Prospective Evaluation of the Automatic Location System During Capsule Endoscopy Examination of the Small Intestine

Prospective Evaluation of the Automatic Location System During Capsule Endoscopy Examination of the Small Intestine Jean-Christophe Souquet, Marie Bellecoste-Martin, Soraya Belbouab, Denis Pere-Verge, Sylvie Radenne, Annie Tailhandier Accurate determination of the location of visualized abnormality is one of the main limits of capsule endoscopy study of the small intestine. Knowledge of this position is necessary to compare capsule endoscopy with other imaging methods and to choose the best available treatment. Two criteria are usually considered: i) the time between pylorus crossing and the lesion visualization; ii) the position graphically shown by the computerized system. This last device has been poorly studied so far. Therefore the aim of the present study was to evaluate this device by comparing the position of the capsule given by the automatic graphic and by a standard abdominal X-ray. Patients and Methods: when an abdominal X-ray is performed during capsule examination, multiple bright dots appear on up to 2 frames. Its is thus possible to know the position of the capsule on the automatic system at the moment of the X-ray. Sixty patients have been studied so far (mean age 61 yr; 28 female and 42 male). Indications for capsule (Pillcam, Given Imaging Co) were: unexplained GI bleeding (n Z 46), Crohn’s disease (n Z 4) and others (n Z 10). Capsule was ingested around 9.30 am; abdominal X-ray was obtained 2 hours later in the upright position. Location of the capsule given by the 2 methods was measured on a vertical and an horizontal axis passing by the navel. Results: Abdominal X-ray was obtained at a mean of 126 min after capsule ingestion. Time of X-ray could be accurately determined at capsule reading in all patients. There was a fair agreement in 40 cases (67%) between X-ray and automatic location device. In 20 cases, concordance was poorer; however the difference concerned only one of the 2 axes. In 13 cases, the capsule was lower at automatic reading than on X-ray. This resulted in only 4 cases in positionning the capsule in the lower left abdominal quadrant at capsule while in the upper left quadrant on X-ray. In the remaining 7 cases, agreement was fair for location on the vertical axis, but the lateral positioning was not concordant resulting in different right and left quadrant in 4 cases. Conclusions: in this prospective study, the comparison between computerized device and X-ray showed a good concordance in almost 70 of examinations for capsule location. However, in about 30% agreement was poorer resulting in positionning the capsule in different quadrants in 8 cases (13%). No clear explanations could be found for these discrepancies. Abstracts