Capsule endoscopy assisted by traditional upper endoscopy

Antecedentes y objetivos: la cápsula endoscópica puede resultarinútil en caso de dificultad para tragar el dispositivo y/o deretención gástrica del mismo. En tales casos, llevar la cápsula hastael duodeno mediante endoscopia resulta muy útil.Describimos las indicaciones y los resultados de unos casos enque las técnicas endoscópicas tradicionales permitieron llevar lacápsula hasta el duodeno.Pacientes y métodos: se trata de una serie descriptiva y retrospectivade casos. Se identificaron todos los pacientes en las situacionescitadas y se anotaron las indicaciones de la cápsula endoscópica,la técnica endoscópica de colocación, las complicaciones yel grado de cobertura del intestino delgado por las imágenes.Resultados: la colocación endoscópica de la cápsula se hizo necesariaen 13 pacientes (2,1% de todas las endoscopias con cápsula;7 varones; media de edad – 47,9 ± 24,9 años, intervalo de 13 a79 años). Las indicaciones de la colocación endoscópica fueron: incapacidadpara tragar la cápsula (7), retención gástrica en exploracionesprevias (3) y anomalías de la anatomía digestiva alta (3). Enocho casos, la cápsula se introdujo en la vía GI mediante: sólo la redpara recuperar cuerpos extraños (3), la red y un capuchón transparente(2), el prototipo de un dispositivo a tal efecto (2) o una asa depolipectomía (1). Cinco pacientes ingirieron la cápsula, llevada despuésal duodeno con una asa de polipectomía (3) o una red paracuerpos extraños (2). No se produjeron complicaciones de importancia.La enteroscopia total fue posible en 10 pacientes (77%).Conclusiones: la colocación endoscópica de la cápsula en elduodeno sólo es necesaria rara vez, puede realizarse de forma seguracon distintas técnicas y soluciona algunas de las principales limitacionesde la cápsula endoscópica. Las mejores metodologíasson la utilización de una red y un capuchón transparente cuandoel paciente no pudo ingerir la cápsula y sólo una red para capturarlaen el estómago si la traga fácilmente

Background and aims: capsule endoscopy (CE) can be preventedby difficulties in swallowing the device and/or its gastric retention.In such cases, endoscopic delivery of the capsule to duodenumis very useful.We describe the indications and outcomes of cases in whichtraditional endoscopic techniques allowed placement of the capsulein duodenum.Patients and methods: this is a retrospective, descriptivecase series. All patients in the above conditions were identifiedand indications for CE, endoscopic-placement technique, complicationsand completeness of small bowel imaging were registered.Results: endoscopic-assisted delivery of the capsule was necessaryin 13 patients (2.1% of all CE; 7 males; mean age – 47.9 ±24.9 years, range 13 to 79 years). Indications for endoscopic deliveryincluded: inability to swallow the capsule (7), gastric retentionin previous exams (3), abnormal upper gastrointestinal anatomy(3). In eight patients, the capsule was introduced in GI tractwith: foreign body retrieval net alone (3), retrieval net and atranslucent cap (2), prototype delivery device (2) or a polypectomysnare (1). Five patients ingested the capsule that was then placedin duodenum with a polypectomy snare (3) or a retrieval net (2).No major complications occurred. Complete small bowel examinationwas possible in 10 patients (77%).Conclusions: endoscopic placement of capsule endoscope inthe duodenum is rarely needed. However it may be safely performedby different techniques avoiding some limitations of CE. The bestmethods for endoscopic delivery of the capsule in the duodenumseem to be a retrieval net with a translucent cap when the patient isunable to swallow the device or a retrieval net only to capture thecapsule in the stomach when the patient swallows it easily

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Capsule endoscopy assisted by traditional upper endoscopy.

BACKGROUND AND AIMS: Capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum. PATIENTS AND METHODS: This is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered. RESULTS: Endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age--47.9 +/- 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%). CONCLUSIONS: Endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patients swallows it easily.