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  • Title: How good is capsule endoscopy for detection of periampullary lesions? Results of a tertiary-referral center.
    Author: Clarke JO, Giday SA, Magno P, Shin EJ, Buscaglia JM, Jagannath SB, Mullin GE.
    Journal: Gastrointest Endosc; 2008 Aug; 68(2):267-72. PubMed ID: 18378233.
    Abstract:
    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.
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