Kapsül endoskopinin gastroenteroloji pratiğinde kullanımı: Tek merkez deneyimi

Yıl 2024, Cilt: 23 Sayı: 3, 109 - 113, 25.12.2024

Osman Çağın Buldukoğlu Galip Egemen Atar Serdar Akça Ferda Harmandar , Serkan Öcal , Ayhan Hilmi Çekin

https://doi.org/10.17941/agd.1591719

Öz

Giriş ve Amaç: Kapsül endoskopi gastrointestinal traktın değerlendirilmesinde kullanılan, kolay uygulanabilen ve girişimsel olmayan bir tanısal yöntemdir. Değerli bir tanı yöntemi olmasına karşın Türkiye’de yaygın kullanımı mevcut değildir. Bu çalışma ile kapsül endoskopide tek merkez deneyimimizi aktarmayı ve kapsül endoskopinin gastroenteroloji pratiğinde kullanımını araştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif çalışma Antalya Eğitim ve Araştırma Hastanesinde yürütüldü. 2018 ile 2024 yılları arasında kapsül endoskopi ile değerlendirilen hastalar çalışmaya alındı. Bulgular: Çalışmaya 31 hasta dahil edildi. En sık endikasyon aşikar kanamalı ince bağırsak kanaması şüphesi ve demir eksikliği anemisi idi. Aşikar kanamalı ince bağırsak kanaması şüphesi ve demir eksikliği anemisi nedeniyle kapsül endoskopi yapılan hastalarda her iki grup için de en sık bulgu anjiyodisplaziler idi (her iki endikasyon için de n = 3, %33). Karın ağrısı nedeniyle kapsül endoskopi yapılan hastalardaki en sık bulgu ince bağırsakta ülserler idi (n = 5, %62). Crohn hastalığı tanısı bulunan ve hastalık aktivitesi değerlendirilen dört hastada da ince bağırsak ülserleri saptandı. Çalışmaya dahil edilen 31 hastanın 8’inde (%26), kapsül endoskopi endikasyonu ile ilişkili bir bulguya rastlanmadı. Sonuç: Kapsül endoskopi aydınlatılmamış gastrointestinal sistem kanamalarından inflamatuvar bağırsak hastalığı değerlendirmesine kadar geniş bir çerçevede gastrointestinal sistem hastalıklarının değerlendirmesinde faydalıdır. Kapsül endoskopiye erişimin artırılması ve bu alanda gastroenterologların eğitimi, gastroenteroloji pratiğinde tanı koymada zorluk yaşanan durumlarda fayda sağlayacaktır.

Anahtar Kelimeler

Kapsül endoskopi, gastrointestinal kanama, demir eksikliği anemisi

Utility of capsule endoscopy in gastroenterology practice: A single-center experience

Öz

Background and Aims: Capsule endoscopy is an easy and a non-invasive diagnostic tool used in evaluation of gastrointestinal tract. Despite being a valuable diagnostic method, widespread use has not been established in Türkiye. With this study, we aimed to report our single-center experience with capsule endoscopy in order to both reveal our data and utility of capsule endoscopy in gastroenterology practice. Materials and Methods: This retrospective study was conducted at Antalya Training and Research Hospital. Patients evaluated by capsule endoscopy between 2018 and 2024 were included in the study. Results: Thirty one patients were included in the study. Most common indications were overt bleeding with suspicion of small bowel bleeding and iron deficiency anemia. Angiodysplasias were the most common finding in both overt bleeding with suspicion of small bowel bleeding and iron deficiency anemia groups (n = 3, 33% for both indications). Ulcers in small intestine were the most common finding in patients with abdominal pain (n = 5, 62%). All of the four patients with Crohn’s disease evaluated for disease activity had ulcers in small intestine. Out of 31 patients enrolled in the study, capsule endoscopy did not reveal an underlying condition related to clinical indication in 8 patients (26%). Conclusion: Capsule endoscopy is a valuable tool in evaluating gastrointestinal disorders ranging from obscure bleeding to inflammatory bowel diseases. Accessibility of capsule endoscopy devices and training of gastroenterologists will help the healthcare team with diagnostic challenges in gastroenterology practice.

