Limited ability of capsule endoscopy to detect normally positioned duodenal papilla

• Published in: Gastrointestinal endoscopy Vol. 64; no. 4; pp. 538 - 541
• Main Authors: Kong, Hwi, Kim, Yong Sik, Hyun, Jong Jin, Cho, Young Jig, Keum, Bora, Jeen, Yoon Tae, Lee, Hong Sik, Chun, Hoon Jai, Um, Soon Ho, Lee, Sang Woo, Choi, Jai Hyun, Kim, Chang Duck, Ryu, Ho Sang, Hyun, Jin Hai
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-10-2006; Elsevier
• Subjects: Adult; Aged; Ampulla of Vater - pathology; Biological and medical sciences; Capsule Endoscopy; Digestive system. Abdomen; Endoscopy; Endoscopy, Digestive System; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - etiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Observer Variation; Reference Values; Retrospective Studies; Sensitivity and Specificity; Capsule endoscopy; Duodenal papilla
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2006.02.028

The current power of capsule endoscopy (CE) to diagnose patients with obscure GI bleeding is 42% to 74.4%.
The aim of this study was to evaluate the diagnostic power of CE through its ability to detect duodenal papilla.
A total of 112 consecutive CEs were retrospectively reviewed. All patients had undergone esophagogastroduodenoscopy and had their normal duodenal papilla confirmed.
The CE findings were reviewed separately at a rate of 15 images/second by 2 experienced and competent capsule readers.
The CE detection rate of duodenal papilla was calculated. In addition, the number of frames showing duodenal papilla was counted.
Among the total CEs, 2 cases were excluded because the capsule could not traverse the second portion of duodenum. The most common indication was obscure GI bleeding. CE only detected duodenal papilla in 48 cases (43.6%). The mean number of frames of the visualizing duodenal papilla was 3.5 ± 2.5 (range 1-13).
Choosing duodenal papilla as the reference may not be optimal because its position is difficult to identify.
Our study conveys an important message on the present power of CE; we should carefully review CE findings at a slower review rate to raise the detection ability of the current-powered CE, when it is passing through several “difficult to identify” locations such as second portion of the duodenum. In addition, to raise the power of CE, technologic improvements of CE, such as an extracoporeal-controllable device or a multiside viewing capsule, are needed.