Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video).
BACKGROUND
Video capsule endoscopy (VCE) may be useful for surveillance of small-bowel polyps in patients with familial adenomatous polyposis (FAP).


OBJECTIVE
To compare VCE to standard endoscopy for diagnosing small-bowel polyps in a defined segment of small bowel (proximal to a tattoo) and the entire examined small bowel.


METHODS
Prospective.


METHODS
Single tertiary referral center.


METHODS
Participants with FAP (n = 32). The majority were selected for their high number of proximal small-bowel polyps and prior endoscopic tattoo placement in the proximal small bowel.


METHODS
VCE (interpreted by 2 readers), push enteroscopy (PE), and lower endoscopy (LE) to count and measure small-bowel polyps.


RESULTS
In the defined segment, VCE detected a median of 10.0 (interquartile range [IQR], 5.0-19.0) and 9.0 (IQR, 6.0-16.0) polyps for each reader compared with a median of 41.0 (IQR, 19.0-64.0) polyps on PE (P = .002). Agreement between the 2 methods was fair (kappa = 0.34, 0.36). Agreement between VCE and PE was poor to fair (kappa = 0.10, 0.22) for estimating the size of the largest polyp and poor (kappa = -0.20, -0.27) for detecting large polyps (> or =1 cm). In the entire examined small bowel, VCE diagnosed a median of 38.0 (IQR, 10.5-71.5) and 54.0 (IQR, 13.0-100.0) polyps for each reader compared with a median of 123.0 (IQR, 38.5-183.0) for combination endoscopy (PE and LE) (P < .001). Agreement between the 2 methods was fair to moderate (kappa = 0.21, 0.56).


CONCLUSIONS
Participants selected for high polyp burden, and results may not be applicable to all patients with FAP.


CONCLUSIONS
VCE underestimates the number of small-bowel polyps in persons with FAP and does not reliably detect large polyps.
Wong
Robert F
RF
Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Tuteja
Ashok K
AK
Haslem
Derrick S
DS
Pappas
Lisa
L
Szabo
Aniko
A
Ogara
Maydeen M
MM
DiSario
James A
JA
D011125:Adenomatous Polyposis Coli / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D001706:Biopsy; D053704:Capsule Endoscopy / Q000706:statistics & numerical data; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007580:Jejunal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D007583:Jejunum / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013653:Tattooing