Capsule endoscopy: a surgical perspective

Capsule endoscopy (CE) is gaining acceptance as an accurate method of imaging the small bowel. However, it is still being assessed for its use in successfully changing management and improving outcomes. We report the initial experience of CE in Tasmania.

Findings were collected retrospectively for the first 55 consecutive CE carried out in Tasmania from May 2003 to June 2005. One surgeon had carried out and reported on these tests. Findings included indication, previous tests, abnormalities detected, subsequent change in management and outcomes.

The median age was 68 years (range 33-87). Fifty-two CE were carried out for obscure gastrointestinal bleeding (23 for overt and 29 for occult bleeding) and 3 for abdominal pain without bleeding. Fifty-six per cent of tests had an abnormal result. Seven laparotomies were carried out to treat the abnormal findings of three suspected small bowel angiodysplasias, two suspected small bowel tumours, one patient with slow small bowel transit and abdominal pain and one patient with suspected Crohn's disease. Two patients died of cardiac arrest within 1 week of surgery, three patients showed improvement of their symptoms of gastrointestinal bleeding, one patient had resection and definitive diagnosis of Crohn's disease and another had excision of a bleeding Meckel's diverticulum.

CE is an effective investigation for diagnosis of small bowel diseases amenable to medical or surgical management. However, the most appropriate use of this test to achieve an improvement in outcome is yet to be determined.