PositiveTip for
Encouraging News on the Colonoscopy Front
Posted by Fred Hardinge on
Putting off having a colonoscopy? "Nicer" alternatives are being developed.
While certainly not our favorite screening procedure, colonoscopy remains the best method of detecting colorectal cancer early. A surprising number of people simply refuse this important screening test. Technology may be coming to their rescue (and ours also). Capsule endoscopy involves swallowing a large capsule with a camera at each end and the electronics to image the entire colon. Patients must prepare carefully before swallowing, then swallow the capsule which goes into "sleep mode" for the transit time to the colon, "wakes up" and for 10 hours images your colon! Is it a viable option yet? The most recent study demonstrated it was adequate in 93% of patients when compared to the standard method, but more development is needed.
PositiveTip: Don't wait for this technology to be refined if your health care provider recommends a colonoscopy. Get it done now. It could save your life!
Comments (2)
#1 from Anonymous on .
Acute symptomatic small bowel obstruction due to capsule impaction
Otto S. Lin, MD, MScCorresponding Author Information, John J. Brandabur, MD, Drew B. Schembre, MD, Maw-Soan Soon, MD, Richard A. Kozarek, MD
Background
Capsule impaction is a well-recognized complication of capsule endoscopy, with an incidence rate of 0.75% to 21%, depending on indication. There have been only 2 reported cases of capsule impaction causing symptomatic obstruction.
Objective
We present 3 cases of capsule impaction causing acute symptomatic obstruction and/or perforation.
Design
Case series.
Setting
Teaching hospital.
Patients
A 71-year-old woman had iron deficiency anemia in the setting of negative upper endoscopy, colonoscopy, enteroclysis, and enteroscopy. She developed severe abdominal pain, vomiting, and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn's stricture leading to perforation. A 64-year-old woman with Gardner's syndrome and a history of colectomy and subsequent episodes of small bowel obstruction underwent capsule endoscopy to define the site of obstruction. She experienced severe abdominal pain 24 hours after capsule ingestion, and emergent enteroscopy was done to retrieve the capsule, which was impacted at a previously undiagnosed annular mass in the distal duodenum. An 85-year-old man with episodic small bowel obstruction due to radiation enteritis underwent capsule endoscopy to localize the site of obstruction in anticipation of surgery. He returned with severe abdominal pain and vomiting 3 days later. At surgery, the capsule was found to be impacted at an ileal radiation stricture.
Main Outcome Measurements
Acute symptomatic bowel obstruction.
Results
These cases show that bowel obstruction and even possibly perforation can occur as a result of capsule impaction.
Conclusions
The possibility of acute symptomatic small bowel obstruction should be included in the informed consent for capsule endoscopy.
Seattle, Washington, USA
#2 from Fred Hardinge on .
Tempted to put off a recommended endoscopic procedure? Don't! Remember, capsule endoscopy is still very much experimental. The above report underscores a significant risk. In time it may be proven safe and effective--or it may be demonstrated otherwise.
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