Application And Follow-up Study Of280Cases Of Capsule Endoscopy In The Diagnosis Of Small Bowel Diseases

Objective: As the small intestine’s lengthy (about5~7meters of the totallength) and deep Anatomical position, which was coiled and folding arrangedin abdominal cavity, it is limited to diagnose small bowel diseases bytranditional method. Therefore, it has been difficult to diagnosis of smallbowel diseases in clinical accurately. The capsule endoscopy which wasinvented in recent years is a new, noninvasive and the whole digestive tractexamination method. The capsule endoscopy provides an important way fordiagnosis of the small bowel diseases under direct vision and has made greatprogress. Although a large number of domestic and foreign literatures haveconfirmed that the capsule endoscopy has a high value for the diagnosis ofsmall bowel disease, there is few follow-up study of a larger sample size afterthe examination of the endoscopy. Hence, this paper studied the retrospectiveanalysis of the capsule endoscopy on280patients, combining with thefollow-up study, aimed to evaluate the consistency of the diagnosis which wasmade by capsule endoscopy and in final clinical. And furthermore, explore theapplication value of capsule endoscopy in the diagnosis of small boweldiseases.Methods:280patients who were made the examination of the capsuleendoscopy at the Second Hospital of Hebei Medical University from Apr.2007to Nov.2013were included in a research of a retrospective analysis andfollow-up study, the revisit time ranged from5months to7years.171femaleand109male cases were included, aged between17-80years old. Finally,the results were analyzed by statistical method.Results:1The running time of the capsule endoscopy: running times of thecapsule endoscopy in the esophagus, stomach and small bowel were 28.7±10.8(4~54)s,48.5±40.8(2~189)min,304.8±61.2(64.7~501.4)min,respectively. It took49.3±41.5(2.2~189.1) min to reach the pyloric, andtook258.7±60.8(59-499)min to reach the ileocecal valve.2In total of280patients with capsule endoscopy examination, thesuccess rate was99.3%（278/280）, the detection rate of lesions was66.4%（186/280）, the pass rate of the ileocecal valve was87.5%（245/280）and therate of missed was0.7%(2/280).3The detection rate of lesions by capsule endoscopy was66.4%（186/280）,Vascular lesions accounted for20.4%(57/280), non-specificinflammation accounted for11.8%（33/280), ulcerative lesions accounted for9.6%（27/280) and space occupying lesions accounted for7.9%（22/280). Thefollowed lesions were polyps accounted for5.0%（14/280)，lymphangiectasisaccounted for4.3%（12/280)，Crohn’s disease accounted for2.5%（7/280)，active bleeding accounted for1.8%（5/280), diverticulum accounted for1.1%（3/280), xanthelasma accounted for1.1%（3/280), mesenchymoma accountedfor0.7%（2/280) and lipoma accounted for0.4%（1/280), respectively.4Capsule endoscopy detection results in different symptoms group:①The detection rate of lesions by capsule endoscopy in200patients withobscure gastrointestinal bleeding was70.0%（140/200)，among which, vascularlesions accounted for25.5%（51/200), non-specific inflammation accountedfor10.5%（21/200), space occupying lesion accounted for9.5%(19/200) andulcerative lesions accounted for9.0%(18/200);②The detection rate of lesionsby capsule endoscopy in58patients with un explained abdominal pain was58.6%（34/58), among which, non-specific inflammation accounted for13.8%（8/58), ulcerative lesions accounted for12.1%（7/58)；③The detection rateof lesions by capsule endoscopy in22patients with other symptoms group was54.5%（12/22). The detection rate of lesions by capsule endoscopy betweenthe groups with tree different symptoms had no significant difference bychi-square test.5The complications of the capsule endoscopy：3cases (1.1%) occurredcapsule retention, and stranded capsule endoscopies were removed by the surgery.6Follow-up study: The rate of follow-up was60.4%（169/280）, inyouth group, middle aged group and older age-group were54.9%（39/71),57.9%(81/140),71.0%(49/69), respectively. The rate of follow-up in differentage group had no significant difference by chi-square test.After the examination of the capsule endoscopy,51patients werediagnosed and received further treatment, among them,27cases werediagnosed by small bowel enteroscopy,6cases were diagnosed byangiography,11cases were diagnosed by exploratory laparotomy operationand treatment,5cases were suspected as NASIDS related ulcer,2cases weresuspected as allergic purpura and had underwent diagnostic treatment trials.51cases were diagnosed finally. There were7cases with ulcerative lesions,6cases with non-specific inflammation,6cases with vasodilation,5cases withNASIDS related ulcer,5cases with diverticulum,3cases with vascularmalformations,3cases with hemangioma,3cases with mesenchymoma,2cases with polyp,2cases with allergic purpura,1case with xanthelasma,1case with lipoma，1case with cryptogenic multifocal ulcerous stenosingenteritis and1case with Neuroendocrinetumors, respectively, another5patients were normal.7The compliance rate of the diagnosis that was made by the capsuleendoscopy and in final clinical: the detection rate of small bowel diseases bycapsule endoscopy was76.5%(39/51), among which, the diagnosticcompliance rate of capsule endoscopy was88.9%（32/36）in the obscuregastrointestinal bleeding group.Conclusion:1Capsule endoscopy had a high value of diagnosis for the small boweldisease, especially for the patients with obscure gastrointestinal bleeding. 2Much more attention should be paid to the follow-up study afterexamination of the capsule endoscopy in the future.