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PA.215 DIAGNOSTIC YIELD OF VIDEO CAPSULE ENDOSCOPY IN OVERT AND OCCULT OBSCURE GASTROINTESTINAL BLEEDING
S154
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
to two days prior to PCC procedure, all patients were required to start a low-residue diet. One day before the examination patients had a “liquids only” diet and ingested 3 L of polyethylene glycole (PEG). On the morning of the procedure, the subjects continued bowel preparation with another litre of PEG, according to manufacture indication and previous data. After the PCC reached the small bowel a boost dose of 40 ml sodium phosphate was given to the patients. When the patient did not undergo colonoscopy on the same day, he continued with the liquid diet, but no other pharmacological agents were given. Colonoscopies were performed by experienced endoscopists who were blinded about PCC results. The colon cleansing was evaluated using a 3 point scale for both procedures (poor, fair and good). All patient provided a written informed consent to undergo PCC and colonoscopy Results: No complications were documented in both procedures. In one case PCC stopped working two minutes after ingestion; in two other cases the PCCs failed to work before ingestion and were substituted with other capsules. Positive findings were detected in 5 cases (diverticulis, inflammation of the mucosa and polyp) and were confirmed in all colonoscopies. In a patient a gastric polyp was detected by PCC and confirmed by an EGDS. One small polyp (5 mm) was detected by conventional colonoscopy, but was missed by PCC. The colon cleansing was considered good in 3 cases, fair in 3 cases and poor in 4 cases. Conclusions: PCC is feasible and is a promising tool for the detection of the pathologies of the colon and of the others tracts of the intestine visualized during the examination. Further studies are needed to confirm the value of this endoscopic technique in clinical practice and moreover further technical improvements are needed in capsule engineering. # Q. Diagnostic endoscopy 6. Video-capsule
PA.214 DIAGNOSTIC YIELD OF SMALL BOWEL CAPSULE ENDOSCOPY FOR INDICATIONS OTHER THAN OBSCURE GASTROINTESTINAL BLEEDING C.M. Girelli ∗ , V. Malacrida, F. Barzaghi Ospedale di Circolo di Busto Arsizio, Busto Arsizio Background and aim: Although small bowel capsule endoscopy (SBCE) is now widely accepted as a first line diagnostic modality for obscure gastrointestinal bleeding (OGB), its role for non-OGB conditions is less clear. Aim of the study was to compare demographics and diagnostic yield of SBCE between patients with and without OGB, and to seek the indications with the highest diagnostic yield within non-OGB group. Material and methods: From September 2001, to September 2007, we performed 323 SBCE on as many patients. 135 (42%) for occult OGB, 101 (31%) for overt OGB and 87 (27%) for non-OGB conditions, namely: 35, suspected Crohn’s disease (CD); 20, chronic unexplained diarrhoea; 9, refractory coeliac disease; 8, staging of known polyposis syndrome; 6, recurrent unexplained abdominal pain; 5, metastasis from primary unknown; 4, suspected neuro-endocrine tumour (NET). We retrospectively compared demographic data and yield of SBCE in nonOGB patients with those having OGB. All SBCE were made by Pillcam SB and read by Rapid software (givenimaging® , Yoqneam, Israel). Continuous and dichotomous variables were compared by Student-t test and chi-square (Fisher exact test, when appropriate), respectively. Results: Patients of non-OGB group were younger than their OGB counterparts (42±18 yrs vs 64±17; t=10; p<0.0001). No gender differences were observed. Diagnostic yield in non-OGB group (36%) was lower than the OGB group, either of overt or occult type (78%; χ2 =35, p<0.0001 and 72%; χ2 =28, p<0.0001; respectively). Subgroup analysis of non-OGB indications showed a highest yield for suspected CD (46%), staging polyposis syndrome (62%) and suspected NET (75%) (Subgroup A); whereas the lowest yield was for chronic diarrhoea (30%), refractory coeliac disease (22%), abdominal pain (0%) and metastasis of primary unknown (0%) (Subgroup B). Yield comparison
between Subgroup A and B was statistically significant (p=0.003, Fisher exact test). Conclusions: In comparison with OGB group, patients with non-OGB indications to SBCE are younger and have a lower frequency of small bowel abnormalities. Within non-OGB indications, suspected CD, staging of known polyposis syndrome, and suspected NET are those with the highest yield. # Q. Diagnostic endoscopy 6. Video-capsule