Anahtar Kelimeler

Capsule endoscopy, gastrointestinal bleeding, iron deficiency anemia

Kaynakça

• 1. Akyüz F, Çavuş B, Akyüz Ü. What is the effective clinical use of small bowel capsule endoscopy in real life? Turk J Gastroenterol. 2020;31(9):609-13.
• 2. Akyüz F, Ersoy O, Erzin Y, et al. Small Bowel Video Capsule Endoscopy Guidance in Practice: Expert Opinion Report. Turk J Gastroenterol. 2023;34(Suppl1):2-19.
• 3. Wetwittayakhlang P, Verdon C, Starr M, et al. Mucosal Healing and Clinical Efficacy of Adalimumab in Small Intestinal Crohn's Disease (SIMCHA Study): Final Results From a Prospective, Open-Label, Single-Arm Study. Turk J Gastroenterol. 2023;34(6):603-10.
• 4. Mascarenhas-Saraiva MJ, Oliveira E, Mascarenhas-Saraiva MN. The Use of a PEG/Ascorbate Booster Following Standard Bowel Preparation Improves Visualization for Capsule Endoscopy in a Randomized, Controlled Study. Turk J Gastroenterol. 2021;32(5):437-42.
• 5. Akın FE, Tayfur Yürekli Ö, Tahtacı M, Ersoy O. Sennoside A+B is as effective as polyethylene glycol in preparation for small intestine capsule endoscopy. Turk J Gastroenterol. 2024;35(5):360-5.
• 6. Freitas M, Macedo Silva V, Xavier S, et al. Prolonged Gastric Transit Time in Small-Bowel Capsule Endoscopy: Which Patients Are at Risk and What Are the Implications? Turk J Gastroenterol. 2023;34(3):227-33.
• 7. Lasa J, Cernadas G, Olivera PA, Moore R. Prolonged Intestinal Transit Time and Its Relation with Capsule Endoscopy Diagnostic Yield. Turk J Gastroenterol. 2022;33(6):520-4.
• 8. Robertson KD, Singh R. Capsule Endoscopy. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482306/
• 9. Lobo A, Torrejon Torres R, McAlindon M, et al. Economic analysis of the adoption of capsule endoscopy within the British NHS. Int J Qual Health Care. 2020;32(5):332-41.
• 10. Meltzer AC, Ward MJ, Gralnek IM, Pines JM. The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED. Am J Emerg Med. 2014;32(8):823-32.
• 11. Iddan GJ, Swain CP. History and development of capsule endoscopy. Gastrointest Endosc Clin N Am. 2004;14(1):1-9.
• 12. Akpunonu B, Hummell J, Akpunonu JD, Ud Din S. Capsule endoscopy in gastrointestinal disease: Evaluation, diagnosis, and treatment. Cleve Clin J Med. 2022;89(4):200-11.
• 13. Xie X, Xiao YF, Yang H, et al. A new artificial intelligence system for both stomach and small bowel capsule endoscopy. Gastrointest Endosc. 2024;100(5):878.e1-878.e14. Epub 2024 Jun 6.
• 14. Cao Q, Deng R, Pan Y, et al. Robotic wireless capsule endoscopy: recent advances and upcoming technologies. Nat Commun. 2024;15(1):4597.
• 15. Leighton JA. The role of endoscopic imaging of the small bowel in clinical practice. Am J Gastroenterol. 2011;106(1):27-36.
• 16. Kav T, Bayraktar Y. Five years' experience with capsule endoscopy in a single center. World J Gastroenterol. 2009;15(16):1934-42.
• 17. Scapa E, Jacob H, Lewkowicz S, et al. Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology. Am J Gastroenterol. 2002;97(11):2776-9.
• 18. Singla N, Inavolu P, Jagtap N, et al. Small Bowel Capsule Endoscopy: Experience from a single large tertiary care centre. Endosc Int Open. 2023;11(6):E623-8.
• 19. Sriram PV, Rao GV, Reddy DN. Wireless capsule endoscopy: experience in a tropical country. J Gastroenterol Hepatol. 2004;19(1):63-7.
• 20. Haslach-Häfner M, Mönkemüller K. Reading capsule endoscopy: Why not AI alone? Endosc Int Open. 2023;11(12):E1175-6.
• 21. O'Hara FJ, Mc Namara D. Capsule endoscopy with artificial intelligence-assisted technology: Real-world usage of a validated AI model for capsule image review. Endosc Int Open. 2023;11(10):E970-5.
• 22. Ormeci AC, Akyuz F, Baran B, et al. Retention during capsule endoscopy: Is it a real problem in routine practice? J Int Med Res. 2016;44(4):968-75.
• 23. Kim SH, Lim YJ, Park J, et al; Research Group for Capsule Endoscopy/Small Bowel Endoscopy. Changes in performance of small bowel capsule endoscopy based on nationwide data from a Korean Capsule Endoscopy Registry. Korean J Intern Med. 2020;35(4):889-96.
• 24. Sidhu R, Chetcuti Zammit S, Baltes P, et al. Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2020;52(8):669-86.
• 25. Nielsen AB, Jensen MD, Brodersen JB, et al. More than 20 procedures are necessary to learn small bowel capsule endoscopy: Learning curve pilot study of 535 trainee cases. Endosc Int Open. 2024;12(5):E697-E703.
• 26. Tai FWD, Parker C, Sidhu R, et al. Training pathway for small bowel capsule endoscopy in the UK. Frontline Gastroenterol. 2021;13(3):206-10.