Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video) - 16/08/11
Reprint requests: Robert F. Wong, MD, University of Utah School of Medicine, 30 North 1900 East, Rm 4R118, Salt Lake City, UT 84132.Salt Lake City, Utah, USA
Abstract |
Background |
Video capsule endoscopy (VCE) may be useful for surveillance of small-bowel polyps in patients with familial adenomatous polyposis (FAP).
Objective |
To compare VCE to standard endoscopy for diagnosing small-bowel polyps in a defined segment of small bowel (proximal to a tattoo) and the entire examined small bowel.
Design |
Prospective.
Setting |
Single tertiary referral center.
Patients |
Participants with FAP (n = 32). The majority were selected for their high number of proximal small-bowel polyps and prior endoscopic tattoo placement in the proximal small bowel.
Interventions |
VCE (interpreted by 2 readers), push enteroscopy (PE), and lower endoscopy (LE) to count and measure small-bowel polyps.
Results |
In the defined segment, VCE detected a median of 10.0 (interquartile range [IQR], 5.0-19.0) and 9.0 (IQR, 6.0-16.0) polyps for each reader compared with a median of 41.0 (IQR, 19.0-64.0) polyps on PE (P = .002). Agreement between the 2 methods was fair (κ = 0.34, 0.36). Agreement between VCE and PE was poor to fair (κ = 0.10, 0.22) for estimating the size of the largest polyp and poor (κ = −0.20, −0.27) for detecting large polyps (≥1 cm). In the entire examined small bowel, VCE diagnosed a median of 38.0 (IQR, 10.5-71.5) and 54.0 (IQR, 13.0-100.0) polyps for each reader compared with a median of 123.0 (IQR, 38.5-183.0) for combination endoscopy (PE and LE) (P < .001). Agreement between the 2 methods was fair to moderate (κ = 0.21, 0.56).
Limitations |
Participants selected for high polyp burden, and results may not be applicable to all patients with FAP.
Conclusions |
VCE underestimates the number of small-bowel polyps in persons with FAP and does not reliably detect large polyps.
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| This work was presented at the 2005 American College of Gastroenterology National Meeting, Honolulu, Hawaii, October 28-November 2, 2005. Grant support was provided by the 2004 American Society for Gastrointestinal Endoscopy Wireless Video Capsule Endoscopy Clinical Research Award; National Cancer Institute R01 CA80852-05, National Institutes of Health; and National Center for Research Resources M01RR00064. |
Vol 64 - N° 4
P. 530-537 - octobre 2006 Retour au numéro
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