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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 1  |  Page : 57-60

The application value of capsule endoscopy in diagnosing small intestinal carcinoma


1 Department of Endoscopy, Xinxiang Central Hospital, Henan Province, PR China
2 Department of Oncology, Xinxiang Central Hospital, Henan Province, PR China

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Wenliang Han
Department of Endoscopy, Xinxiang Central Hospital, Henan Province 453000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_584_17

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 > Abstract 

Objective: The aim of this study was to explore the clinical value of capsule endoscopy in the diagnosis of small intestine neoplastic lesions.
Materials and Methods: A retrospective analysis was conducted on the clinical data of 108 patients who underwent capsule endoscopic examination in the Endoscopy Center of Xinxiang Central Hospital from February 2010 to January 2014. The characteristics of different small bowel diseases were observed, and the prevalence rates of different small bowel lesions were calculated.
Results: Of the included 108 patients who received capsule endoscopic examination, 74 cases showed lesions, with a detection rate of 68.52%. Of these 74 patients, 56 cases (51.85%) suffered from small bowel diseases and 18 cases (16.67%) were manifested with other gastrointestinal lesions. Moreover, obvious lesion was not observed in 34 cases (31.48%). Among the patients with lesions, we observed seven cases of submucosal tumor in small intestines, five cases of small intestinal carcinoma, two cases of small intestinal polyps, two cases of small intestinal roundworm, eight cases of small intestine ulcer, one case of Crohn's disease, 18 cases of enteritis, two cases of small intestine diverticula, four cases of small intestine hemangioma, one case of small intestine vascular malformation, one case of intestinal lymphangiectasia, one case of small intestine compression, two cases of small intestine hemorrhage, and two cases of small intestinal lipoma. Among the patients who showed other gastrointestinal lesions, we observed one case of esophageal diverticula, three cases of gastric erosion, six cases of superficial gastritis, four cases of gastric ulcer, one case of pyloric ulcer, one case of colonic polyps, and two cases of colon tumor.
Conclusion: Capsule endoscopy demonstrated a high diagnostic value for various small bowel diseases, including both tumor and inflammatory lesions. Given its simplicity, safety, and reliability, capsule endoscopy was an important examination tool for the diagnosis of small bowel diseases.

Keywords: Capsule endoscopy, diagnosis, small intestinal disease


How to cite this article:
Li X, Gui Y, Shen F, Zhao CL, Yang Y, Han W. The application value of capsule endoscopy in diagnosing small intestinal carcinoma. J Can Res Ther 2018;14:57-60

How to cite this URL:
Li X, Gui Y, Shen F, Zhao CL, Yang Y, Han W. The application value of capsule endoscopy in diagnosing small intestinal carcinoma. J Can Res Ther [serial online] 2018 [cited 2019 Nov 16];14:57-60. Available from: http://www.cancerjournal.net/text.asp?2018/14/1/57/226743


 > Introduction Top


Small intestine is a long and narrow organ located deep down in the human body away from the mouth and anus. Thus, the diagnosis of small intestine diseases has always been a problem for clinicians.[1] Since its introduction approach, capsule endoscopy has been favored by both physicians and patients in the gastroenterology department. Capsule endoscopy offered several advantages, including convenient inspection, causing neither trauma nor pain, without risk of cross-infection, and requiring no hospitalization. In addition, the normal activities of patients were not affected.[2] This technique was a historic breakthrough in the diagnosis of small bowel diseases. Compared to the technique involving insert able endoscopic instrument, capsule endoscopy was safe and noninvasive. Thus, the application of this technique has saved patients from pain and risk during gastrointestinal examination.[3] Capsule endoscopy was, therefore, the appropriate gastrointestinal examination approach for patients with serious heart and lung dysfunction and among elderly patients. Capsule endoscopy examination has been started in our Endoscopy Center since 2010. At the end of January 2014, capsule endoscopy has been performed on 108 patients. The small bowel endoscopy results of these 108 cases were summarized as follows.


 > Materials and Methods Top


Instruments and equipment

An OMOM capsule endoscopy system (purchased from Chongqing Jinshan company) and ECG monitor (purchased from the United States GE Company) were applied in endoscopic examinations.

Preparation before examination

Before the conduction of a complete set of relevant laboratory examinations, the patients were informed of the examination process and potential risks. They were asked to sign relevant documents. One day before the examination, the patients were fed with rice congee (for those patients taking Chinese medicine, the examination was performed 2 days after they stopped taking their medication) and then orally administered with phenolphthalein tablets 3 times to soften their stool. Four hours before the examination, the patients were orally administered with polyethylene glycol for bowel preparation, which would be proved ready at the point of clear defecation.

