Heads or tails, does it make a difference? Capsule endoscope direction in small bowel studies is important

Sn, Adler; Yc, Metzger

doi:10.1055/s-2007-966780

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…Our prospective study compares the performance of SB3 and PillCam Colon 2 capsules for the investigation of suspected small bowel bleeding. Previous studies of pan-intestinal capsule investigation and double headed small bowel capsules have suggested a bidirectional, double headed, capsule, including PillCam Colon 2, designed for colonic imaging, may have a diagnostic advantage in the small bowel (6,7,13,14). Our findings do not support this hypothesis.…”

Section: Discussioncontrasting

confidence: 89%

Single or double headed capsules for the investigation of suspected small bowel bleeding: Are two heads better than one

McCarthy¹,

Sihag²,

Deane³

et al. 2022

Front. Gastroenterol.

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BackgroundCapsule endoscopy is now the accepted first line investigation for suspected small bowel (SB) bleeding. Recent evidence suggests the diagnostic yield for SB pathology may be higher for tailored double headed (DH) SB capsules. Whether other forms of bidirectional capsules offer a similar advantage is less clear.AimTo compare the efficacy of single headed versus bidirectional capsules in detecting pathology in patients with suspected small bowel bleeding.MethodsA single centre prospective comparison study was conducted over an 8 month period in a tertiary care hospital. Patients referred with overt or suspected SB bleeding were assigned to either SB3 Medtronic SB capsule (SH) during the initial four months or PillCam Colon 2 Medtronic capsule (DH) during the subsequent four months. Studies were analysed by trained Capsule Endoscopists and approved by our institutions capsule review board. Findings were compared between SH and DH capsules using a chi2 or t-test as appropriate. A p value of <0.05 was considered significant.Results201 subjects were included, mean age 61.8 years, 90 (45%) male. Majority referred with occult bleeding, 153 (76%). DH and SH capsule used in 100 and 101 cases, respectively. 90% (n=181) capsules were complete and overall diagnostic yield was 57% (n=114). Diagnostic yield was similar between both groups - DH 53% (n=53), SH 60% (n=61). Positive finding in overt bleeding; SH 85% (n=22) versus DH 50% (n=11), p<0.02. SH capsules more frequently detected SB inflammation, 27 (27%) versus 9 (9%), p<0.002. More patients had another diagnosis in the DH (19) than the SH (9), p<0.04, the majority were type 1a vascular lesions, “red spots” or diminutive colonic polyps.ConclusionSingle head and double head capsules perform similary in terms of diagnostic yield overall. This supports the continued use of standard small bowel capsules for investigation of the small bowel.

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Section: Discussioncontrasting

confidence: 89%

Single or double headed capsules for the investigation of suspected small bowel bleeding: Are two heads better than one

McCarthy¹,

Sihag²,

Deane³

et al. 2022

Front. Gastroenterol.

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“…The exact contribution of this factor is uncertain; however, it is clear that some of findings may escape the camera that is facing the opposite direction despite it's wide angle of capture (for example, 156°for PillCam TM SB2 and 140°for PillCam TM SB1). In a study by Adler and Metzger [3], three patients with Crohn's disease underwent two capsule endoscopies each within a week. The capsule traversed the pylorus in opposite direction in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…The direction of the passage of the ileocecal valve was determined as head first when a clear view of the valve with a following appearance of a cecal image was obtained. If no image of the ileocecal valve was obtained, the direction of the passage was described as tail-first [3].…”

Section: Determination Of Movement Directionmentioning

confidence: 99%

“…head first) due to yet unknown causes. With single-camera capsules, the direction of capsule movement may bear significant impact on clinical outcome of intestinal visibility, as it was suggested that head-forward movement provides superior view of the mucosa compared to tail-first viewing [3]. Moreover, with recent technological efforts to devise capsules for diverse applications such as drug delivery or luminal content sampling [4], such Electronic supplementary material The online version of this article (doi:10.1007/s10620-011-1913-6) contains supplementary material, which is available to authorized users.…”

