Second-generation colon capsule endoscopy is feasible in the out-of-clinic setting.

BACKGROUND: No colorectal imaging test may be performed on an out-of-clinic basis. This represents a major drawback compared with fecal tests. Because colon capsule endoscopy (CCE) automatically detects small bowel mucosa, it has the potential to become the first colorectal imaging test to be performed out-of-clinic. This study aimed to evaluate the feasibility and efficiency of CCE when offered as an out-of-clinic procedure. METHODS: Patients with known or suspected colonic diseases who had up to 40 min of travel time from clinic to home were offered CCE as an out-of-clinic procedure. These patients were provided with four numbered vials (1 with metoclopramide, 2 with sodium phosphate, 1 with bisacodyl) and detailed instructions on how to interact with data-recorder automatic signaling. Patient compliance with data-recorder instructions, CCE excretion, and detection rates were prospectively assessed. RESULTS: The study enrolled 41 patients (29 men) with a mean age of 57 years. According to data recorder DR3-registered alerts, 14 patients (34 %) required a single booster only, 27 patients (66 %) required two boosters, and 13 patients (32 %) required a suppository. Comparison of the DR3 alerts with the returned vials showed that patient compliance to DR3 alerts was 100 %. During the procedure, 16 patients (39 %) called the physician/clinic from home. In 85 % of the cases, the CCE was excreted within the battery operating time. Lesions size 6 mm or larger were detected in 10 (24 %) of the 41 patients. CONCLUSIONS: As an out-of-clinic procedure, CCE is feasible and easily performed. A home-based procedure may be associated with better acceptability and potentially with increased adherence to Colorectal cancer screening.

Positive coeliac serology in irritable bowel syndrome patients with normal duodenal biopsies: Video capsule endoscopy findings and HLA-DQ typing may affect clinical management.

OBJECTIVES: To investigate a group of IBS patients (Rome criteria) with positive coeliac serology (EMA, TTG, IgG or IgA AGA) and normal small bowel biopsies. Video capsule endoscopy (VCE) findings of the small bowell were compared with DQ-typing. METHODS: Twenty-two patients with chronic abdominal pain (with or without diarrhea) and at least one positive result of any of the coeliac serological markers (AGA, TTG, EMA) and normal duodenal biopsy were enrolled and underwent VCE. Twelve healthy volunteers with VCE served as control group. Coeliac related HLA DQ2 or DQ8 markers were determined. RESULTS: 12/ 22 (55%) patients had small bowel abnormalities with VCE. No mucosal abnormalities were recognized in the control group (p = 0.002). Inflammatory changes were classified as moderate or pronounced. Eight patients (36%) had moderate changes and four patients (18%) demonstrated pronounced changes. Only 6 of the 21 IBS patients were positive for DQ2 and/or DQ8. CONCLUSIONS: The patients in this study fulfilled the diagnostic Rome criteria for Irritable Bowel Syndrome. We suggest that patients with positive coeliac serology and normal duodenal biopsies should undergo HLA typing. In patients positive for DQ2 and/or DQ8, a VCE should be performed. Patients with mucosal abnormalities compatible with CD should be considered as a group distinct from IBS patients and could be tested with gluten challenge or treated with a gluten free diet.

Occult inflammatory small-bowel disease: not so occult anymore.

Four cases are described in which reliance on small-bowel follow-through would have led to an incorrect diagnosis. In all cases, capsule endoscopy resulted in a diagnosis of inflammatory bowel disease, leading to successful treatment with mesalamine (PENTASA; Ferring Pharmaceuticals, Copenhagen, Denmark) and corresponding reductions in aphthous lesions on repeated capsule endoscopy. Based on our experience and a review of the literature, it is concluded that relying on a negative small-bowel follow-through examination to rule out small-bowel disease would be unfair to patients with suspected small-bowel disease.