Capsular endoscopy: a single centre experience.

Abstract

Abstract Background: Capsule endoscopy (CE) is a relatively new modality in the assessment of obscure occult and obscure overt gastroenterological (GI) bleeding in South Africa. Objectives: The aim of this study was to describe the indications, findings and outcomes of CE at a referral hospital in the public sector in Kwa-Zulu Natal (KZN). Methods: Ethical approval was obtained from the Biomedical Research Ethics Committee of the University of Kwa-Zulu Natal (UKZN). A retrospective electronic chart review of 27 subjects who underwent CE from its introduction in 2013 to 2018 was undertaken. A structured data sheet was used to extract demographic and clinical details and the endoscopist‘s report. Indications were classified as obscure occult GI bleeding, obscure overt GI bleeding, suspected Crohn‘s disease and unexplained macrocytic anaemia (in a single subject). The findings at endoscopy were categorised as vascular (angiodysplasia, varices), inflammatory (villous oedema, erythematous mucosa erosions, ulcers or stenosis), normal, inconclusive or other (villous atrophy, polyps, tumours). Results: The mean age of the 27 patients was 51.2 years ± 21.3 years, with a majority of women (15, 56%) and 12 (44.4%) men. The most common indications for CE were either obscure occult GI bleeding or obscure overt GI bleeding. One patient each had unexplained anaemia and suspected Crohn‘s disease. All subjects had had previous oesophagogastroduodenoscopy (OGD) and colonoscopy prior to the CE, 15 subjects (55.5%) had had a CT scan of the abdomen and seven (26%) underwent red cell scans. Of the 14 subjects with occult GI bleeding, 12 had severe iron deficiency anaemia, with symptom duration ranging from one year to 40 years. These subjects had undergone a minimum of one up to a maximum of six OGDs, with a total of 38 OGDs prior to CE. Abnormal findings on CE were reported in nine subjects (64.3%), the commonest of which was inflammatory, and a definitive diagnosis was made in six (42.9%) subjects. The 11 subjects with obscure overt GI bleeding had undergone a total of 27 prior OGDs prior to CE. Abnormal findings on CE were reported in three of the 11 subjects (27.3%) with obscure overt GI bleeding and a definitive diagnosis made in two subjects (18%). In addition, the diagnosis was supported in the patient with Crohn‘s disease who had been symptomatic for eight years and had had several previous OGDs and colonoscopies. In the total group who underwent CE, nine (33.3%) subjects attained a definitive diagnosis. A further 18.5% attained a diagnosis following subsequent investigations. In three subjects (11.1%) the initial indication resolved requiring no further therapy or investigation and two patients (7.4%) were lost to follow up. Capsule retention occurred in two patients and the capsule was successfully retrieved via laparoscopic surgery. Conclusion: Capsule endoscopy is a useful modality to further investigate select patients with unexplained GI bleeding, including the identification of lesions outside the small bowel. A guideline for the application of CE in the South African context is required.