The present study aimed to determine the diagnostic yield of OMOM capsule endoscopy for small bowel diseases in adults. A total of 89 patients, including 45 cases of obscure abdominal pain, 22 of chronic diarrhea, 18 of obscure gastrointestinal bleeding and 4 of obscure anemia were enrolled in the present study. The transit time of the endoscopy capsule in the digestive tract was recorded and the testing results were analyzed. All detections were completed except for four capsule retentions and the completion rate was 95.51%. The average transit time of the endoscopy capsule in the esophagus, stomach and small intestine was 62.18±64.23 sec, 67.46±63.13 and 346.53±102.81 min, respectively. Of the 89 patients, 54 (60.67%) were found to have lesions, among which 19 had mucosal erosion (21.35%), 15 had anabrosis (16.85%), 9 were diagnosed with polyps (10.11%), 5 with angiodysplasia (5.62%); furthermore, tumors were identified in 5 patients (5.62%) and ancylostomiasis in 1 patient (1.12%). The results confirmed the feasibility and validity of OMOM capsule endoscopy for diagnosing small bowel diseases in adults.
Patients with small bowel diseases usually present with abdominal pain, diarrhea, hematochezia, fever as well as weight loss. However, due to the length, tortuosity and location of the small bowel, its examination is technically difficult in previous times. Furthermore, conventional methods, such as X-ray analysis with barium enteroclysis, angiography, radioisotope scanning, computed tomography (CT) and magnetic resonance imaging are usually poorly tolerated or indirect, and have low diagnostic efficacy (
Since its implementation ~10 years ago, capsule endoscopy has become one of the most important tools for small bowel investigation (
OMOM capsule endoscopy, developed by Jinshan Science & Technology Co. (Chongqing, China), has an added automatic mode and quickview mode, which functions through elimination of similar images as well as analyzing colors and patterns (
A total of 89 consecutive patients aged >20 years who underwent OMOM capsule endoscopy at the People's Hospital of Xinghua (Jiangsu, China) from March 2012 to September 2014 were recruited for the present study. These patients had small bowel diseases, including obscure abdominal pain, chronic diarrhea, gastrointestinal bleeding and anemia. Capsule endoscopy was not performed in patients who were unable to swallow, suffering from digestive tract stenosis or obstruction, acute ulcerative colitis, ischemic bowel diseases or radioactive colitis, suspected to have digestive tract stenosis and fistula and/or those with a cardiac pacemaker or other electro-medical device implanted.
The present study was approved by the Ethics Committee of Xinghua People's Hospital (Jiangsu, China). Written informed consent to undergo the entire procedure of capsule endoscopy and for the use of images/data for publication in the present study was obtained from each of the included patients.
The OMOM endoscopy capsule was purchased from Jinshan Science & Technology (Chongqing, China). This diagnostic system consisted of an OMOM capsule (13.0×27.9 mm), an image recorder and a workstation. Image features included a resolution of 0.1 mm and a 140° field of view. Images were first captured at a rate of two per second and the acquired images were then transmitted to the image recorder, which was later connected to the workstation. Images were finally processed in the workstation by a specifically designed software package.
Patients were instructed to follow a 1-day minimum-residue diet with an overnight fast prior to undergoing the procedure. At 3–4 h following dinner, each of them took polyethylene glycol electrolyte powder orally with 3–4 l drinking water for small-bowel cleansing and then took 100 mg simethicone to prevent bubbles in the small bowel half an hour prior to undergoing OMOM capsule endoscopy.
The procedure of capsule endoscopy was performed as previously described (
Continuous and categorical variables were respectively presented as the mean ± standard deviation and frequency (%). All calculations and analyses were performed by SPSS 19.0 software (IBM Corp., Armonk, NY, USA). P<0.05 was considered to indicate a statistically significant difference.
A total of 89 patients, including 43 males and 46 females, were included in the present study. The age of the included patients ranged from 20 to 80 years and the median age was 53.41 years. Among these patients, 45 presented with obscure abdominal pain, 22 with chronic diarrhea, 18 with obscure gastrointestinal bleeding and 4 with anemia.
