BACKGROUND: Ampullary adenomas are increasingly being recognized, particularly in patients with familial adenomatous polyposis. A capsule endoscopy (CE) is routinely recommended for surveillance of small-intestinal polyposis. Performance characteristics of CE for the detection of periampullary lesions are unclear. OBJECTIVE: To evaluate the ability of CE to detect the major duodenal papilla. DESIGN AND PATIENTS: A total of 146 consecutive CE studies were reviewed by 2 CE gastroenterologists at 5 frames per second. Primary outcome was visualization of the major duodenal papilla. Discrepancies were reviewed by 5 CE gastroenterologists. SETTING: A tertiary-referral center. MAIN OUTCOME MEASUREMENTS: The ability of CE to detect the duodenal papilla. RESULTS: Among 146 consecutive CE studies, 21 were excluded: capsule retention (3), patient age <18 years (6), duplicate study (8), and prior surgery disrupting duodenal anatomy (4). Of the remaining 125 studies, indications were the following: obscure GI bleeding (45.6%), iron deficiency anemia (19.2%), abdominal pain (17.6%), diarrhea (10.4%), and Crohn's disease (4.8%). In total, 13 major duodenal papillae were visualized. The median time of detection was 31 seconds after the first duodenal image. This translates to a CE sensitivity of 10.4% for detection of the major papilla. LIMITATION: Papilla position was not verified by an EGD. CONCLUSIONS: CE has limited sensitivity to visualize the major papilla and lesions in the periampullary small intestine. Nondiagnostic CE studies must not be relied upon as proof that small-bowel lesions do not exist. Consideration should be given for an enteroscopy or side-viewing duodenoscopy in cases where significant clinical concern exists for unrecognized periampullary lesions. The current recommendations about surveillance for small-bowel polyposis should be revised.
BACKGROUND: Ampullary adenomas are increasingly being recognized, particularly in patients with familial adenomatous polyposis. A capsule endoscopy (CE) is routinely recommended for surveillance of small-intestinal polyposis. Performance characteristics of CE for the detection of periampullary lesions are unclear. OBJECTIVE: To evaluate the ability of CE to detect the major duodenal papilla. DESIGN AND PATIENTS: A total of 146 consecutive CE studies were reviewed by 2 CE gastroenterologists at 5 frames per second. Primary outcome was visualization of the major duodenal papilla. Discrepancies were reviewed by 5 CE gastroenterologists. SETTING: A tertiary-referral center. MAIN OUTCOME MEASUREMENTS: The ability of CE to detect the duodenal papilla. RESULTS: Among 146 consecutive CE studies, 21 were excluded: capsule retention (3), patient age <18 years (6), duplicate study (8), and prior surgery disrupting duodenal anatomy (4). Of the remaining 125 studies, indications were the following: obscure GI bleeding (45.6%), iron deficiency anemia (19.2%), abdominal pain (17.6%), diarrhea (10.4%), and Crohn's disease (4.8%). In total, 13 major duodenal papillae were visualized. The median time of detection was 31 seconds after the first duodenal image. This translates to a CE sensitivity of 10.4% for detection of the major papilla. LIMITATION: Papilla position was not verified by an EGD. CONCLUSIONS: CE has limited sensitivity to visualize the major papilla and lesions in the periampullary small intestine. Nondiagnostic CE studies must not be relied upon as proof that small-bowel lesions do not exist. Consideration should be given for an enteroscopy or side-viewing duodenoscopy in cases where significant clinical concern exists for unrecognized periampullary lesions. The current recommendations about surveillance for small-bowel polyposis should be revised.
Authors: Ignacio Fernandez-Urien; Cristina Carretero; Erika Borobio; Ana Borda; Emilio Estevez; Sara Galter; Begoña Gonzalez-Suarez; Benito Gonzalez; Marisol Lujan; Jose Luis Martinez; Vanessa Martínez; Pedro Menchén; Javier Navajas; Vicente Pons; Cesar Prieto; Julio Valle Journal: World J Gastroenterol Date: 2014-10-21 Impact factor: 5.742
Authors: Paul Tescher; Finlay A Macrae; Tony Speer; Damien Stella; Robert Gibson; Jason A Tye-Din; Geeta Srivatsa; Ian T Jones; Kaye Marion Journal: Hered Cancer Clin Pract Date: 2010-04-04 Impact factor: 2.857