Double-Headed Capsule Endoscopy Data:

Double-headed capsule endoscopy: real-world experience from a multicentre British study

A first multicentre UK study that examines the potential benefits of using double-headed capsules compared to conventional single-headed ones in a real-world cohort of patients.

Methods: Capsule endoscopy (CE) is a well-established mode of investigation for small bowel (SB) pathology. Over a 9-month period, patients referred for routine SBCE at 4 tertiary referral centres in the UK underwent double-headed CE in lieu of conventional single-headed CE, using MiroCam® MC2000 capsules.

Results: 211 CE examinations were performed. 7 failed to reach the SB; 204 cases were analysed. Overall, the use of two CE heads impacted diagnosis in 30/204 (14.7%) of cases in our cohort.

Conclusion: The use of double-headed CE provides more information which has the potential to change clinical diagnosis and therefore management. Therefore, the routine adoption of double-headed CE in SB assessment should be considered

Double-headed capsule endoscopy: real-world experience from a multicentre British study
  • D. E. Yung1*, J. Brzeszczynska2, I. Rahman3, L. Sinha4, R. Sidhu5, P. Patel3, S. Mason4, M. McAlindon5, J. N. Plevris1,2, A. Koulaouzidis1 1The Royal Infirmary of Edinburgh, Edinburgh; 2The University of Edinburgh, Edinburgh; 3Southampton General Hospital, Southampton; 4Queens Hospital, Romford; 5Royal Hallamshire Hospital, Sheffield

Case Study-Occult gastrointestinal bleeding: two eyes are better than one

Introduction: A 55-year-old woman was referred for investigation of an incidental iron deficiency anaemia. Upper gastrointestinal endoscopy was normal, with no evidence of coeliac disease on duodenal biopsies. Colonoscopy showed diverticulosis. A capsule endoscopy was then performed, using a new generation dual camera capsule (Mirocam MC2000, Intromedic, Seoul, Korea).

Small bowel images from capsule camera 1 were entirely normal. A small bowel abnormality was identified only by camera 2. The lesion was not seen on a retrospective review of the ‘normal’ camera 1 images, and was not identified on a contrast computerised tomography of the abdomen. Small bowel MRI was arranged to characterise it further.

Answer The patient underwent laparoscopic small bowel resection with primary anastomosis. A 5cm mass with surface ulcerations was identified in the proximal ileum. Single camera capsule endoscopy has a significant false negative rate for tumours, particularly for those in the proximal small bowel. Almost 13% of these examinations may give false reassurance, and clinically significant lesions may remain undetectable even on retrospective review when the ultimate diagnosis is known. Indeed, relying on a negative capsule endoscopy report has been described as one of the top 10 mistakes in capsule endoscopy. To our knowledge, this is one of the largest lesions identified by dual camera—but not single camera—capsule endoscopy. Wider introduction of dual camera technology may ultimately prove cost effective, if two eyes reduce the need for a second look.

Case Study-Occult gastrointestinal bleeding: two eyes are better than one
  • Samuel Pannick, 1 Katherine van Ree,2 Patrizia Cohen,3 Geoff Smith,1 John Martin1 1 Gastroenterology, Imperial College Healthcare NHS Trust, London, UK 2 Radiology, Imperial College Healthcare NHS Trust, London, UK 3 Pathology, Imperial College Healthcare NHS Trust, London

UK Correspondence to Dr Samuel Pannick, Gastroenterology, Imperial College Healthcare NHS Trust, London W6 8RF, UK; sam.pannick@nhs.net