Gastrointestinal semptomlara göre kapsül endoskopinin açıklayıcı gücü ve önemi

Year 2018, , 17 - 26, 26.04.2018

Süleyman Orman , Orhan Sami Gültekin

https://doi.org/10.17940/endoskopi.410494

Abstract

Giriş ve Amaç: Kapsül endoskopi sebebi bulunamayan gastrointestinal semptomları araştırmada sıklıkla kullanılan bir tanı yöntemidir. Amacımız gastrointestinal semptomlara göre kapsül endoskopinin açıklayıcı gücü ve önemini saptamaktır. Gereç ve Yöntem: Kapsül endoskopi yapılan 95 hasta retrospektif olarak değerlendirildi. Hastaların demografik verileri, şikayetleri, kapsül endoskopik verileri, gastroskopi ve kolonoskopi sonuçları değerlendirildi. Bulgular: Hastaların %38,9’u (n=37) kadın; %61,1’i (n=58) erkek idi. İşlemler sırasında toplam 141 lezyon saptandı. Olguların yaş ortalaması 56,98±18,95 (14-92) idi. Gizli gastrointestinal sistem kanaması ile başvuran hastalarda 44 lezyon saptanmış olup bunların %61,4’ü jejunumda idi. Açık gastrointestinal sistem kanaması ile başvuran hastalarda 56 lezyon saptanmış olup bunların %42,9’u jejunumda idi. İshal ile başvuran hastalarda 16 lezyon saptanmış olup bunların %50’si ileumda yer almaktaydı. Karın ağrısı ile başvuran hastalarda 25 lezyon saptanmış olup bunların %56’sı ileumda görülmekte idi. Açık ve gizli gastrointestinal sistem kanaması şikayetleri bulunan hastalarda en sık saptanan lezyon türü ve yeri jejunal angiodisplaziler olup sırasıyla 21/37 ve 20/32 olarak saptandı. İshal ve karın ağrısı şikayetleri bulunan hastalarda en sık saptanan lezyon türü ve yeri ileal Crohn hastalığı olup sırasıyla 4/5 ve 3/4 olarak saptandı. Semptom sayısına göre hastalardeğerlendirildiğinde hastaların %41.1’inde (n=39) yalnızca tek semptom olduğu gözlendi. Semptomlar tek tek ele alındığında hastaların en sık anemi (49/170) ile başvurduğu gözlenmiştir. Anemi ile başvuran hastaların %79,6’sında herhangi bir lezyon saptanmıştır. Ancak herhangi bir lezyon saptananların %97,4’ünün patolojiyi açıklayıcı lezyon olduğu gözlenmiştir. Sonuç: Kapsül endoskopi uygun endikasyonla kullanıldığında gastrointestinal semptomların nedenini saptamada oldukça etkin bir tanı yöntemidir.

Keywords

Kapsül endoskopi, gastroskopi, kolonoskopi

Explanatory power and importance of capsule endoscopy according to gastrointestinal symptoms

Abstract

Background and Aims: Capsule endoscopy is a commonly used diagnostic method for investigating gastrointestinal complaints that are not detected by endoscopy. Our aim is to determine the explanatory power and importance of capsule endoscopy according to the type of gastrointestinal symptoms. Materials and Methods: A total of 95 patients who underwent capsule endoscopy were retrospectively evaluated. Demographic data, complaints, capsule endoscopic data, gastroscopy, and colonoscopy results were evaluated. Results: Of the total patients, 38.9% (n= 37) were female and 61.1% (n= 58) were male. A total of 141 lesions were detected during the procedures. The mean age of the cases was 56.98±18.95 (range: 14-92). Forty-four lesions were detected in patients with obscure gastrointestinal bleeding, of which 61.4% were found in the jejunum. In the patients with overt gastrointestinal bleeding, 56 lesions were found, of which 42.9% were in the jejunum. Sixteen lesions were found in patients with diarrhea, and 50% of them were in the ileum. Twenty-five lesions were found in patients with abdominal pain, and 56% of them were in the ileum. Jejunal angiodysplasia was the most common lesion type and location in patients with overt and occult gastrointestinal bleeding complaints, 21/37 and 20/32, respectively. Patients with diarrhea and abdominal pain had the most common type and location of ileal Crohn’s disease, 4/5 and 3/4, respectively. According to the number of symptoms, 41.1% (n= 39) of patients had only one symptom upon evaluation. Examination of individual symptoms revealed that patients were most frequently referred with anemia (49/170). In all, 79.6% of patients with anemiahad lesions; however, 97.4% of these lesions were elucidatory. Conclusion: Capsule endoscopy is a very effective diagnostic method when it is used with appropriate indications to determine the origin of gastrointestinal symptoms.

