Objectives
Capsule endoscopy (CE) has been shown to have poor diagnostic performance when the capsule passes quickly through the small bowel, especially the proximal jejunum. This study aimed to evaluate the diagnostic yield of proximal jejunal lesions with third‐generation CE technology.
Methods
We retrospectively examined 138 consecutive patients, 76 (55.0%) of whom were men. The patients’ median age was 70 years, and proximal jejunal lesions were detected by CE and/or double‐balloon endoscopy at Hiroshima University Hospital between January 2011 and June 2021. We analyzed the diagnostic accuracy of CE for proximal jejunal lesions and compared the characteristics of the discrepancy between the use of CE and double‐balloon endoscopy with Pillcam SB 2 (SB2) and Pillcam SB 3 (SB3).
Results
SB2 and SB3 were used in 48 (35%) and 90 (65%) patients, respectively. There was no difference in baseline characteristics between these groups. Small‐bowel lesions in the proximal jejunum comprised 75 tumors (54%), 50 vascular lesions (36%), and 13 inflammatory lesions (9%). The diagnostic rate was significantly higher in the SB3 group than in the SB2 group for tumors (91% vs. 72%,
p
< 0.05) and vascular lesions (97% vs. 69%,
p
< 0.01). For vascular lesions, in particular, the diagnostic rate of angioectasia improved in the SB3 group (100%) compared with that in the SB2 group (69%).
Conclusions
SB3 use improved the detection of proximal jejunal tumors and vascular lesions compared with SB2 use.
A 69-year-old woman underwent esophagogastroduodenoscopy (EGD) due to abdominal pain. We identified two submucosal tumors (SMTs) measuring <10 mm in size at the gastric fundus (Picture 1). A year later, follow-up EGD revealed that one of the lesions had rapidly grown to approximately 30 mm in size with ulceration (Picture 2). Biopsy specimens of the lesion indicated serous adenocarcinoma with WT1 and estrogen receptor (ER) positivity (Picture 3).
With the increasing use of capsule endoscopy (CE), screening tests for the small bowel can be performed with minimal invasiveness. However, occasionally, the entire small bowel cannot be observed because of decreased peristalsis of the stomach. For such cases, we perform delivery of CE by an endoscope. We retrospectively examined the usefulness of the endoscopic delivery method using a retrieval net for patients with CE stagnation in the stomach. From 2,270 patients who underwent small-bowel CE at Hiroshima University Hospital from January 2013 to January 2020, 29 consecutive patients (1.3% of the total number) in whom the small bowel could not be observed due to CE stagnation in the stomach at the time of the initial CE underwent the endoscopic delivery method using a retrieval net for secondary small-bowel CE. This study included 16 male (55%) and 13 female (45%) patients with a mean age of
69.2
±
13.2
years
. 11 patients (38%) had a history of gastrointestinal surgical resection. The entire small bowel could be observed in 19 patients (66%), and CE reached the terminal ileum in the remaining patients. A history of gastrointestinal surgical resection was significantly more frequent in the group where the entire small bowel could not be observed. The rate of small-bowel lesion detection was 55% (16/29). There were no adverse events associated with our endoscopic delivery method. Thus, the endoscopic delivery method using a retrieval net for patients with initial CE stagnation in the stomach may be safe and useful for the detection of small-bowel lesions.
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