Identification of the Duodenal Papilla by Colon Capsule Endoscope

Abstract

The sensitivity of small-bowel capsule endoscopy in visualizing a single finding present in everyone, the duodenal papilla, is limited. In this retrospective case series study we evaluated whether the duodenal papilla can be better visualized by a capsule endoscope equipped with cameras on both ends. The recordings of 45 colonic capsule endoscopies (PillCam Colon) performed in a single tertiary center were re-evaluated seeking for the duodenal papilla. The two-hour sleeping period of the colon capsule endoscopy system led to the imaging of duodenum in 10 / 45 patients. The duodenal papilla was identified in 6 / 10 (60 %) patients while the number of frames where the papilla was clearly visualized ranged from 2 - 9. Consequently, a small-bowel capsule endoscope containing two cameras could better identify the duodenal papilla and theoretically other obscure areas of the small bowel, expanding its diagnostic accuracy.

First clinical trial of a newly developed capsule endoscope with panoramic side view for small bowel: A pilot study

“…Detection rate exceeds that of other capsule systems, where a single camera provides detection in 10–44% . The duodenum is known to be the fastest moving section of the small bowel and therefore difficult to evaluate . In a study of 14 examinations, the duodenal papilla could not be identified .…”

Detection of the ampulla of Vater in small bowel capsule endoscopy: Experience with two different systems

“…However, other investigators presented less favourable results . One would think that results should improve with advanced CE technical characteristics, but the experience from the studies using double‐headed CE with improved optics and frame acquisition rate are only partially concordant . Furthermore, although different generations of small bowel PillCam models and types have been scrutinized (with regard to the AoV detection rate), other CE systems have not been put under the test …”

“…,23,25 Furthermore, although different generations of small bowel PillCam models and types have been scrutinized (with regard to the AoV detection rate), other CE systems have not been put under the test 20,22,23,26. …”

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

“…Interestingly, most of the lesions diagnosed on push enteroscopy have been found in locations accessible to standard esophagogastroduodenoscopy, emphasizing the importance of second-look endoscopy ( 22,39 ). When a dedicated push enteroscope is used, it may be performed with an overtube designed to reduce looping in the improved to 60% if a dual camera capsule is used ( 63 ). Nonetheless, VCE does miss clinically important duodenal and proximal jejunal lesions (64)(65)(66)(67), and thus cannot be solely relied upon for exclusion of bleeding lesions in these areas.…”