Keywords

Capsule endoscopy, gastroscopy, colonoscopy

References

• 1. Lewis BS, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: Results of a pilot study. Gastrointest Endosc 2002;56:349-53.
• 2. ASGE Technology Committee, Chauhan SS, Manfredi MA, et al. Enteroscopy. Gastrointest Endosc 2015;82:975-90.
• 3. Matas JL, Asteinza M, Loscos JM, et al. Diagnostic yield and safety of capsule endoscopy. Rev Esp Enferm Dig 2006;98:666-73.
• 4. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015;47:352-76.
• 5. Tacheci I, Devière J, Kopacova M, et al. The importance of upper gastrointestinal lesions detected with capsule endoscopy in patients with obscure digestive bleeding. Acta Gastroenterol Belg 2011;74:395-9.
• 6. Song HJ, Moon JS, Jeon SR, et al; Korean Gut Image Study Group. Diagnostic yield and clinical impact of video capsule endoscopy in patients with chronic diarrhea: A Korean multicenter CAPENTRY study. Gut Liver 2017;11:253-260.
• 7. Yang L, Chen Y, Zhang B, et al. Increased diagnostic yield of capsule endoscopy in patients with chronic abdominal pain. PLoS One 2014;9:e87396.
• 8. Malagelada C, De Iorio F, Azpiroz F, et al. New insight into intestinal motor function via noninvasive endoluminal image analysis. Gastroenterology 2008;135:1155-62.
• 9. Fry LC, Bellutti M, Neumann H, et al. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding. Aliment Pharmacol Ther 2009;29:342-9.
• 10. Schönfeld J, Hauser D, Hartmann CA, Schroeder J. Adenomas and carcinomas missed in routine colonoscopy: A prospective study in resected colon segments. Z Gastroenterol 2014;52:1153-6.
• 11. ASGE Standards of Practice Committee, Gurudu SR, Bruining DH, et al. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc 2017;85:22-31.
• 12. Rondonotti E, Marmo R, Petracchini M, et al. The American Society for Gastrointestinal Endoscopy (ASGE) diagnostic algorithm for obscure gastrointestinal bleeding: eight burning questions from everyday clinical practice. Dig Liver Dis 2013;45:179-85.
• 13. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature 2000;405:417.
• 14. Martínez-González J, TéllezVillajos L, Aicart-Ramos M, et al. Capsule endoscopy and obscure gastrointestinal bleeding: Does the form of presentation matter? Gastroenterol Hepatol 2015;38:47-53.
• 15. Singh A, Marshall C, Chaudhuri B, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study. Gastrointest Endosc 2013;77: 761-6.
• 16. Law R, Varayil JE, Wong Kee Song LM, et al. Assessment of multi-modality evaluations of obscure gastrointestinal bleeding. World J Gastroenterol 2017;23:614-21.
• 17. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005;100:2407-18.
• 18. Leighton JA, Triester SL, Sharma VK. Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease. Gastrointest Endosc Clin N Am 2006;16:229-50.
• 19. Yung DE, Koulaouzidis A, Avni T, et al. Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis. Gastrointest Endosc 2017;85:305-17.
• 20. Tziatzios G, Gkolfakis P, Dimitriadis GD, Triantafyllou K. Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding. Ann Transl Med 2017;5:196.
• 21. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010;71:280-6.
• 22. Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309-16.
• 23. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133-40.
• 24. Ormeci A, Akyuz F, Baran B, et al. What is the impact of capsule endoscopy in the long term period? World J Gastrointest Endosc 2016 10;8:344-8.
• 25. Clark SF. Iron deficiency anemia: diagnosis and management. Curr Opin Gastroenterol 2009;25:122-8.
