A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions

doi:10.1053/gast.2000.20844

Gastroenterology

Volume 119, Issue 6, December 2000, Pages 1431-1438

https://doi.org/10.1053/gast.2000.20844 Get rights and content

Abstract

Background & Aims: Wireless capsule endoscopy is a new, painless method of imaging the entire small bowel. It has not been compared with push enteroscopy. We compared the sensitivity, specificity, and safety of capsule and push enteroscopy in detecting small-bowel lesions. Methods: Nine to 13 radiopaque, colored beads (3–6 mm diameter) were sewn in random order inside 9 canine small bowels, half within the first meter, and confirmed on x-ray. After recovery, the number, order, and color of beads were assessed in 23 capsule enteroscopies and 9 push enteroscopies in a random order. The surgeons, push enteroscopists, capsule video interpreters, and pathologist were blinded to the others' findings. Results: The capsules identified more beads than push enteroscopy (median, 6 [range, 2–9] vs. 3 [range, 2–6 beads]; P < 0.001). The sensitivity of the capsule was 64% compared with 37% for push enteroscopy. The specificity was 92% for capsule enteroscopy and 97% for push enteroscopy. The capsules identified significantly more beads beyond the reach of the push enteroscope (median, 4 [range, 2–7] vs. 0; P < 0.0001). Hair, ingested plastic, ulceration, submucosal swelling, and worms were clearly identified by the capsule. The capsules passed safely through the animals with no significant histologic findings. Conclusions: Wireless capsule endoscopy detected more abnormalities in the small bowel than push enteroscopy.

GASTROENTEROLOGY 2000;119:1431-1438

Section snippets

Materials and methods

Animals had beads sewn into the small bowel at laparotomy under anesthetic by the surgical team. The beads were inserted in a predetermined randomized order, and the number, site, and color of the bead were recorded. Half were inserted within a meter of the pylorus, within the potential range of the push enteroscope. A week later, push enteroscopy and 1–3 capsule enteroscopies were performed in a random order under sedation by the endoscopy team. Macroscopic damage was assessed at postmortem.

Characteristics of study animals

Ten dogs were used with a male-to-female ratio of 4:6. Their weights ranged from 24 to 30 kg. The number of beads implanted was 9–13 (total, 99), but this was reduced to 9–12 (total, 89) after 7 days when the animals were x-rayed (Table 1) after the initial enteroscopy.

. Characteristics of study animals

Animal	Gender	Weight (kg)	Beads implanted	Beads x-rayed
1	F	25	13	9
2	F	24	10	8
3	M	25	10	10
4	F	25	9	9
5	M	30	12	11
6	M	30	11	11
7	F	25	12	10
8	M	25	12	12
9	F	30	10	9
10	F	25	0	0

This was presumably because some of the sutures holding the beads had

Discussion

The wireless capsule endoscope was repeatedly able to identify beads sewn beyond the reach of the push enteroscope and also identified unexpected pathology. All capsules were retrieved intact with no sign of damage.

The capsule endoscope successfully transmitted clear, color video images of the dog stomach, small bowel, and some of the colon for up to 6 hours. The transparent dome window overlying the videocamera lens remained clear throughout the procedure, with any debris collecting on the

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Optimal bowel preparation before capsule endoscopy (CE) is currently unknown. In this multicenter, blinded, randomized controlled trial, we assessed clinical effectiveness of 2 types of purgative regimen and a control arm of clear fluid only.
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This paper provides an overview of key aspects of human gastrointestinal anatomy and physiology and compares parameters to those reported in animal species. The value of each species can be determined based upon the parameter of interest from the ingested device when considering the use of pre-clinical animal testing.
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^☆: Address requests for reprints to: Paul Swain, M.D., Department of Gastroenterology, Royal London Hospital, Whitechapel Road, Whitechapel, London E11BB, England. Fax: (44) 20-7377-7441.

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Animal	Gender	Weight (kg)	Beads implanted	Beads x-rayed
1	F	25	13	9
2	F	24	10	8
3	M	25	10	10
4	F	25	9	9
5	M	30	12	11
6	M	30	11	11
7	F	25	12	10
8	M	25	12	12
9	F	30	10	9
10	F	25	0	0

Animal	Gender	Weight (kg)	Beads implanted	Beads x-rayed
1	F	25	13	9
2	F	24	10	8
3	M	25	10	10
4	F	25	9	9
5	M	30	12	11
6	M	30	11	11
7	F	25	12	10
8	M	25	12	12
9	F	30	10	9
10	F	25	0	0

Rapid CommunicationA randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions☆

Abstract

Section snippets

Materials and methods

Characteristics of study animals

Discussion

Clin Radiol

Gastrointest Endosc Clin North Am

Gastroenterology

Gastrointest Endosc Clin North Am

Gastrointest Endosc Clin North Am

Gastrointest Endosc Clin North Am

Gastrointest Endosc

Gastrointest Endosc Clin North Am

Gastrointest Endosc Clin North Am

Rapid Communication
A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions☆

Animal	Gender	Weight (kg)	Beads implanted	Beads x-rayed
1	F	25	13	9
2	F	24	10	8
3	M	25	10	10
4	F	25	9	9
5	M	30	12	11
6	M	30	11	11
7	F	25	12	10
8	M	25	12	12
9	F	30	10	9
10	F	25	0	0