Azienda Ospedaliera Universitaria Policlinico

Seconda Università degli Studi di NapoliDipartimento di Chirurgia generale e specialistica

U.O.C. di Chirurgia Endoscopica

Direttore: Prof. Angelo Pezzullo

Prof. Vincenzo Napolitano Prof. Giuseppe Amato

Dott. Pietro Schettino Dott.ssa Rosamaria Bozzi

Congresso Nazionale – Palermo 28/30 Ottobre 2010

Wireless Capsule Endoscopy

Years after Michelassi Stricturoplasty

for Crohn’s Disease

Relatore

Pietro Schettino

Congresso Nazionale – Palermo 28/30 Ottobre 2010

VCE nella Malattia di Crohn

Diagnosi

Disease assessment:

a. Sede

b. Estensione (lesioni digiunali)

c. Tipo

d. Recidiva post-chirurgica

e. Risposta alla terapia

Contraindications

Absolute:

Suspected small intestinal obstruction

Pacemakers/AICD’s.

Pregnancy

Relative:

Motility disturbances:

Gastroparesis/Achalasia

Small bowel diverticulosis

Poor surgical candidatesPoor surgical candidates

Complications

Retention of capsule: 1-5%

Bowel obstruction: .5 %

Aspiration: Rare

Variabilità della % di ritenzione della VCE a seconda del quadro clinico.

Chewitz AJG 200621 %4 / 19Suspected

stenosis

Chewitz AJG 200613 %5 / 38Suspected CD

Chewitz AJG 20061.6 %1 / 64CD

Li et al GIE 20061.5 %10 / 667OGBI

Gestwein et al

Clin Gastroint.Hep

‘05

0%0 / 773Healthy

volunteers

Retention rateRetentionSituation

Capsule Endoscopy is Superior to SBFT

For the Evaluation of Crohn’s Disease

Author N SBFT Yield CE Yield

Scapa 2002 13 0% 46%

Fireman 2003 17 0% 71%

Herrerias 2003 21 0% 43%

Hara 2005 17 0% 71%

Mow 2004 50 32% 60%

Arguelles 2004 12 0% 59%

Sant’Anna 2005 20 0% 60%

**Patients with strictures by SBFT were excluded likely

accounting for low yields of SBFT

Patency System

Patency CapsulePatency Capsule Patency ScannerPatency Scanner

26mm long X 11mm diameter

(same dimensions as

CapsuleSB)

A dissolvable capsule containing a detectable Radio Frequency Identification

(RFID) tag and is propelled through the GI tract by natural peristalsis.

Spada C., et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given

patency capsule. Endoscopy 2005;37;9:793-800

• Capsule disintegrates after 40 hours

• Capsule excreted intact in >80% of

patients in less than 40 hours

Capsule disintegrates after 40 hours

-

Patency

proven

Ingestion

Scanning*

(24-36 hours)

Patency

NOT

proven

*If Given® Patency

Scanner is

contraindicated,

use fluoroscopy

Patency Procedure

Spada C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given

patency capsule. Endoscopy 2005;37;9:793-800

Before

After

Patency Procedure

Case Report

• In 2005 a 27-year-old woman, affected with CD underwent

surgery for a long ileal stenosis (74 cm), which was treated

by performing a side-to-side isoperistaltic stricturoplasty,

with a jejunostomy closed 7 months later.

• After 3 years the patient was asthenic and presented

mild malleolar oedema. Serum albumin (2.9 g/dl),

total protein test (6.0 g/dl) and haemoglobin (6.7 g/dl)

were low and a blood transfusion was necessary.

Case Report

•• TheThe patient did not complainpatient did not complain ofof obstructive obstructive

symptomssymptoms. .

•• Crohn’s Disease Activity IndexCrohn’s Disease Activity Index (CDAI)(CDAI) waswas 170. 170.

•• Erythrocyte sedimentationErythrocyte sedimentation rate(30 mm/h) and rate(30 mm/h) and

CC--reactive proteinreactive protein (20 mg/l)(20 mg/l) were slightly were slightly

increasedincreased. .

•• Intestinal ultrasonographyIntestinal ultrasonography,, pancolonscopypancolonscopy

and and aesophagogastroscopy wereaesophagogastroscopy were negativenegative for for

recurrencerecurrence.

The patient refused to undergo MRE,

and a small bowel barium enema was

administered, revealing no stenotic tracts.

what is the best choice?

VCEVCE

VCEVCE

We believe that WCE can be performed

maybe in selected CD patients who have

undergone surgery.

However, further studies are needed to

clarify the WCE role in patients with long-

stricturoplasties and to establish which

examination could be the most effective in

selecting patients.

Conclusion

« Non capisco tutto

questo clamore per lo

sbarco dell'uomo sulla luna,

Io l'avevo

previsto trent'anni fa e

fui deriso. Già, ma Giulio

Verne l'aveva previsto un

secolo prima »

« Nella vita, a differenza

degli scacchi, il gioco

continua dopo lo scacco

matto. »

Isaac Asimov

Grazie per l’attenzione

1965