PA.215 DIAGNOSTIC YIELD OF VIDEO CAPSULE ENDOSCOPY IN OVERT AND OCCULT OBSCURE GASTROINTESTINAL BLEEDING C.A.A. Petrini ∗ , S. Gasperoni, M.L. Brancaccio, F. Cantoni, T. Casetti S Maria delle Croci Hospital, Ravenna Background and aim: Conventional available techniques have low diagnostic yield in obscure gastrointestinal bleeding (OGIB). Video Capsule Endoscopy (VCE) is a new non-invasive diagnostic tool able to explore the small bowel and to detect bleeding lesions. OGIB was defined as occult when it manifested as recurrent iron-deficiency anemia and/or positive fecal blood test, without any clinically evident bleeding episode, or as overt bleeding when manifested as recurrent episodes of visible hematemesis, melena, or hematochezia. The aim of this study was to investigate the role of VCE in detecting lesions of the small bowel in patients with overt or occult OGIB. Material and methods: Between June 2002 and November 2007, 209 consecutive patients (126 men and 83 women, with a mean age of 65.3 years, range 15-93 years) with OGIB underwent VCE. Obscure-overt bleeding was present in 119 patients; obscure-occult bleeding was present in 90 patients. All the patients had a previous study with EsofagoGastroDuodenoscopy and Colonoscopy. The intestinal preparation included the administration of 4 litres of polyethylene glycol-based solution and an overnight fasting. Results: In patients with obscure-overt bleeding VCE revealed: angiodysplasias in 36 patients, erosions and/or ulcers in 23, presence of blood or clots in 16, polyps in 7, mass/tumors in 2, venous structures in 1, diverticula in 1, a normal finding in 33. In patients with obscure-overt bleeding overall diagnostic yield was 72.3%. In patients with obscureoccult bleeding VCE revealed: angiodysplasias in 26 patients, erosions and/or ulcers in 17, mass/tumors in 7, polyps in 3, venous structures in 2, atrofic mucosa and/or abnormal villi in 1, a normal finding in 34. In patients with obscure-occult bleeding overall diagnostic yield was 62.2%. Conclusions: VCE is mandatory in patients with OGIB. The diagnostic yield is higher in patients with obscure-overt bleeding compared to patients with obscure-occult bleeding. Advantages of VCE includes its applicability and simplicity. These factors are particularly important because obscure bleeding often occurs in an increasingly ageing cohort of patients with multiple comorbidities. # Q. Diagnostic endoscopy 6. Video-capsule
PA.216 VIDEO CAPSULE ENDOSCOPY: EXPERIENCE IN OUR CENTRE C.A.A. Petrini ∗ , S. Gasperoni, M.L. Brancaccio, F. Cantoni, T. Casetti S.Maria delle Croci Hospital, Ravenna Background and aim: Video Capsule Endoscopy (VCE) is a widespread non invasive modality to diagnose small bowel diseases. Generally VCE is well tolerated by patients, but there are a few limitations and risks which should be taken into consideration. The most frequent indication for VCE is the diagnosis of obscure gastrointestinal bleeding, overt or
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
to two days prior to PCC procedure, all patients were required to start a low-residue diet. One day before the examination patients had a “liquids only” diet and ingested 3 L of polyethylene glycole (PEG). On the morning of the procedure, the subjects continued bowel preparation with another litre of PEG, according to manufacture indication and previous data. After the PCC reached the small bowel a boost dose of 40 ml sodium phosphate was given to the patients. When the patient did not undergo colonoscopy on the same day, he continued with the liquid diet, but no other pharmacological agents were given. Colonoscopies were performed by experienced endoscopists who were blinded about PCC results. The colon cleansing was evaluated using a 3 point scale for both procedures (poor, fair and good). All patient provided a written informed consent to undergo PCC and colonoscopy Results: No complications were documented in both procedures. In one case PCC stopped working two minutes after ingestion; in two other cases the PCCs failed to work before ingestion and were substituted with other capsules. Positive findings were detected in 5 cases (diverticulis, inflammation of the mucosa and polyp) and were confirmed in all colonoscopies. In a patient a gastric polyp was detected by PCC and confirmed by an EGDS. One small polyp (5 mm) was detected by conventional colonoscopy, but was missed by PCC. The colon cleansing was considered good in 3 cases, fair in 3 cases and poor in 4 cases. Conclusions: PCC is feasible and is a promising tool for the detection of the pathologies of the colon and of the others tracts of the intestine visualized during the examination. Further studies are needed to confirm the value of this endoscopic technique in clinical practice and moreover further technical improvements are needed in capsule engineering. # Q. Diagnostic endoscopy 6. Video-capsule
PA.214 DIAGNOSTIC YIELD OF SMALL BOWEL CAPSULE ENDOSCOPY FOR INDICATIONS OTHER THAN OBSCURE GASTROINTESTINAL BLEEDING C.M. Girelli ∗ , V. Malacrida, F. Barzaghi Ospedale di Circolo di Busto Arsizio, Busto Arsizio Background and aim: Although small bowel capsule endoscopy (SBCE) is now widely accepted as a first line diagnostic modality for obscure gastrointestinal bleeding (OGB), its role for non-OGB conditions is less clear. Aim of the study was to compare demographics and diagnostic yield of SBCE between patients with and without OGB, and to seek the indications with the highest diagnostic yield within non-OGB group. Material and methods: From September 2001, to September 2007, we performed 323 SBCE on as many patients. 135 (42%) for occult OGB, 101 (31%) for overt OGB and 87 (27%) for non-OGB conditions, namely: 35, suspected Crohn’s disease (CD); 20, chronic unexplained diarrhoea; 9, refractory coeliac disease; 8, staging of known polyposis syndrome; 6, recurrent unexplained abdominal pain; 5, metastasis from primary unknown; 4, suspected neuro-endocrine tumour (NET). We retrospectively compared demographic data and yield of SBCE in nonOGB patients with those having OGB. All SBCE were made by Pillcam SB and read by Rapid software (givenimaging® , Yoqneam, Israel). Continuous and dichotomous variables were compared by Student-t test and chi-square (Fisher exact test, when appropriate), respectively. Results: Patients of non-OGB group were younger than their OGB counterparts (42±18 yrs vs 64±17; t=10; p<0.0001). No gender differences were observed. Diagnostic yield in non-OGB group (36%) was lower than the OGB group, either of overt or occult type (78%; χ2 =35, p<0.0001 and 72%; χ2 =28, p<0.0001; respectively). Subgroup analysis of non-OGB indications showed a highest yield for suspected CD (46%), staging polyposis syndrome (62%) and suspected NET (75%) (Subgroup A); whereas the lowest yield was for chronic diarrhoea (30%), refractory coeliac disease (22%), abdominal pain (0%) and metastasis of primary unknown (0%) (Subgroup B). Yield comparison
between Subgroup A and B was statistically significant (p=0.003, Fisher exact test). Conclusions: In comparison with OGB group, patients with non-OGB indications to SBCE are younger and have a lower frequency of small bowel abnormalities. Within non-OGB indications, suspected CD, staging of known polyposis syndrome, and suspected NET are those with the highest yield. # Q. Diagnostic endoscopy 6. Video-capsule
PA.215 DIAGNOSTIC YIELD OF VIDEO CAPSULE ENDOSCOPY IN OVERT AND OCCULT OBSCURE GASTROINTESTINAL BLEEDING C.A.A. Petrini ∗ , S. Gasperoni, M.L. Brancaccio, F. Cantoni, T. Casetti S Maria delle Croci Hospital, Ravenna Background and aim: Conventional available techniques have low diagnostic yield in obscure gastrointestinal bleeding (OGIB). Video Capsule Endoscopy (VCE) is a new non-invasive diagnostic tool able to explore the small bowel and to detect bleeding lesions. OGIB was defined as occult when it manifested as recurrent iron-deficiency anemia and/or positive fecal blood test, without any clinically evident bleeding episode, or as overt bleeding when manifested as recurrent episodes of visible hematemesis, melena, or hematochezia. The aim of this study was to investigate the role of VCE in detecting lesions of the small bowel in patients with overt or occult OGIB. Material and methods: Between June 2002 and November 2007, 209 consecutive patients (126 men and 83 women, with a mean age of 65.3 years, range 15-93 years) with OGIB underwent VCE. Obscure-overt bleeding was present in 119 patients; obscure-occult bleeding was present in 90 patients. All the patients had a previous study with EsofagoGastroDuodenoscopy and Colonoscopy. The intestinal preparation included the administration of 4 litres of polyethylene glycol-based solution and an overnight fasting. Results: In patients with obscure-overt bleeding VCE revealed: angiodysplasias in 36 patients, erosions and/or ulcers in 23, presence of blood or clots in 16, polyps in 7, mass/tumors in 2, venous structures in 1, diverticula in 1, a normal finding in 33. In patients with obscure-overt bleeding overall diagnostic yield was 72.3%. In patients with obscureoccult bleeding VCE revealed: angiodysplasias in 26 patients, erosions and/or ulcers in 17, mass/tumors in 7, polyps in 3, venous structures in 2, atrofic mucosa and/or abnormal villi in 1, a normal finding in 34. In patients with obscure-occult bleeding overall diagnostic yield was 62.2%. Conclusions: VCE is mandatory in patients with OGIB. The diagnostic yield is higher in patients with obscure-overt bleeding compared to patients with obscure-occult bleeding. Advantages of VCE includes its applicability and simplicity. These factors are particularly important because obscure bleeding often occurs in an increasingly ageing cohort of patients with multiple comorbidities. # Q. Diagnostic endoscopy 6. Video-capsule
PA.216 VIDEO CAPSULE ENDOSCOPY: EXPERIENCE IN OUR CENTRE C.A.A. Petrini ∗ , S. Gasperoni, M.L. Brancaccio, F. Cantoni, T. Casetti S.Maria delle Croci Hospital, Ravenna Background and aim: Video Capsule Endoscopy (VCE) is a widespread non invasive modality to diagnose small bowel diseases. Generally VCE is well tolerated by patients, but there are a few limitations and risks which should be taken into consideration. The most frequent indication for VCE is the diagnosis of obscure gastrointestinal bleeding, overt or