Section: Introductionmentioning

confidence: 99%

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Head or Tail: The Orientation of the Small Bowel Capsule Endoscope Movement in the Small Bowel

et al. 2011

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“…As Kopylov et al point out, previous data suggest that that the vector of CE small-bowel transit impacts on the CE diagnostic yield [2]. It has been shown that single-headed CE may have limitations when compared to double-headed CE [3,4], in the detection of anatomical landmarks, i.e., ampulla of Vater.…”

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confidence: 99%

Heads or Tail Orientation in Small-Bowel Capsule Endoscopy: 2 Capsule Models with 2 Reviewers

2012

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We read with great interest the article by Kopylov et al. [1] on the orientation of the small-bowel capsule endoscope's (CE) movement in the small bowel. Although factors determining the orientation of a CE during a small-bowel study-and thus the diagnostic yield-are complex and largely due to random chance, this study represents an important attempt to highlight the importance of capsule passage orientation when imaging the small-bowel.The authors have also clearly demonstrated (using submersion testing) that the PillCam Ò SB2 capsule has its center of gravity closer to the antenna dome due to the heavier battery compartment.In our center, we use two CE systems, i.e., Given Ò Imaging PillCam Ò and Intromedic Ò Ltd MiroCam Ò . We aimed to determine how the MiroCam Ò capsules compared to PillCam Ò in orientation of small-bowel movement.We therefore repeated the submersion experiment by immersing a PillCam Ò SB2 and a MiroCam Ò in a glass of plain tap water. It was noted that the PillCam Ò replicated the previous experiment by orientating its antenna's dome first. However, the MiroCam Ò lay horizontally on the bottom of the glass (Fig. 1).As Kopylov et al. point out, previous data suggest that that the vector of CE small-bowel transit impacts on the CE diagnostic yield [2]. It has been shown that single-headed CE may have limitations when compared to double-headed CE [3,4], in the detection of anatomical landmarks, i.e., ampulla of Vater.We have recently reported our center's experience with two different small-bowel capsule endoscopy systems [5]. Review of our dual system small-bowel capsule endoscopy (SBCE) patient database was performed and all SBCE with either suboptimal image quality due to poor preparation or technical failures, i.e., inability to retrieve video-sequences stored in compact disks due to time corruption and/or incomplete recording were excluded. The remaining 17 patients have been investigated multiple times with both CE systems at different points in their diagnostic work-up totaling 20 PillCam Ò procedures and 18 MiroCam Ò procedures. The indications for SBCE were: obscure (overt/ occult) gastrointestinal bleeding (n = 13), Crohn's (known/suspected) disease assessment (n = 4). Both reviewers (AK, reviewer 1 and SD, reviewer 2) have extensive experience with CE. We re-examined the SBCE aiming to detect the direction (head-or tail-first) of each CE system through the pylorus and the ileocecal valve as suggested by Kopylov et al. [1]. In the PillCam Ò cohort, the pylorus was entered head-first in 13/20 (65%) and 14/20 (70%) examinations, for reviewer 1 and 2, respectively. The head-first direction of transit through the IC valve was seen in 14/20 (70%) and 15/20 (75%) examinations, for reviewer 1 and 2, respectively. In the MiroCam Ò group, the head-first pyloric entry was recorded in 13/18 (72%) and 14/18 (78%) examinations, for reviewer 1 and 2, respectively. For the IC head-first transit, the values were 14/18 (78%) and 11/18 (61%), respectively (Fig. 2).The interobserver variability was qu...

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Heads or tails, does it make a difference? Capsule endoscope direction in small bowel studies is important

Cited by 5 publications

References 3 publications

Single or double headed capsules for the investigation of suspected small bowel bleeding: Are two heads better than one

Single or double headed capsules for the investigation of suspected small bowel bleeding: Are two heads better than one

Head or Tail: The Orientation of the Small Bowel Capsule Endoscope Movement in the Small Bowel

Heads or Tail Orientation in Small-Bowel Capsule Endoscopy: 2 Capsule Models with 2 Reviewers

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