Method of examination

Real-time image monitoring was initiated as soon as the capsule endoscope was swallowed by patient. To speed up the movement of the capsule, chewing gums or intramuscular injection of metoclopramide may be applied, if necessary. One hour after the capsule entered the small intestine, the patient may drink water, and they may take normal meals after 4 h. Moreover, the patient was informed to note, and the time was recorded when the capsule was completely passed through the small intestine.


 > Results Top


For the included 108 patients, 69 were males and 39 were female. Their ages were ranged between 20 and 83 years, with a mean age of 53.3 ± 20.6 years. There were 42 cases of unexplained abdominal pain, 24 cases of unexplained gastrointestinal bleeding, 3 cases of increased carcinoembryonic antigen value during physical examination, 14 cases of diarrhea, 7 cases of anemia, 4 cases of weight loss and fatigue, 3 cases of long-term constipation, 3 cases of chest discomfort, and 8 cases were found healthy after the physical examination. Of the 108 patients who received capsule endoscopic examination, lesions were observed in 74 patients, with a detection rate of 68.52%. Among the 74 cases, there were 56 cases (51.85%) of small bowel diseases and 18 cases (16.71%) of other types of gastrointestinal lesion. Moreover, no obvious lesion was observed in 34 patients (31.48%) under the enteroscope. Among the patients with lesions, we have observed seven cases of submucosal tumor in small intestine, five cases of small intestinal carcinoma, two cases of small intestinal polyps, two cases of small intestinal roundworm, eight cases of small intestine ulcer, one case of Crohn's disease, 18 cases of enteritis, two cases of small intestine diverticula, four cases of small intestine hemangioma, one case of small intestine vascular malformation, one case of intestinal lymphangiectasia, one case of small intestine compression, two cases of small intestine hemorrhage, and two cases of small intestinal lipoma. Among the patients with other gastrointestinal lesions, there was one case of esophageal diverticula, three cases of gastric erosion, six cases of superficial gastritis, four cases of gastric ulcer, one case of pyloric ulcer, one case of colonic polyps, and two cases of colon tumor [Figure 1]. During the capsule endoscopic examination, small intestine and ascending colon incarcerations were found in two cases. The lesions were surgically resected and then the capsule was removed.
Figure 1: Small intestine lesions revealed by capsule endoscopy: (a) normal small intestine observed via the endoscope; (b and c) small intestinal bleeding; (d) small intestinal roundworm; (e) submucosal tumor in the jejunum; (f) submucosal tumor in the ileum; (g and h) small intestinal tumor; (i and j) colon tumor; (k) Crohn's disease; (l) small intestinal polyps; (m and n) subacute enteritis; (o and p) small intestinal lipoma

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 > Discussion Top


Capsule endoscopy was convenient and safe with good compliance.[4],[5] This examination method was preferred by patients who were afraid of insertable endoscope and by those with serious heart and lung dysfunction or the elderly patients.[6] The cause of the disease suffered by most of the patients in this study was not determined after routine endoscopic and colonoscopic examinations, so clinicians resorted to capsule endoscopy. The detection rate of small intestine diseases has been high for capsule endoscopy.[2],[4] Of the included 108 patients, lesions were detected in 74 patients (68.52%). Of the 74 cases, small bowel diseases were observed in 56 cases (51.85%), and other types of gastrointestinal lesions were observed in 18 cases (16.67%). Moreover, no obvious lesion was observed in 34 cases (31.48%). Pennazio et al.[7] have reported 100 cases of unexplained intestinal bleeding after capsule endoscope, suggesting that small bowel vascular dysplasia (29%) and Crohn's disease (6%) were the most common causes of bleeding. The most common causes of bleeding in our study were small intestinal submucosal tumor and small intestinal enteritis. Two patients with submucosal tumor in their small intestine suffered from intermittent hematochezia for 2 years, and this condition was surgically confirmed in our hospital with capsule endoscopy examination.

Clinically, most of the patients who had undergone the examination were those who suffered from a condition with an unknown cause even after routine gastrointestinal endoscopy (73%) exanimation.[8] Thus, various intervening measures were taken to improve the positive rate during capsule endoscopic examination, as follows: (1) Real-time monitoring. The capsule endoscope was moved at a speed of 2 frames/s and then its movement was changed to the medium speed (1 frame/s) through the system channel 10 min after the capsule entered the stomach so that the shooting frequency could be reduced to save power and extend the working hours. (2) If the capsule endoscope took >30 min to pass the pylorus, chewing gums or intramuscular injection of metoclopramide (10 mg) was applied to promote defecation. (3) Patient orientation was changed into the right lateral position. In this study, the examination rate of the entire intestines was 89%. Capsule endoscopic examination was expensive, and image data were huge, and interpretation of images was critical in diagnosis. The correctness of image interpretation was closely related to the quality and clarity of images as well as the doctor's endoscopic experience and skills. In our endoscopy center, capsule endoscopic images were independently interpreted and reviewed by a senior endoscopy physician (deputy chief physician), an attending physician, and a junior physician (with experience of >3 years).