• 26. Clere-Jehl R, Sauleau E, Ciuca S, et al. Outcome of endoscopy-negative iron deficiency anemia in patients above 65: A longitudinal multicenter cohort. Medicine 2016;95:e5339.
• 27. Koulaouzidis A, Rondonotti E, Giannakou A, Plevris JN. Diagnostic yield of small-bowel capsule endoscopy in patients with iron-deficiency anemia: a systematic review. Gastrointest Endosc 2012; 76:983-92.
• 28. Sidhu PS, McAlindon ME, Drew K, et al. Diagnostic yield of small-bowel capsule endoscopy in patients with iron deficiency anemia: does it affect management? Gastrointest Endosc 2013;78:800-1.
• 29. Pasha SF, Leighton JA. Evidence-Based Guide on Capsule Endoscopy for Small Bowel Bleeding. Gastroenterol Hepatol 2017;13:88-93.
• 30. Jensen MD, Brodersen JB, Kjeldsen J. Capsule endoscopy for the diagnosis and follow up of Crohn's disease: a comprehensive review of current status. Ann Gastroenterol 2017;30:168-78.
• 31. Panes J, Bouhnik Y, Reinisch W, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013;7:556-85.
• 32. Panés J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther 2011;34:125-45.
• 33. Spada C, Hassan C, Barbaro B, et al. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut 2015;64:272-81.
• 34. Rondonotti E, Borghi C, Mandelli G, et al. Accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test. Clin Gastroenterol Hepatol 2014;12:1303-10.
• 35. ASGE Standards of Practice Committee, Fisher DA, Maple JT, et al. Complications of colonoscopy. Gastrointest Endosc 2011;74:745-52.
• 36. Bujanda L, Sarasqueta C, Zubiaurre L, et al. Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer. Gut 2007;56:1714-8.
• 37. IJspeert JE, TuteinNolthenius CJ, Kuipers EJ, et al. CT-Colonography vs. colonoscopy for detection of high-risk sessile serrated polyps. Am J Gastroenterol 2016;111:516-22.
• 38. Toth E, Yung DE, Nemeth A, et al. Video capsule colonoscopy in routine clinical practice. Ann Transl Med 2017;5:195.
• 39. Juanmartiñena Fernández JF, Fernández-UriénSainz I, Zabalza Ollo B, et al. Colonic lesions in patients under going small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact. Rev Esp Enferm Dig 2017;109.
• 40. Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Physician 2011;84:1119-26.
• 41. May A, Manner H, Schneider M, et al. Prospective multicenter trial of capsule endoscopy in patients with chronic abdominal pain, diarrhea and other signs and symptoms (CEDAP-Plus Study). Endoscopy 2007;39:606-12.
• 42. Katsinelos P, Fasoulas K, Beltsis A, et al. Diagnostic yield and clinical impact of wireless capsule endoscopy in patients with chronic abdominal pain with or without diarrhea: a Greek multicenter study. Eur J Intern Med 2011;22:63-6.
• 43. Pan SY, Morrison H. Epidemiology of cancer of the small intestine. World J Gastrointest Oncol 2011;3:33-42.
• 44. Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World J Gastroenterol 2008;14:5245-53.
• 45. Johnston CA, Yung DE, Joshi A, et al. Small bowel malignancy in patients undergoing capsule endoscopy at a tertiary care academic center: Case series and review of the literature. Endosc Int Open 2017;5:E463-70.
• 46. Graham DY, Opekun AR, Willingham FF, Qureshi WA. Visible small intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol 2005;3:55-9.
• 47. Kopylov U, Yablecovitch D, Lahat A, et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn’s disease using biomarkers, capsule endoscopy and imaging. Am J Gastroenterol 2015;110:1316-23.
• 48. Eliakim R. Where do I see minimally invasive endoscopy in 2020: clock is ticking. Ann Transl Med 2017;5:202.