Upper Gastrointestinal Tract Lesion Identification by Small Bowel Capsule Endoscopy

Purpose: Previous studies have demonstrated capsule endoscopy's ability to identify lesions within the reach of conventional endoscopy. However, the significance of this has yet to be clarified, and at this time it is unclear in how much detail upper gastrointestinal images need to be reviewed for routine practice. The purpose of this retrospective review of capsule endoscopy findings is to determine frequency and significance of lesions in the upper gastrointestinal tract within the reach of conventional endoscopy. Methods: A retrospective review was made of the Cleveland Clinic IRB approved Capsule Endoscopy Database consisting of 296 patients who underwent capsule endoscopy over a one year period at our institution. Significant lesion was defined as a lesion which explained the patient's clinical presentation. Arbitrarily we defined upper gastrointestinal as proximal to the ligament of treitz. Findings on capsule endoscopy were then compared to findings on upper endoscopy or push enteroscopy. Results: Out of 296 patients, 77 patients with positive capsule endoscopy findings were identified (38 males, 39 females, mean age of 60.09 years). Of these 23/ 77 (30%) patients had significant findings on capsule endoscopy of upper gastrointestinal tract. The most common indications for capsule endoscopy were iron deficiency anemia (45%), gastrointestinal bleed (34%), and FAP (8%). Upper endoscopy and push enteroscopy findings were reviewed and were available for all 23 patients with significant findings in the upper gastrointestinal tract. 11/23 (47.8%) patients with positive capsule endoscopy had negative upper endoscopy or push enteroscopy. 12/23 (52.2%) patients with positive capsule endoscopy had corresponding positive findings identified on upper endoscopy or push enteroscopy. In 10/23 (43.5%) patients positive findings identified by upper endoscopy or push enteroscopy were not identified by capsule endoscopy. Conclusion: Capsule endoscopy may be a useful diagnostic tool in identifying upper gastrointestinal lesions. This study showed that 47.8% of upper gastrointestinal lesions identified on capsule endoscopy was not seen on upper endoscopy or push enteroscopy. Although limitations of the study prevent defining recommendations, it is our opinion that upper gastrointestinal images in capsule endoscopy need to be reviewed as carefully as small bowel images.