However, this examination method also presented some drawbacks: the speed and position of the capsule during the examination could not be controlled; thus there may be missed diagnosis, and the current diagnostic criteria were not unified. Thus, the results must be further analyzed and the examination method must be improved.

The advent of capsule endoscopy was a major breakthrough in the diagnostic technology for small bowel diseases.[9],[10],[11] This method was safe and noninvasive and could visually examine the entire small intestine. A large number of studies have demonstrated its clinical value in the diagnosis of small intestine diseases.[12],[13],[14] Its extensive use, simple operation, and reliability render it a promising tool in clinics.

Financial support and sponsorship

The project was financially supported by Xinxiang Municipal Science and Technology Foundation (No. ZGl3027).

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Ekisenina NI, Sivash ES, Krums LM, Gudkova RB, Kurochkina OK. Differential diagnosis of diseases of the small intestine. Sov Med 1986;79:39-42.  Back to cited text no. 1
    
2.
Qvigstad G, Fløttum O, Waldum HL. Capsule endoscopy – A new method for the diagnosis of diseases of the small intestine. Tidsskr Nor Laegeforen 2005;125:163-6.  Back to cited text no. 2
    
3.
Iida M. Diagnosis and treatment of diseases of the small intestine. Nihon Naika Gakkai Zasshi 2007;96:492-7.  Back to cited text no. 3
    
4.
Nakatis IaA, Borisov AE, Kashchenko VA, Sishkova EA, Raspereza DV, Lobach SM, et al. Video capsule endoscopy in the diagnostics of small intestine diseases. Vestn Khir Im I I Grek 2008;167:34-9.  Back to cited text no. 4
    
5.
Liu MK, Yu FJ, Wu JY, Wu IC, Wang JY, Hsieh JS, et al. Application of capsule endoscopy in small intestine diseases: Analysis of 28 cases in Kaohsiung medical university hospital. Kaohsiung J Med Sci 2006;22:425-31.  Back to cited text no. 5
    
6.
Cooley DM, Walker AJ, Gopal DV. From capsule endoscopy to balloon-assisted deep enteroscopy: Exploring small-bowel endoscopic imaging. Gastroenterol Hepatol (N Y) 2015;11:143-54.  Back to cited text no. 6
    
7.
Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: Report of 100 consecutive cases. Gastroenterology 2004;126:643-53.  Back to cited text no. 7
    
8.
Palimaka S, Blackhouse G, Goeree R. Colon capsule endoscopy for the detection of colorectal polyps: An economic analysis. Ont Health Technol Assess Ser 2015;15:1-43.  Back to cited text no. 8
    
9.
Shim KN, Jeon SR, Jang HJ, Kim J, Lim YJ, Kim KO, et al. Quality indicators for small bowel capsule endoscopy. Clin Endosc 2017;50:148-60.  Back to cited text no. 9
    
10.
Barkin JA, Barkin JS. Video capsule endoscopy: Technology, reading, and troubleshooting. Gastrointest Endosc Clin N Am 2017;27:15-27.  Back to cited text no. 10
    
11.
McAlindon ME, Ching HL, Yung D, Sidhu R, Koulaouzidis A. Capsule endoscopy of the small bowel. Ann Transl Med 2016;4:369.  Back to cited text no. 11
    
12.
Günther U, Bojarski C, Buhr HJ, Zeitz M, Heller F. Capsule endoscopy in small-bowel surveillance of patients with hereditary polyposis syndromes. Int J Colorectal Dis 2010;25:1377-82.  Back to cited text no. 12
    
13.
Kovács M, Pák P, Pák G, Fehér J. Screening and surveillance for hereditary polyposis and non-polyposis syndromes with capsule endoscopy. Orv Hetil 2008;149:639-44.  Back to cited text no. 13
    
14.
Bayraktar Y, Ersoy O, Sokmensuer C. The findings of capsule endoscopy in patients with common variable immunodeficiency syndrome. Hepatogastroenterology 2007;54:1034-7.  Back to cited text no. 14
    


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