Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.
OBJECTIVE
At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel.


METHODS
We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients.


RESULTS
A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients.


CONCLUSIONS
Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.
Schulmann
Karsten
K
Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.
Hollerbach
Stephan
S
Kraus
Katja
K
Willert
Jörg
J
Vogel
Tilman
T
Möslein
Gabriela
G
Pox
Christian
C
Reiser
Markus
M
Reinacher-Schick
Anke
A
Schmiegel
Wolff
W
D011125:Adenomatous Polyposis Coli / Q000150:complications* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D002214:Capsules; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000209:etiology / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010580:Peutz-Jeghers Syndrome / Q000150:complications* / Q000473:pathology; D011446:Prospective Studies; D014741:Video Recording / Q000295:instrumentation*
D002214:Capsules