20-09-2012, 04:36 PM
Wireless Capsule Endoscopy In Crohn’s Disease
wireless_capsule_endoscopy_ibd_ibs.ppt (Size: 1.69 MB / Downloads: 53)
Capsule Endoscopy for IBD
SS is a 40 year old male with a past medical history of ulcerative colitis s/p total proctocolectomy with ileostomy for dysplasia. Post operative course complicated by an SBO requiring small bowel resection.
SS did well for 11 years following his colectomy but then developed bright red blood in his ileostomy bag and abdominal pain.
Evaluation of the Small Intestine in Crohn’s Disease
Push Enteroscopy
Sonde and rope-way enteroscopy
CT Enterography
Small Bowel MRI’s
Intra-operative enteroscopy
Balloon Enteroscopy
The Capsule
Diameter 11mm: Length 26mm
Optical dome: Intestinal illumination by white light emitting diodes (LED’s)
Lens
Complementary metal-oxide silicone imager (color camera chip)
Transmitter
Two batteries (silver oxide)
Features of the Capsule
Capsule takes two images per second
On average, 50,000 images are obtained during an 8 hour exam
Magnification: 8x
Capsule coating: non-adherant
Disposable
Performancece
Overnight 12 hour fast
Sensors placed on patient
Patient wears a belt that contains a battery pack and data recorder.
Patient ingests capsule around 8am
Patient may have clears two hours after ingestion
Patient may have a light lunch 4 hours after ingestion
Avoid other patients who ingested a capsule.
Patient returns 7-8 hours later
Indications
Obscure gastrointestinal bleeding
Evaluation of extent of small intestinal disorders such as Crohn’s disease or Celiac sprue
Abnormal small intestinal imaging
Suspected malabsorption
Surveillance of polyposis syndromes involving small intestine
Informed Consent
WCE does not replace examination of the stomach or colon
Risk includes bowel obstruction that may require surgery
No MRI’s until capsule has passed
May not visualize the entire small bowel
Patency System
The main complication of WCE is capsule retention by a GI stricture
Current visualization of small-bowel strictures uses traditional radiological studies:
High-dose radiation
False negatives
Methods do not always reveal small-bowel patency for solids
Patient
XX is a 32 year old female with a history of Crohn’s disease for ten years. Eight years ago, she underwent a terminal ileal resection with an ileo-transverse colon anastomosis.
For the past 6 months, she was experiencing 4-6 loose stools per day and mid abdominal pain. She denied obstructive symptoms such as nausea, vomiting or obstipation.
She was being treated with pentasa 3 grams/d and enterocort
Laboratory evaluation was significant for an ESR of 55
A SBFT was normal
A colonoscopy was normal to the terminal ileum