Esophageal capsule endoscopy is an adequate alternative diagnostic method for the study of gastroesophageal reflux disease and for the screening of esophageal varices in patients refusing to undergo conventional upper gastrointestinal endoscopy.

Objective: to evaluate the type, frequency, and severity of macroscopic small bowel mucosal injury after chronic NSAID intake as assessed by capsule endoscopy (CE), as well as to correlate the severity of gastroduodenal and intestinal damage in these patients.Material and methods: a prospective, endoscopist-blind, controlled trial. Sixteen patients (14F/2M; age: 57.06 ± 10.16 yrs) with osteoarthritis (OA) on chronic therapy with NSAIDs underwent CE and upper gastrointestinal endoscopy (UGE). Seventeen patients with OA (9F/2M; age: 57.47 ± 9.82 yrs) who did not take NSAIDs were included as a control group. A scale ranging from 0 to 2 (0 = no lesions, 1-minor = red spots or petechiae, denuded areas and/or 1-5 mucosal breaks; 2-major = > 5 mucosal breaks and/or strictures, or hemorrhage) was designed to assess the severity of small bowel mucosal injuries.Results: CE found intestinal lesions in 75% (12/16) of patients in the study group and in 11.76% (2/17) of controls (p < 0.01). Seven out of 16 NSAID consumers (43.75%) and none in the control group (0%) had a major small bowel mucosal injury (p < 0.01). The percentages of patients with grade 1 and 2 gastroduodenopathy in the study group, as assessed by UGE, were 37.14 and 23.81%, respectively. There was no significant difference in the rate of major enteropathy between patients with none or minor gastroduodenal injury, and those with major gastroduodenopathy (43.75 vs. 40%; p = N.S.).Conclusions: chronic NSAID intake is associated with a high rate of small bowel mucosal injuries. Our data have failed to demonstrate a relationship between the severity of gastroduodenal and intestinal injury.Key words: NSAID. Small bowel mucosal injury. Capsule endoscopy. Enteropathy. Prospective. Controlled. INTRODUCTIONNonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a significant risk of gastrointestinal events with clinical and economic consequences (1-6). Gastric and duodenal ulcerations are the most widely studied manifestations of injury to the gastrointestinal tract caused by NSAIDs, but these medications also can affect the jejunum and ileum, and can cause other types of abnormalities (inflammation, stricture, perforation, mucosal diaphragms and villous atrophy) (7,8).Most of the previously available knowledge about the small bowel comes from autopsy examinations (9), case reports (10) or case series (11). Some techniques have been devised to study the small bowel injury ( 111 In-labeled leukocytes, 51 Cr-EDTA, fecal calprotectin levels), but they are indirect and are not generally available to the clinician (8). Push enteroscopy provides good visualization of the small bowel mucosa, and it has been used to study NSAID enteropathy (12), but does not examine the entire gut, is timeconsuming, cumbersome for the patient, and usually requires sedation (13). Therefore, the true prevalence, location and extent of NSAID enteropathy are still unclear.Capsule endoscopy (CE) is a new diagnostic method that has recently made non-invasive digital imaging of the enti...

Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology.Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed.Results: a total of 144 subjects (67 women and 77 men); (52.17±16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified.In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %.The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn´s Disease in 9 and ulcerative colitis in other 8 cases.Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agreement with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data. INTRODUCTIONCapsule endoscopy has been established as the diagnosis of obscure gastrointestinal bleeding and in other small bowel suspected lesions (1-3) and it is known to be useful only for the study of small bowel mucosa injuried (4). Following the path marked by this capsule, a colon capsule endoscopy has been developed. Several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared to the colonoscopy in the study of the colonic pathology (5,6).The CCE is similar to the conventional capsule but has two cameras which are able to record video images from both ends. The device measures 31 by 11 mms and acquires images at a rate of 4 frames per second. The preprogrammed "sleep" mode allows recording of images from the esophagus and the stomach for 3 minutes and after that capsule switches to sleep mode for 1 hour 45 minutes, so that it saves battery. During this period, the capsule is likely to transit most of the small bowel and reaches ap...

Aim: to study the usefulness and safety of capsule endoscopy as a diagnostic tool in various small bowel disorders. Design: a retrospective analysis of a series of cases. Material and methods: between August 2001 and August 2002, 92 capsule endoscopy procedures were performed in 88 patients (53M/39F, age: 43.87 ± 16.78). Indications included: chronic diarrhea (n = 33); unknown abdominal pain (n = 29); occult gastrointestinal bleeding or iron-deficiency anemia (n = 13); abdominal discomfort in NSAID takers (n = 7); staging of gastrointestinal tumors (n = 4), and asymptomatic controls (n = 2). Previously performed gastroscopy, colonoscopy, and smallbowel follow-through were not conclusive in all patients. Results: most frequently relevant findings included: jejunoileal apthas and ulcerations (29 patients), vascular malformations (13 patients), and intestinal neoplasm (6 patients). The groups with a higher rate of findings related to this indication were occult gastrointestinal bleeding (76.92%) and chronic diarrhea (67.85%), with the lowest rate in the abdominal pain group (34.48%). Therapeutic strategy was directly changed in 36 of 88 patients (40.90%) because of capsule-endoscopic findings. The only observed complication was the failed excretion of one of the capsules because of an unknown ulcerated intestinal stricture. Conclusions: capsule endoscopy is a safe procedure which can study the entire small bowel, meaning a valuable tool for the management of patients with suggestive signs and symptoms of intestinal disorders.

Background and study aimsColon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis.Patients and methodsWe included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its “sleep” mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device (“camera 1”); and the other reviewed the opposite side (“camera 2”). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers.ResultsA complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373–0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement.ConclusionThe use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.