Clinical Study On Video Capsule Retention And Retrieval Via Double Ballon Enteroscopy

As is far away from oral cavity and anus and overlaps circuitously,small intestine,the total length of which is about 4~6 meters,is the relatively blind area of the whole gastrointestinal tract.Small intestinal diseases can't be diagnosed accurately by conventional examination,such as X-ray barium meal contrast examination,push-type small-bowel endoscope,radioisotope scanning et al,which are limited by low diagnostic rate and location accuracy,great pain and more complications to achieve for clinical application.In 2001,the successive advent of capsule endoscopy(CE)and double ballon enteroscopy(DBE)filled the small intestine to lack the viewability inspection the blank.Video capsule achieves painless,noninvasive,wireless and directly observation of the mucous membrane of small intestine.Except acquiring more distinct picture by air inflation and water injection,the physician can also perform biopsy and treatment via DBE.Currently,CE is the first choice for those suspected small bowel dieases and excluded contraindications.For those can't detect lesions by CE or need further therapy,DBE is a superior option.Combination of both methods represented a significant breakthrough for diagnosis and treatment of diseases in the small bowel,including Crohn Disease(CD),small bowel vascular malformation and P-J syndrome et al.However,capsule retention is the major complication that plagued physicians.Though the retention rate is as low as only1%,the feasibility of obstruction and perforation is remarkably improved.Most patients isn't without any clinical manifestation,however,it can aggravate the strain of mental effort of patients.The risk factors of capsule retention hasn't been clarified nowadays and the physicians can't predict the possibility of retention.Once entrapped,most doctors and patients are inclined to take the capsule out and surgery is still the major method in majority departments.Though noninvasive and safely,while the data for this approach is limited.There is only one demestic retention case reported and several foreignal documents related the capsule retrieved via DBE can be researched,yet all including limited cases.Moreover,the factors associating successful retrieval via DBE is also uncertain.Additionally,the correlation between the time after swallow the capsule and the insertion depth of DBE when detect the lesion is undefined,which resulting in that the DBE must be performed second times via different way of insertion to discover the lesions.All of the above increase the health care costs.This study retrospectively reviewed patients visited our department,including capsule retention cases,those accepted capsule examination without retention,those accepted retention capsules retrieval via DBE and those detected lesions by video capsule and DBE simultaneously,aiming at clarifying the potential risk factors of capsule retention,the factors associating with the successful retrieval of the detained capsule by DBE and illuminating the correlation between the time after swallowing the capsule and the insertion depth of the DBE when find the pathological changes,so as to combine these two examination tightly and applying in clinical practice perfectly.Part?The analysis on risk factors of video capsule retentionObjective The aim of our study was to confirm potential risk factors of CE retention.Methods(1)Patients We retrospectively collected data of 49 retention cases who refered to our department from January 2007 to January 2016 and 429 cases accepted CE examinations without retention in our hospital from July 2014 to January 2016.(2)Data collection Data were collected mainly though electronic medical record system and telephone calls,including gender,age,height,weight,BMI,CE examination in outpatient clinic or ward,indication of CE,use of NSAID,smoking and drinking history et al.(3)Statistical analysis Differences in continuous variables were analyzed by the t test or Mann–Whitney U test,as appropriate,whereas differences in categorical variables were analyzed by the?2 test.A multivariable analysis using logistic regression was made.Each variable having statistical difference on univariate analysis was incorporated into a multivariate regression model to confirm its independent association with retention.Results Multivariate analyses showed CE examination in ward(P=0.000 odds ratio[OR]4.15,95% confidence interval [CI] 1.90-9.06),stomachache(P=0.020 OR 2.76,95%CI 1.17-6.49),suspected or known Crohn's diease(P=0.001 CD OR 5.55 95%CI1.95-15.81)may increase the risk of retention,male gender(P=0.010 OR 3.17 95%CI1.31-7.63),while BMI(P=0.001 OR 0.84 95%CI 0.76-0.93)is the protective factors.Conclusions Male gender,CE examination in ward,stomachache,suspected or known CD and emaciation are potential risk factors for CE retention.Part?Study of successful retrieval of retained video capsulesby double ballon enteroscopyObjectives The aim of our study was to evaluate the value of double ballon enteroscopy(DBE)in retrieval of capsule and further identify the influencing factors of successful retrieval.Methods(1)Patients A total of 49 consecutive retention cases who firstly came to our department and accepted retrieval of retained capsules by DBE from January 2007 to January 2016 were enrolled in this study.All patients were allocated into successful group and fail group according to whether the capsule was taken out.(2)Data collection The successful retrieval rate was calculated and insertion route,insertion depth,diagnosis,symptoms etc were collected mainly by electronic medical record system and telephone calls.(3)Statistical analysis Differences in continuous variables were analyzed by the t test or Mann–Whitney U test,as appropriate,whereas differences in categorical variables were analyzed by the?2 test.Results 24 cases of the whole 49 retention cases were caused by Crohn Disease(CD).32 cases were successfully retrieved,including 31 via oral route,1 via anal route.The successful rate was 72.7%.The mean entrapped period of CE had no significant difference between the 32 successful cases and 17 failed cases(17.5(14.3,62.5)d vs 20.5(15.0,54.0)d P=0.701).Performing DBE via oral route exhibited remarkable higher successful retrieval rate than anal route(70.5% vs 7.7%,P <0.001).Compared with ileum,CE located at duodenum and jejunum was more easy to be taken out than ileum(100% vs 62.5%,P=0.013).Moreover,the retention CE caused by malignancy more likely located at duodenum and jejunum than ileum compared with inflammatory lesions(90.9% vs 25.9%p<0.001),which was more easily to be taken out(100% vs 63.6%,P=0.051),though without statistical significance.The successful retrieval rate became lower when DBE encountered multiple strictures(42.9% vs 85.3%,P=0.049).Whether the capsule was in pelvic cavity shown by x-ray film before surgery was irrelevant to the successful rate(61.5% vs 90% P=0.432)and the insertion depth of the DBE when discover the capsule(ileum or not 62.5% vs 50% P=0.675),also to the actual site of the capsule(P=1.00).Thediameter of enteric cavity which DBE couldn't get through was significantly larger than the strictures hindered the capsule(0.50±0.04 cm vs 0.9±0.07 cm P=0.000).Conclusions DBE is an effective method for removal of retained CE and the successful retrieval rate wasn't affected by the entrapped period.The antegrade insertion of the scope was most recommended and the retained CE locates at duodenum and jejunum is more easy to be taken out than ileum.Whether the capsule was in pelvic cavity shown by x-ray film is irrelevant to the successful retrieval rate.Part?Study on the correlation between the time after swallowthe capsule and the insertion depth of DBE when detectthe lesionObjective Illuminating the correlation between the time after swallow the capsule and the insertion depth of the DBE.Methods(1)Patients We consecutively reviewed the patients who accepted CE and DBE and detected the lesions simultaneously in our department from January 2007 to November 2015.The whole patients were allocated into Oral group and Anus group according to the insertion method of DBE.(2)We recorded the insertion depth,the time between pylorus and the lesion and the time between pylorus and the ileocecal valve by reviewed the reports of enteroscopy and capsule endoscopy and calculated the time index.(3)Deduce the correlation between the insertion depth of DBE and time index.Results The time index in Oral group was significantly different with the index in Anus group(0.16 ± 0.03 vs 0.71 ± 0.05 P=0.000).In Oral group,there are good correlation between insertion depth of the double ballon endoscopy and time index of capsule endoscopy(correlation coefficient(r)=0.85 P=0.000).The three dimensional regression equation was y=22.13 +88.57 x + 3278.84x2-5540.81x3,(the correlation index(R2)= 0.802 P=0.000).Linear regression equation was y=23.66+433.47 x,(R2= 0.718P=0.000).However,in Anus group,the correlation was not so strong(r=.0.512).The three dimensional regression equation was y=343.24-1235.03 x + 2213.29x2-1310.99x3(R2=0.357 P=0.019).Linear regression equation was y=216.54-165.36x(R2= 0.30P=0.004)?Conclusions The time index of CE examination is remarkably correlates with the insertion depth of DBE via oral,while isn't related to the insertion depth of DBE via anal.