Five-year single center experience of small bowel capsule endoscopy *
Capsule endoscopy (CE) has been shown to be superior to other minimally invasive available investigative modalities for diagnosing small bowel diseases. Health insurance began to cover CE for obscure gastro-intestinal bleeding (OGIB) from October 2007 in Japan. We investigated the clinical backgrounds of the patients examined at our institute for 5 years (from 2007 January to December 2011). Beginning in 2009 March after introduction of the real-time viewer, the small bowel was regularly monitored and action was taken if CE was delayed (e.g., administration of water, intravenous metoclopramide, or endoscopic-assisted duodenal placement of CE). Two endoscopists independently reviewed the CE images from 404 CE procedures in 341 patients (187 men and 154 women, average age 64 years old). Heart diseases such as ischemic heart disease, valvular diseases of the heart, atrial fibrillation were present in 18.4% and chronic renal failure in 8.7%. The most frequent purpose of the examination was survey for OGIB. CE procedures were repeated in 10 patients (10.6%). 118（34.6%）patients were taking anti-thrombotics including low dose aspirin which was most frequent (23.4%). The most frequently detected lesions were erosions and ulcers; half of these lesions were induced by NSAIDs including low dose aspirin. Angioectasia was diagnosed in 13.8%, tumors in 15.2%. No abnormal lesion was detected in only 16.1% of the patients. Capsule retention occurred in one case and the capsule was retrieved using double-balloon endoscopy. 6 patients with cardiac pacemaker underwent CE without incident in any of these patients. After the CE procedure, endoscopic hemostasis and endoscopic polypectomy were performed in 9 and 5 patients respectively. 12 patients underwent surgery: jejunal cancer, lipoma and GIST were each present in 2 cases; Heyde’s syndrome, juvenile polyp, inversion of enteric duplication, pyogenic granuloma, Meckel’s diverticulum, and inflammatory fibroid tumor were each in one case. Small bowel CE is a safe and useful modality with high diagnostic yield for small bowel diseases, especially in elderly patients with underlying diseases. (Accepted on April 9, 2012)