As presented in
On capsule endoscopy examination, small intestinal lesions were identified in 54 of 89 patients (60.67%), among which 19 (21.35%), 15 (16.85%), 9 (10.11%), 5 (5.62%), 5 (5.62%) and 1 (1.12%) were diagnosed with mucosal erosion, anabrosis, polypus, angiodysplasia, tumor and ancylostomiasis (
Specifically, of the 45 patients with obscure abdominal pain, 10 (22.22%) were diagnosed with mucosal erosion, 5 (11.11%) with anabrosis, 5 (11.11%) with polypus and 3 (6.67%) with tumors. Among the 22 chronic diarrhea patients, 5 (22.73%) had mucosal erosion, 5 (22.73%) had ulcers, 2 (9.09%) had polypus and 1 (4.55%) had one tumor. Of the 18 subjects with obscure gastrointestinal bleeding, 4 (22.22%) were diagnosed with mucosal erosion, 3 (16.67%) with anabrosis, 2 (11.11%) with polypus, 5 (27.78%) with angiodysplasia (3 (16.67%) with active bleeding and 2 (11.11%) with bleeding) and 1 (5.56%) with one tumor. Of the 4 anemia patients, 3 (75.00%) had anabrosis and 1 (25.00%) had ancylostomiasis.
OMOM capsule endoscopy, a promising and innovative technique, has been widely used in China, Africa and Europe since its marketing from 2005 onwards. The present prospective study presented the diagnostic value of OMOM capsule endoscopy in practice. The results demonstrated that the average transit time of the endoscopy capsule in the esophagus, stomach and small intestine was 62.18±64.23 sec, 67.46±63.13 min and 346.53±102.81 min, respectively. In addition, OMOM capsule endoscopy identified 54 out of 89 patients (60.67%) with various types of small intestinal lesion, among which 19 (21.35%), 15 (16.85%), 9 (10.11%), 5 (5.62%), 5 (5.62%) and 1 (1.12%) were diagnosed with mucosal erosion, anabrosis, polypus, angiodysplasia, tumor and ancylostomiasis.
The small bowel is characterized by its considerable length, tortuosity and inaccessibility, which makes small bowel examinations a challenge for physicians. Conventional modalities for diagnosing suspected small bowel lesions have been reported to be low in sensitivity or invasive and difficult to tolerate for patients (
The transit time in the digestive tract is a key parameter for successful completion of capsule endoscopy. A retrospective study demonstrated that a transit time of >45 min in the stomach is an independent risk factor for incomplete capsule endoscopy in the small bowel (
The diagnostic yield of capsule endoscopy varies among different studies. Mohan
As other capsules, the OMOM endoscopy capsule has several limitations. First, the diagnostic value for esophagus and colon lesions is limited due to the short transit time and battery life. Furthermore, there are blind areas and the capsule cannot accurately identify all lesions due to the small bowel residue, bleeding or peristalsis. Therefore, studies focusing on these limitations as well as those aiming to improve the diagnostic accuracy are required to realize the full potential of capsule endoscopy.
In conclusion, the present 2-year retrospective study confirmed the feasibility and validity of OMOM capsule endoscopy as a diagnostic tool for small bowel disease in adults. In China, OMOM capsule endoscopy may be a better choice for investigating the cause of obscure chronic abdominal pain, diarrhea and gastrointestinal bleeding, as it is relatively low-cost and while having an acceptable diagnostic value.
Capsule endoscopic images of small bowel lesions in patients. Representative images of (A) ulcer, (B) polypus, (C) bleeding, (D) ancylostomiasis and (E) tumor.
Transit time of capsule endoscopy in the digestive tract of patients.
Transit in stomach (min) | Transit in small intestine (min) | |||||||
---|---|---|---|---|---|---|---|---|
Transit in esophagus (sec) | <90 | 90–120 | >120 | 120–240 | 240–360 | 360–420 | 420–480 | |
Cases (n) | 89 | 60 | 21 | 8 | 10 | 58 | 17 | 4 |
Transit time | 62.18±64.23 | 67.46±63.13 | 346.53±102.81 |
Capsule endoscopy results depending on different symptoms within the cohort (n=89).
Diagnosis | Abdominal pain | Diarrhea | Gastrointestinal bleeding | Anemia | Total, n (%) |
---|---|---|---|---|---|
Mucosal erosion | 10 | 5 | 4 | 0 | 19 (21.35) |
Anabrosis | 5 | 5 | 2 | 3 | 15 (16.85) |
Polypus | 5 | 2 | 2 | 0 | 9 (10.11) |
Angiodysplasia | 0 | 0 | 5 | 0 | 5 (5.62) |
Tumor | 3 | 1 | 1 | 0 | 5 (5.62) |
Ancylostomiasis | 0 | 0 | 0 | 1 | 1 (1.12) |
Total | 23 | 13 | 14 | 4 | 54 (60.67) |