Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE‐J study)

Abstract

Background and Aim: We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes.Methods: We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers.Results: Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years,respectively(P = 0.6661),butthetotalenteroscopyrate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantlymorecommonthanprolongedlodginginthestomach(64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc.Conclusions: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.

Capsule endoscopy in patients with surgically altered gastric anatomy: Oral ingestion should be preferred to endoscopic delivery

“…

Letters, Techniques and ImagesCapsule endoscopy in patients with surgically altered gastric anatomy: Oral ingestion should be preferred to endoscopic delivery Dear Sir, We read with interest the AdvanCE-J study by Ohmiya et al reporting on the outcomes of 546 endoscopic deliveries (ED) of small bowel (SB) capsule endoscopy (CE). 1 The results are in line with the European standards for ingested SBCE (completion rate ≥80%, detection rate ≥50%, retention rate ≤2%). 2 However, it is pointed out that ED increases procedural risks and costs.Unsuccessful ingestion and esophagogastric CE lodging were the main indications for ED, whereas two patients only (0.4%) had ED because of a history of gastrectomy.

…”

Small bowel endoscopy for children: Collaboration of capsule endoscopy and device‐assisted enteroscopy

“…Sedation is not usually required for CE examination, but where the patient is unable to swallow and endoscopy is indicated, it should be offered. In a large study of endoscopic delivery devices for CE in patients younger than 16 years, 56% received intravenous anesthesia and 44% received general anesthesia 21 . By contrast, BAE is often performed under general anesthesia, with reports of intravenous anesthesia being used for older children (age >16 years) 27,28 .…”

AdvanCE, a capsule endoscope delivery device, is effective in investigating a waterfall stomach

“…However, it is often abandoned in patients with dysphagia or difficulty passing CE through the pylorus 2 . AdvanCE is a device that eases insertion of a CE by conventional endoscopy 3 . We present a case where an AdvanCE CE delivery device (US Endoscopy, Mentor, OH, USA) was used because the patient's small bowel could not be observed by CE alone, due to waterfall stomach.…”