Non-small-bowel abnormalities identified during small bowel capsule endoscopy

AIM:To investigate the incidence of non-small-bowelabnormalities in patients referred for small bowel capsule endoscopy,this single center study was performed.METHODS:Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding.This is defined as bleeding from the digestive tract that persists or recurs without an obviousetiology after a normal gastroduodenoscopy and colonoscopy.Nevertheless,capsule endoscopy sometimesreveals findings outside the small bowel,i.e.,withinreach of conventional endoscopes.In this retrospectivesingle center study,595 patients undergoing capsuleendoscopy between 2003 and 2009 were studied.Theincidence of non-small bowel abnormalities was defined as visible abnormalities detected by capsule endoscopy that are located within reach of conventionalendoscopes.RESULTS:In 595 patients,referred for obscure gastrointestinal bleeding or for suspected Crohn’s disease,abnormalities were found in 306(51.4%).Of these 306patients,85(27.7%)had abnormalities within reach of conventional endoscopes;63 had abnormalities apparently overlooked at previous conventional endoscopies,10 patients had not undergone upper and lower endoscopy prior to capsule endoscopy and 12 had abnormalities that were already known prior to capsule endoscopy.The most common type of missed lesions were vascular lesions(n=47).Non-small-bowel abnormalities were located in the stomach(n=15),proximal small bowel(n=22),terminal ileum(n=21),colon(n=19)or at other or multiple locations(n=8).Ten patients with abnormal findings in the terminal ileum had not undergone examination of the ileum during colonoscopy.CONCLUSION:A significant proportion of patients undergoing small bowel capsule endoscopy had lesions within reach of conventional endoscopes,indicating that capsule endoscopy was unnecessarily performed.