Importance of wireless capsule endoscopy in the diagnosis of small bowel diseases – advances and limitations

Introduction: Wireless capsule endoscopy (c.e.) was introduced worldwide in 2001. Since then it has been applied in clinical routine. This new diagnostic method has been available at our Department since 2001, and is used in co-operation with other Saxon HELIOS hospitals for decision-making in patients with suspected small bowel diseases and especially with obscure gastrointestinal bleeding.

Purpose: It was our intention to prove whether c. e. is useful for further diagnostic and therapeutic approach to patients with different indication for c. e. in clinical routine and to demonstrate its advances and limitations.

Patients and methods: We analysed indication and results for this purpose of c.e. in 41 patients (17 males, 24 females, mean age 50.4 years) examined in our dept. during a period of 29 months between September 2002 and January 2005 by the M2A capsule of Given Imaging.

Results: The indication of c. e. were mainly obscure gastrointestinal bleeding and suspected manifestation of Crohn's disease in the small bowel as well as rare indication, e.g. suspected carcinoid tumour in the small bowel, Klippel-Trenaunay-Syndrome, interenteric fistulas, and abdominal pain or diarrhoea without clear reason as well as neuroendokrine tumour and polyposis syndrome.

Findings: The bleeding source was detected in 10 of 20 patients with obscure gastrointestinal bleeding: angiodysplasias in 5 cases with active bleeding in 2 pts., a small bowel mass, a bleeding ulcer in a Billroth-II-stomach and haemorrhagic lesions in the jejunum in one case each and active Crohn's disease in 2 cases. No bleeding source could be found in 10 patients. In 4 of 13 patients with suspected Crohn's disease typical lesions were demonstrable, e.g. focal atrophy of the villi, lymphatic hyperplasia, aphthous lesions, ulcers and stenosis of the small intestine. Despite clinical suspicion, Crohn's disease could not be detected in 9 patients. Moreover, in 2 pts. suffering from obscure gastrointestinal bleeding active Crohn's disease was diagnosed. Enteroscopy was performed in 4 cases for further endoscopic interventional or surgical therapy.

Conclusions: The diagnostic yield of c. e. is very high. Over all, the findings in c.e. had an influence on further diagnostic and therapeutic approach to these patients in more than 70%. Meanwhile, in obscure gastrointestinal bleeding c. e. is the method of the first choice to confirm or rule out a bleeding source in the small bowel. It should be applied as the next diagnostic step if there was no bleeding source detected in oesophago-gastro-duodenoscopy and ileo-colonoscopy. Moreover, this new method can be useful in early establishing the diagnosis of small bowel manifestations of Crohn's disease. Other reasons for c.e. are still under examination. Because the evaluation of c. e. images by the physician is time consuming and still very expensive this diagnostic technique should be concentrated in gastroenterological centres. Even experienced endoscopists need to learn to make correct and valid diagnoses from the findings in c.e. Therefore, the use of c. e. in a hospital network can make it more effective.