The utility of capsule endoscopy small bowel surveillance in patients with polyposis.
BACKGROUND
Small intestinal (SI) surveillance is recommended for polyposis patients. The utility and safety of capsule endoscopy (CE) for surveillance of SI neoplasia in patients with familial adenomatous polyposis (FAP) and Peutz-Jeghers syndrome (PJS) is unknown.


METHODS
CE was offered to consecutive FAP and PJS patients due for routine upper endoscopic surveillance. The prevalence, location (jejunum, ileum), size (1-5 mm, 6-10 mm, >10 mm) and number (1-5, 6-12, >20) of polyps detected by CE was assessed.


RESULTS
19 subjects (15 FAP/4 PJS) with a mean age of 43 were included. All subjects had previous intestinal surgery. No complications occurred with CE. CE in FAP: 9/15 (60%) of subjects with FAP had SI polyps. The prevalence of SI polyps was related to the duodenal polyposis stage and subject age. The location, size and number of polyps progressed as duodenal polyposis stage advanced. CE in PJS: 3/4 (75%) of subjects with PJS had SI polyps. The polyps were diffuse in 2/4 and only in the ileum in one subject. CE findings led to laparotomy with intra-operative endoscopic polypectomy in two PJS patients.


CONCLUSIONS
SI polyps are common in FAP but their importance is unknown. CE should be performed in FAP patients with stage III and IV duodenal disease. Clinically significant polyps are commonly detected by CE in PJS and lead to change in management in 50% of PJS subjects. CE should replace radiographic SI surveillance for PJS patients. CE is safe in polyposis patients who have undergone major intestinal surgery.
Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Carol A
CA
Burke
Janice
J
Santisi
James
J
Church
Gavin
G
Levinthal
D011125:Adenomatous Polyposis Coli / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010580:Peutz-Jeghers Syndrome / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence