The duodenal papilla as quality criterion of small bowel capsule endoscopy. SV1– A newly developed small bowel capsule endoscope with 360° view

Introduction: Capsule endoscopy has evolved to become a first-line, noninvasive diagnostic technique for the small bowel. However, the inability to visualize the duodenal papilla is an inherent limitation of this method. We evaluated the diagnostic yield and completeness of the small bowel examination with a newly developed video capsule (SV1, Capsovision, Saratoga, CA) with panoramic 360° imaging.

Methods: SV1 is a small bowel video endoscope measuring 11×31mm capturing colour high-resolution images at 4 frames per second in a 360-degree-panorama-view for the first 2 hours and 3fps for the rest of time. This enables a side view like with ERCP. The device does not employ wireless technology. SV1 saves the data on the on-board flash memory when it traverses through the bowel. The capsule is retrieved, opened by the docking station where the data are transferred by USB to the reviewing workstation. 24 patients (13 F and 11M, mean age 45 y) in whom evaluation of the small bowel was indicated swallowed SV1 either after colonoscopy or after a preparation with 2l of a PEG solution in the afternoon before the examination. The patients swallowed 20mg of metoclopramide and 170mg of simethicone 30min before swallowing the capsule. They were allowed to eat after 6 hours.

Results: The capsules were retrieved in 23 of 24 patients forming the study population. One patient lost its capsule. The mean time to pass the stomach was 24min and the small bowel 234min. The duodenal papilla was identified in 15 of 23 patients (65%). We further detected mucosal breaks/ulcers in 5 patients with Crohn's disease, in 1 patient with NSAR use and in 1 patient with anemia. No adverse effects were detected.

Discussion: Compared to capsules with cameras at the end, SV1 with a 360° imaging detects the duodenal papilla in a higher proportion which is an advantage for the diagnosis of neoplasms of the papilla and duodenum. We also detected pathologic findings in the lower part of the small bowel. Every capsule reached the ileocecal valve. Small bowel capsule endoscopy with SV1 is a safe procedure. The panoramic imaging capsule seems to have an advantage in small bowel.