Small-bowel lesions caused by portal hypertension of schistosomal origin: a capsule endoscopy pilot study.
BACKGROUND
Schistosomiasis is a highly prevalent disease. It can evolve to its hepatosplenic form in up to 10% of the cases. The small-bowel lesions developed during the hepatosplenic stage of the disease have not been described in vivo.


OBJECTIVE
The aim of this study was to describe, for the first time, in a pilot study, the endoscopic aspects of the lesions in the small bowel of patients with portal hypertension due to schistosomiasis, using the PillCam SB, and to determine the usefulness of the method for the diagnosis of esophageal varices.


METHODS
Case series.


METHODS
Tertiary-care medical center.


METHODS
Nine nonrandomized patients with hepatosplenic schistosomiasis and esophageal varices without previous GI bleeding were selected based on findings from the PillCam SB. Patients using medications that could alter the coagulation, with history of abdominal surgery, who were undergoing treatment of the portal hypertension other than beta-blocker, and with symptoms suggesting bowel obstruction were excluded. The findings were interpreted by a single endoscopist.


RESULTS
Capsule endoscopy was able to diagnose esophageal varices in all 9 patients. All of the patients presented angioectasias and venectasias in the small bowel. Small-bowel varices were present in 22.2% of the patients; edema and erosions were found in 66.7% and 88.9%, respectively. Lesions of so-called "scarred mucosa" were found in 55.5% of the patients.


CONCLUSIONS
Small number of patients; case series.


CONCLUSIONS
The PillCam SB was effective, giving a significant contribution to the description of the esophageal varices and small-bowel lesions of the patients with portal hypertension caused by Schistosoma mansoni.
Ganc
Ricardo L
RL
Department of Endoscopy, Santa Casa Faculty of Medicine, São Paulo, Brazil. ricardoganc@hotmail.com
Malheiros
Carlos A
CA
Nakakubo
Seiji
S
Szutan
Luis A
LA
Ganc
Arnaldo J
AJ
D000328:Adult; D016888:Angiodysplasia / Q000175:diagnosis*; D053704:Capsule Endoscopy; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000175:diagnosis; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D007421:Intestine, Small / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012555:Schistosomiasis mansoni / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014648:Varicose Veins / Q000175:diagnosis*