these patients are referred to as refractory celiac disease (RCD) patients. RCD can be divided in two types based on the absence (type I) or presence (type II) of an, usually clonal, intraepithelial lymphocyte population with aberrant phenotype. RCDI usually runs a benign course and may be difficult to be differentiated from uncomplicated, slow responding CD. In contrast, RCDII can be defined as low-grade intraepithelial lymphoma and frequently transforms into an aggressive enteropathy associated T-cell lymphoma with dismal prognosis. This paper describes the clinical characteristics of RCDI and RCDII, diagnostic approach, and the latest insights in treatment options.
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