[The role of capsule endoscopy in the study of intestinal diseases. Critical analysis and observation of the first 50 cases]

Abstract

The total visualization of the intestinal surface through wireless capsule endoscopy has furnished new insights for the diagnosis of intestinal diseases. The length, difficulty of access and particular morphology of this region makes a correct diagnosis of gastrointestinal diseases associated with bleeding possible only in 5% of cases. Our study was aimed at assessing the clinical impact and diagnostic outcomes of wireless capsule endoscopy through analysis of the first 50 cases observed in our Endoscopy and Coloproctology Unit. Fifty patients aged 23-85 years (mean age: 43.5) were selected for wireless endoscopy. The main indications were patients with a suspected or established diagnosis of inflammatory bowel disease or malabsorption, abdominal pain, chronic diarrhoea and obscure bleeding. Patients with a clinical or radiological diagnosis of gastrointestinal stenosis, Zencker's diverticula, or colonic diverticulosis were excluded from the study. In 2 out of 8 patients with abdominal pain, erosions of the intestinal wall were detected, while in the only patient with gastrointestinal bleeding a neoplastic lesion of the right colon was accidentally diagnosed. As far as inflammatory bowel disease is concerned, in all the cases of established diagnosis of ulcerative colitis no small bowel lesions were visible at wireless endoscopy, while all the cases with silent Crohn's disease of the terminal ileum were confirmed. No cases of neoplastic lesions of the small bowel were recorded in our series either in celiac-disease patients or in patients with familial intestinal polyposis. In celiac-disease patients (N = 24) wireless capsule endoscopy allowed accurate definition of the extent of the mucosal damage. On the basis of our preliminary experience wireless capsule endoscopy would appear to warrant an important role in the management of patients with small bowel diseases, supplementing information obtained with other diagnostic techniques.