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How good is capsule endoscopy for detection of periampullary lesions? Results of a tertiary-referral center.
Gastrointest Endosc. 2008 Aug; 68(2):267-72.GE

Abstract

BACKGROUND

Ampullary adenomas are increasingly being recognized, particularly in patients with familial adenomatous polyposis. A capsule endoscopy (CE) is routinely recommended for surveillance of small-intestinal polyposis. Performance characteristics of CE for the detection of periampullary lesions are unclear.

OBJECTIVE

To evaluate the ability of CE to detect the major duodenal papilla.

DESIGN AND PATIENTS

A total of 146 consecutive CE studies were reviewed by 2 CE gastroenterologists at 5 frames per second. Primary outcome was visualization of the major duodenal papilla. Discrepancies were reviewed by 5 CE gastroenterologists.

SETTING

A tertiary-referral center.

MAIN OUTCOME MEASUREMENTS

The ability of CE to detect the duodenal papilla.

RESULTS

Among 146 consecutive CE studies, 21 were excluded: capsule retention (3), patient age <18 years (6), duplicate study (8), and prior surgery disrupting duodenal anatomy (4). Of the remaining 125 studies, indications were the following: obscure GI bleeding (45.6%), iron deficiency anemia (19.2%), abdominal pain (17.6%), diarrhea (10.4%), and Crohn's disease (4.8%). In total, 13 major duodenal papillae were visualized. The median time of detection was 31 seconds after the first duodenal image. This translates to a CE sensitivity of 10.4% for detection of the major papilla.

LIMITATION

Papilla position was not verified by an EGD.

CONCLUSIONS

CE has limited sensitivity to visualize the major papilla and lesions in the periampullary small intestine. Nondiagnostic CE studies must not be relied upon as proof that small-bowel lesions do not exist. Consideration should be given for an enteroscopy or side-viewing duodenoscopy in cases where significant clinical concern exists for unrecognized periampullary lesions. The current recommendations about surveillance for small-bowel polyposis should be revised.

Authors+Show Affiliations

Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18378233

Citation

Clarke, John O., et al. "How Good Is Capsule Endoscopy for Detection of Periampullary Lesions? Results of a Tertiary-referral Center." Gastrointestinal Endoscopy, vol. 68, no. 2, 2008, pp. 267-72.
Clarke JO, Giday SA, Magno P, et al. How good is capsule endoscopy for detection of periampullary lesions? Results of a tertiary-referral center. Gastrointest Endosc. 2008;68(2):267-72.
Clarke, J. O., Giday, S. A., Magno, P., Shin, E. J., Buscaglia, J. M., Jagannath, S. B., & Mullin, G. E. (2008). How good is capsule endoscopy for detection of periampullary lesions? Results of a tertiary-referral center. Gastrointestinal Endoscopy, 68(2), 267-72. https://doi.org/10.1016/j.gie.2007.11.055
Clarke JO, et al. How Good Is Capsule Endoscopy for Detection of Periampullary Lesions? Results of a Tertiary-referral Center. Gastrointest Endosc. 2008;68(2):267-72. PubMed PMID: 18378233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How good is capsule endoscopy for detection of periampullary lesions? Results of a tertiary-referral center. AU - Clarke,John O, AU - Giday,Samuel A, AU - Magno,Priscilla, AU - Shin,Eun Ji, AU - Buscaglia,Jonathan M, AU - Jagannath,Sanjay B, AU - Mullin,Gerard E, Y1 - 2008/04/18/ PY - 2007/06/07/received PY - 2007/11/28/accepted PY - 2008/4/2/pubmed PY - 2008/10/1/medline PY - 2008/4/2/entrez SP - 267 EP - 72 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 68 IS - 2 N2 - BACKGROUND: Ampullary adenomas are increasingly being recognized, particularly in patients with familial adenomatous polyposis. A capsule endoscopy (CE) is routinely recommended for surveillance of small-intestinal polyposis. Performance characteristics of CE for the detection of periampullary lesions are unclear. OBJECTIVE: To evaluate the ability of CE to detect the major duodenal papilla. DESIGN AND PATIENTS: A total of 146 consecutive CE studies were reviewed by 2 CE gastroenterologists at 5 frames per second. Primary outcome was visualization of the major duodenal papilla. Discrepancies were reviewed by 5 CE gastroenterologists. SETTING: A tertiary-referral center. MAIN OUTCOME MEASUREMENTS: The ability of CE to detect the duodenal papilla. RESULTS: Among 146 consecutive CE studies, 21 were excluded: capsule retention (3), patient age <18 years (6), duplicate study (8), and prior surgery disrupting duodenal anatomy (4). Of the remaining 125 studies, indications were the following: obscure GI bleeding (45.6%), iron deficiency anemia (19.2%), abdominal pain (17.6%), diarrhea (10.4%), and Crohn's disease (4.8%). In total, 13 major duodenal papillae were visualized. The median time of detection was 31 seconds after the first duodenal image. This translates to a CE sensitivity of 10.4% for detection of the major papilla. LIMITATION: Papilla position was not verified by an EGD. CONCLUSIONS: CE has limited sensitivity to visualize the major papilla and lesions in the periampullary small intestine. Nondiagnostic CE studies must not be relied upon as proof that small-bowel lesions do not exist. Consideration should be given for an enteroscopy or side-viewing duodenoscopy in cases where significant clinical concern exists for unrecognized periampullary lesions. The current recommendations about surveillance for small-bowel polyposis should be revised. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/18378233/How_good_is_capsule_endoscopy_for_detection_of_periampullary_lesions_Results_of_a_tertiary_referral_center_ DB - PRIME DP - Unbound Medicine ER -