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Vol. 44. Issue 10.
Pages 680-686 (December 2021)
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Vol. 44. Issue 10.
Pages 680-686 (December 2021)
Original article
Oral ingestion versus endoscopic delivery of endoscopic capsule in patients with previous gastrointestinal surgery (ORENCES study): A Spanish multicentre observational study
Ingesta oral versus colocación endoscópica de la cápsula endoscópica en pacientes con cirugía gastrointestinal previa (estudio ORENCES): un estudio observacional multicéntrico español
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Antonio Giordanoa, Alfonso Elosua Gonzálezb, Francisco Sánchez Ceballosc, Cristina Carretero-Ribónd, Marta Aicart-Ramose, Juan Egea Valenzuelaf, Noelia Alonso-Lázarog, José Luis Martín-Lorenteh, Consuelo Gálvez-Castilloi, Vicente Pons-Beltránj, Ignacio Fernández-Uriénk, Begoña González-Suáreza,
Corresponding author
bgonzals@clinic.cat

Corresponding author.
, On Behalf of the SEED Group of Capsule Endoscopy and Enteroscopy
a Endoscopy Unit, Department of Gastroenterology, Hospital Clínic of Barcelona, Barcelona, Spain
b Department of Gastroenterology, Hospital García Orcoyen, Estella, Spain
c Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
d Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona, Spain
e Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
f Department of Digestive Diseases, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
g Gastrointestinal Endoscopy Unit, Digestive Diseases Department, Hospital Universitari La Fe, Valencia, Spain
h Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain
i Department of Gastroenterology, Hospital Clínic Universitari de València, Valencia, Spain
j Gastrointestinal Endoscopy Unit, Digestive Diseases Department, Hospital Universitari La Fe, Valencia, Spain
k Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
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Table 1. Correlation between SBCE indications and endoscopic findings.
Table 2. Characteristics of study population and SBCE examinations.
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Abstract
Background

Small Bowel Capsule Endoscopy is the first-choice technique for investigating the majority of small bowel diseases. Its most common complications are related to incomplete examinations and capsule retention. There is no consensus on how patients with previous gastrointestinal surgery should receive the capsule.

Objective

The primary endpoint was to compare the rate of complete small-bowel examinations (completion rate) between oral ingestion and endoscopic delivery of the capsule. The secondary endpoint was to compare diagnostic yield and adverse events in the two groups.

Methods

A retrospective observational study was conducted in nine hospitals in Spain. Demographic data, previous surgery, indication for capsule endoscopy, intestinal transit time, diagnosis, completion rate (percentage of capsules reaching the caecum), diagnostic yield (percentage of results compatible with indication for the exam) and adverse events were collected.

Results

From January 2009 to May 2019 fifty-seven patients were included (39 male, mean age 66±15 years). The most common indications for the exam were “overt” (50.9%) and “occult” (35.1%) small bowel bleeding. Previous Billroth II gastrectomy and Roux-en-Y gastric bypass were present in 52.6% and 17.5% of patients respectively. The capsule was swallowed in 34 patients and placed endoscopically in 23 patients. No significant differences were observed between the oral ingestion and endoscopic delivery groups in terms of completion rate (82.4% vs. 78.3%; p=0.742), diagnostic yield (41.2% vs. 52.2%; p=0.432) or small bowel transit time (301 vs. 377min, p=0.118). No capsule retention occurred. Only one severe adverse event (anastomotic perforation) was observed in the endoscopic delivery group.

Conclusions

In our case series, there were no significant differences between oral ingestion and endoscopic delivery in terms of completion rate, diagnostic yield or safety. Being less invasive, oral ingestion of the capsule should be the first-choice method in patients with previous gastrointestinal surgery.

Keywords:
Capsule endoscopy
Billroth
Surgery
Resumen
Antecedentes

La cápsula endoscópica representa la técnica de primera elección para investigar la mayoría de las enfermedades del intestino delgado. Sus complicaciones más comunes frecuentes son las exploraciones incompletas y la retención a nivel de intestino delgado. Hasta el momento no hay acuerdo sobre cómo administrar la cápsula a los pacientes que han sido sometidos a una cirugía gastrointestinal previa.

Objetivo

El objetivo principal fue comparar la tasa de estudios completos entre la ingestión oral y la administración endoscópica de la cápsula. Los objetivos secundarios fueron comparar el rendimiento diagnóstico y los eventos adversos en ambos grupos.

Métodos

Se realizó un estudio observacional retrospectivo en 9 hospitales de España. Se recogieron datos demográficos, cirugía previa, indicación de cápsula endoscópica, tiempo de tránsito intestinal, diagnóstico, tasa de estudios completos (porcentaje de cápsulas que llegan al ciego), rendimiento diagnóstico (porcentaje de resultados compatibles con la indicación del examen) y eventos adversos.

Resultados

Desde enero de 2009 hasta mayo de 2019 se incluyeron 57 pacientes (39 hombres, edad media 66 ± 15 años). Las indicaciones más frecuentes para el examen fueron hemorragia de intestino delgado «manifiesta» (50,9%) y «oculta» (35,1%). El 52,6% de los pacientes presentaba gastrectomía Billroth II y el 17,5% bypass gástrico en Y de Roux. La cápsula fue ingerida en 34 pacientes y colocada endoscópicamente en 23 pacientes. No se observaron diferencias significativas entre los grupos de ingesta oral y de colocación endoscópica en cuanto a tasa de estudios completos (82,4% vs. 78,3%; p = 0,742), rendimiento diagnóstico (41,2% vs. 52,2%; p = 0,432) y tiempo de tránsito del intestino delgado (301 vs. 377 min, p = 0,118). No hubo casos de cápsulas retenidas. Solo se observó un evento adverso severo (perforación anastomótica) en el grupo de colocación endoscópica.

Conclusiones

En nuestra cohorte, no hubo diferencias significativas entre la ingesta oral y la colocación endoscópica en cuanto a la tasa de estudios completos, el rendimiento diagnóstico y los eventos adversos. Dado su carácter menos invasivo, la ingesta oral de la cápsula debería ser el método de primera elección en pacientes con cirugía gastrointestinal previa.

Palabras clave:
Cápsula endoscópica
Billroth
Cirugía

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