[Capsule endoscopy: The evolution in the diagnosis of small bowel diseases]

Wireless capsule endoscopy is a diagnostic procedure to study the pathology of the small intestine physiologically and painlessly. The capsule dimensions are 11 x 26 mm, and takes 2 picture per second whilst 8 hours. Unexplained occult gastrointestinal tract bleeding is the main indication, but everyday new indications for its use come to the literature. Our objective were to review our experience about the clinical usefulness and impact in our clinic. We included 45 cases, excluding 3 because of technical problems. There were 24 women and 18 men, with an average age of 54 years old (18 to 86 years old). Indications for the study were: Gastrointestinal bleeding of obscure origin in 24 cases, anemia in 6 cases, chronic diarrhea in 8 cases, chronic abdominal pain in 2 cases and Crohn's disease in 2 cases. The source of bleeding in the first group was identified in 18 patients (75%), where jejunal and ileal angiodysplasias were found in 11 patients, in 4 cases there were ulcers or erosions, in one case a Meckel diverticulum was found and, in the last one an hammartomatous lesion with an active bleeding was found. In chronic diarrhea patients a lesion was found in 5 cases (62.5%), where mucosal atrophy were found in two patients who responded to a free gluten diet, and in 3 patients acute inflammations with ulcers were treated as Crohn's disease. In the patients with anemia a lesion was found in 2 cases (33%), where a submucosal tumor and a jejunal ulcer were the findings. No lesions were found in the patients with chronic abdominal pain. Finally in the patients with Crohn's disease we were able to know the extent and one patient presented two stenotic lesions. In conclusion, wireless capsule endoscopy is a useful diagnostic tool that let us study easily the small intestine and should be integrated to different study protocols as gastrointestinal bleeding of obscure origin, chronic diarrhea and evaluation of Crohn's disease. It is not useful for abdominal pain, nevertheless we just studied two patients.