Capsule endoscopy in non-steroidal anti-inflammatory drugs-enteropathy and miscellaneous, rare intestinal diseases

Abstract

Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is difficult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and difficult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.

Figure 1

Intestinal stenosis caused by NSAIDs. Capsule endoscopy shows narrowed segment, surrounded by an ulcerated but non-inflammatory mucosa.

Figure 2

Waldmann’s disease. The presence of dilated lymphatic vessels in the submucosa gives a whitish appearance to the mucosa. If lymphangiectasia becomes more prominent, it may protrude into the lumen.

Figure 3

Common variable immunodeficiency disorder. The characteristic lesions include polypoidal and nodular lesions of variable size, which are disseminated over the intestinal mucosa.

Figure 4

Peutz-Jeghers syndrome. Presence of a large polyp in the ileum, in a young patient with Peutz-Jeghers syndrome. The polyp was ulcerated and required endoscopic resection.

Figure 5

Familial adenomatous polyposis. Multiple polyps of regular shape are present in the ileum.

Figure 6

Acute Graft versus Host Disease (GVHD). The lesions correspond to Stage III disease, manifesting as diffuse erythema and oedema of the mucosa, with a few erosions.

Figure 7

Hypobetalipoproteinemia. The endoscopic picture is characterized by a diffuse whitish pattern of the mucosa due to the accumulation of fat vesicles in the enterocytes. The size of the intestinal villi is normal.

Figure 8

Churg and Strauss disease. A large ulcer is present in the ileum.

Figure 9

Cytomegalovirus infection in a heart transplant patient. The disease is characterized by the presence of bleeding ulcers and erosions.

Figure 10

Whipple’s disease. The endoscopic picture shows an oedematous and friable mucosa with erosions and serpiginous ulcers. The lesions may involve the entire length of the small bowel.