Guidelines for capsule endoscopy: diagnoses will be missed.
BACKGROUND
Capsule endoscopy represents a significant advance in the investigation of intestinal disease. National Institute of Health and Clinical Excellence, European Society of Gastrointestinal Endoscopy and American Society for Gastrointestinal Endoscopy guidelines support capsule endoscopy in obscure GI bleeding, Crohn's disease and the evaluation of non-steroidal anti-inflammatory drug side-effects, polyposis syndromes and coeliac disease.


OBJECTIVE
To determine whether the application of guidelines leads to missed diagnoses that would have been made if less stringent indications were adopted.


METHODS
Retrospective analysis of 100 consecutive unselected capsule endoscopy examinations at Homerton Hospital, from October 2003 to November 2005. All referrals accepted following traditional investigations. Indications and findings were recorded. Comparison made as to whether diagnoses would have been missed if guidelines had been followed and capsule endoscopy not performed.


RESULTS
Among the subjects 37 patients were children and 55 were male. Indications included recurrent bleeding and anaemia, assessment of Crohn's disease, 'others', i.e. assessment of coeliac disease, Peutz-Jehgers syndrome, Blue Rubber Bleb syndrome or non-specific abdominal pain. In patients with coeliac disease, widespread enteropathy was confirmed, with additional diagnoses of delayed gastric emptying and colitis. For those with abdominal pain findings included angiodysplasia, lymphoid hyperplasia and distal small bowel ulcers.


CONCLUSIONS
Capsule endoscopy in patients with non-conventional indications yielded abnormal pathology, such as ulcers and inflammation. If published guidelines had been followed such diagnoses would have been missed.
Makins
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R
Department of Gastroenterology, Whipps Cross University Hospital, Leytonstone, London, UK. richardmakins@yahoo.co.uk
Blanshard
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003951:Diagnostic Errors; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies