title: Can capsule endoscopy be used as a diagnostic tool in the evaluation of nonbleeding indications in daily clinical practice? A prospective study.
abstract: OBJECTIVE
  To evaluate the diagnostic yield of capsule endoscopy (CE) and its impact on treatment and outcome in patients without bleeding indications.
  
  
  METHODS
  One hundred and sixty-five nonbleeding patients were enrolled in the study. The most common indications for CE were chronic abdominal pain alone (33 patients) or combined with chronic diarrhea (31 patients) and chronic diarrhea alone (30 patients). Among the 165 patients, 129 underwent CE for evaluation of gastrointestinal symptoms and 36 for surveillance or disease staging.
  
  
  RESULTS
  CE findings were positive, suspicious and negative in 73 (44.2%), 13 (7.9%) and 79 (47.9%) of cases, respectively. The diagnostic yield was highest in patients with refractory celiac disease (10/10, 100%) and suspected Crohn's disease (5/6, 83.3%), followed by patients with chronic abdominal pain and chronic diarrhea (13/31, 41.9%), established Crohn's disease (2/6, 33.3%), chronic diarrhea alone (8/30, 26.7%), chronic abdominal pain alone (8/33, 24.2%) and other indications (3/13, 23.1%) (p < 0.005). The CE findings led to a change of medication in 74 (47.7%) patients, surgery in 15 (9.7%), administration of a strict gluten-free or other special diet in 13 (8.4%) and had other consequences in 11 (6.7%). Management was not modified in 42 (27.1%) patients. Among symptomatic patients (n = 129), 29 (22.5%) were lost to follow-up. The remaining 100 patients were followed up for 8.7 ± 4.0 months (range 2-19). Among the latter, resolution or improvement of symptoms was observed in 86 (86%) patients, no change in 11 (11%) and 3 (3%) died. All 86 patients who experienced resolution or improvement of their symptoms had a modification of their management after CE; only 7/11 patients whose symptoms did not change (63.6%) and 2/3 patients who died (66.7%) had a modification of management (p < 0.001).
  
  
  CONCLUSIONS
  CE appears to be a useful tool in the evaluation of patients with nonbleeding indications. The outcome of most patients with negative findings was excellent.
authors.affiliation: Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Ethnikis Amnis 41, Thessaloniki, Greece. gchatzimav@yahoo.gr
authors.forename: P
authors.initials: P
authors.lastname: Katsinelos
authors.forename: K
authors.initials: K
authors.lastname: Tziomalos
authors.forename: K
authors.initials: K
authors.lastname: Fasoulas
authors.forename: G
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: A
authors.initials: A
authors.lastname: Koufokotsios
authors.forename: K
authors.initials: K
authors.lastname: Mimidis
authors.forename: S
authors.initials: S
authors.lastname: Terzoudis
authors.forename: T
authors.initials: T
authors.lastname: Maris
authors.forename: A
authors.initials: A
authors.lastname: Beltsis
authors.forename: C
authors.initials: C
authors.lastname: Geros
authors.forename: G
authors.initials: G
authors.lastname: Chatzimavroudis
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D011125:Adenomatous Polyposis Coli / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000295:instrumentation / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003424:Crohn Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis; D005260:Female; D005355:Fibrosis / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010580:Peutz-Jeghers Syndrome / Q000175:diagnosis; D011446:Prospective Studies; D055815:Young Adult