Completion small bowel capsule endoscopy after device assisted enteroscopy is of value in managing a variety of patients with small bowel disease

Aims The diagnostic yield of small bowel capsule endoscopy (SBCE) and Device Assisted Enteroscopy (DAE) are known to be similar. As a non-invasive procedure SBCE is normally recommended as the initial diagnostic test, with DAE reserved for therapeutic indications. As most DAE procedures are not panenteroscopy assessments, and capsule transit and location are not easily correlated, a completion SBCE post DAE may be of benefit to identify residual disease. Similarly, in patients where DAE has been performed first, based on a high suspicion of small bowel disease, including abnormal radiology or active severe suspected small bowel bleeding, a completion SBCE could also be of value. We aimed to assess the efficacy of completion SBCE’s following DAE.

Methods A single centre retrospective analysis of 200 consecutive DAE’s over 18 months was performed. Completion SBCE’s were identified from a database. Demographics, clinical details, endoscopy and capsule findings were documented. Patients were excluded if the SBCE was performed for new or worsening symptoms, where a completion SBCE was requested but performed in an external institution or if bidirectional or prior DAEs had been performed. The diagnostic yield and impact on management of completion SBCE’s was assessed.

Results A completion SBCE was performed in 42/ 200 (21%) DAE’s, 25 (59%) men, mean age 58 years (range 17-87), 41 were anterograde, all had a tattoo placed at the limit of insertion. Of these 42, 21 (50%) had a positive SBCE prior to index DAE, 16 /21 (76%) with angiodysplasia (14) or unidentified active bleeding (2), 3 had enterits and 2 abnormal radiology. While 14/ 21 (67%) without a SBCE before the DAE had abnormal small bowel imaging, 5 (24%) severe suspected small bowel bleeding, and 1 had known polyposis and another small bowel Crohn’s disease. Completion SBCE was performed on the same day in 9 (21%) patients. The average time to interval completion SBCE was 13 weeks (range 1-30). 41/42 (98%) capsules were complete and 14/42 (33%) were considered to have identified additional / residual pathology necessitating a change in management, 6 proximal to the DAE tattoo, 5 of these were overlooked angiodysplasias. In those without a SBCE before the DAE, the completion capsule was negative in 17/21 (81%) with no subsequent investigations or treatments undertaken. Of the 4 positive cases, 2 had polyps, 1 enteritis and 1 active bleeding without an identified source, all distal to the DAE tattoo.

Conclusions Same day and interval completion SBCE is feasible and effective. It can detect and localise additional/ residual disease in up to a third of cases while also preventing the need for completion DAE or other investigations in patients referred directly for DAE. Formal prospective assessment of completion SBCE in different clinical scenarios is warranted.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

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Artikel online veröffentlicht:
27. März 2025