title: Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video).
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wong
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Tuteja
authors.forename: Derrick S
authors.initials: DS
authors.lastname: Haslem
authors.forename: Lisa
authors.initials: L
authors.lastname: Pappas
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Maydeen M
authors.initials: MM
authors.lastname: Ogara
authors.forename: James A
authors.initials: JA
authors.lastname: DiSario
mesh_terms: 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