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Role of capsule endoscopy in small bowel management

Nemeth, Artur LU (2019)
Abstract
The small bowel is difficult to reach and to examine endoscopically. Video capsule endoscopy (VCE) using a wireless imaging technology was introduced 2000. VCE is an ingestible capsule camera that takes photographs during its passage throughout the gastrointestinal tract. The diagnosis of small bowel Crohn's disease is among the prime indications for VCE, as one third of patients with Crohn's disease have only small bowel involvement.
The aim of this thesis is to increase the knowledge and critically evaluate the use of VCE and its capability to diagnose small bowel Crohn's disease and to explore the most concerning complication of VCE - capsule retention. Specific aims were to explore the risk of capsule retention, to evaluate the... (More)
The small bowel is difficult to reach and to examine endoscopically. Video capsule endoscopy (VCE) using a wireless imaging technology was introduced 2000. VCE is an ingestible capsule camera that takes photographs during its passage throughout the gastrointestinal tract. The diagnosis of small bowel Crohn's disease is among the prime indications for VCE, as one third of patients with Crohn's disease have only small bowel involvement.
The aim of this thesis is to increase the knowledge and critically evaluate the use of VCE and its capability to diagnose small bowel Crohn's disease and to explore the most concerning complication of VCE - capsule retention. Specific aims were to explore the risk of capsule retention, to evaluate the clinical impact and the
value of the patency capsule test on the risk of capsule retention, to describe the clinical impact of VCE in patients with established Crohn's disease and to examine the impact and safety of VCE performed in children.
The usefulness and risk of VCE was evaluated in different clinical situations. The studies were performed using three different models of small bowel capsule endoscopes. Patency capsule examinations were performed using
a first or a second generation patency capsule.
The studies demonstrate that capsule retention is a rare complication of VCE. Moreover, a majority of patients with capsule retention can be safely and effectively managed with endoscopic intervention instead of surgery.
The results suggest that routine nonselective administration of the patency capsule before VCE in patients with established Crohn's disease is not likely to reduce the risk of video capsule retention. VCE provides meaningful
results leading to therapeutic changes in more than 50% of patients with established Crohn's disease. VCE is a safe method and often leads to a definitive diagnosis and has a significant impact on the clinical management of
pediatric patients with Crohn's disease.
Taken together, VCE has a high capability to diagnose small bowel Crohn's disease and is a very safe method to investigate the small bowel mucosa. The few cases with capsule retention can be mostly managed with endoscopic intervention. (Less)
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author
supervisor
opponent
  • docent Strid, Hans, Göteborg
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Capsule endoscopy, Crohn's disease,, Patency capsule, small bowel, Capsule retention
pages
70 pages
publisher
Lund University, Faculty of Medicine
defense location
Lilla aulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö
defense date
2019-03-29 09:00
ISBN
978-91-7619-755-4
language
English
LU publication?
yes
id
3e1ff94a-bcab-4221-af62-b1836fc86d7b
date added to LUP
2019-02-04 09:43:49
date last changed
2019-02-06 10:04:00
@phdthesis{3e1ff94a-bcab-4221-af62-b1836fc86d7b,
  abstract     = {The small bowel is difficult to reach and to examine endoscopically. Video capsule endoscopy (VCE) using a wireless imaging technology was introduced 2000. VCE is an ingestible capsule camera that takes photographs during its passage throughout the gastrointestinal tract. The diagnosis of small bowel Crohn's disease is among the prime indications for VCE, as one third of patients with Crohn's disease have only small bowel involvement.<br/>The aim of this thesis is to increase the knowledge and critically evaluate the use of VCE and its capability to diagnose small bowel Crohn's disease and to explore the most concerning complication of VCE - capsule retention. Specific aims were to explore the risk of capsule retention, to evaluate the clinical impact and the<br/>value of the patency capsule test on the risk of capsule retention, to describe the clinical impact of VCE in patients with established Crohn's disease and to examine the impact and safety of VCE performed in children.<br/>The usefulness and risk of VCE was evaluated in different clinical situations. The studies were performed using three different models of small bowel capsule endoscopes. Patency capsule examinations were performed using<br/>a first or a second generation patency capsule.<br/>The studies demonstrate that capsule retention is a rare complication of VCE. Moreover, a majority of patients with capsule retention can be safely and effectively managed with endoscopic intervention instead of surgery.<br/>The results suggest that routine nonselective administration of the patency capsule before VCE in patients with established Crohn's disease is not likely to reduce the risk of video capsule retention. VCE provides meaningful<br/>results leading to therapeutic changes in more than 50% of patients with established Crohn's disease. VCE is a safe method and often leads to a definitive diagnosis and has a significant impact on the clinical management of<br/>pediatric patients with Crohn's disease. <br/>Taken together, VCE has a high capability to diagnose small bowel Crohn's disease and is a very safe method to investigate the small bowel mucosa. The few cases with capsule retention can be mostly managed with endoscopic intervention.},
  author       = {Nemeth, Artur},
  isbn         = {978-91-7619-755-4},
  keyword      = {Capsule endoscopy,Crohn's disease,,Patency capsule,small bowel,Capsule retention},
  language     = {eng},
  pages        = {70},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Role of capsule endoscopy in small bowel management},
  year         = {2019},
}