capsule experience - MG Lorenzatto

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Chapter 10
transplant. Indications for SB transplantation were: intestinal
pseudo-obstruction, post-surgical short bowel syndrome and
radiation enteritis. All patients had both ileostomy and natural
canalization and were on immunosuppressive, antibiotic and
antimycotic drugs.
Ileoscopy is poorly tolerated in these patients, as they
complain of bloating and discomfort. The capsule is swallowed
easily and passed naturally in all patients without adverse
events. Standard ileoscopy revealed that the ileal mucosa
was normal in all patients. Ileal histology showed mild
inflammatory infiltrate and edema in the lamina propria in all
cases. Using capsule endoscopy, it was demonstrated that
the mucosa in the ileal segments reached by ileoscopy was
normal. However, mucosal changes were observed in more
proximal segments in 3 of the 4 patients in whom capsule
enteroscopy yielded small bowel images. These changes
were: diffuse blunted or ridge-shaped villi and isolated
hyperemic spots in a patient examined 20 days after
transplantation (Figure 10.1a); small areas with blunted and
ridge-shaped villi and isolated petechiae (Figure 10.2a, 10.2b)
in a patient examined at 6 weeks; diffuse blunted edematous
villi and isolated small erosions in a patient examined at 2
months. In the fourth patient, studied 6 months after small
bowel transplantation, normal well-shaped long villi were
observed (Figure 10.5a).
CONCLUSION
Capsule enteroscopy is better tolerated than retrograde
ileoscopy, and allows a complete examination of the
transplanted small bowel. Proximal mucosal changes missed
by retrograde ileoscopy were identified in 3/4 patients.
Whether these findings seen at different time intervals after
Transplantation
transplantation represent the normal evolution of the graft
over time, or were early signs of immunological or infectious
complications, or represent the normal evolution of the graft
is unknown. Owing to its excellent tolerability, capsule
enteroscopy could become the first step in the endoscopic
monitoring of patients after SBTx. Standard ileoscopy
with biopsy could be reserved for further assessment
in the patients in whom mucosal lesions are identified by
capsule enteroscopy.
References and Suggested Readings
1 Hassainen T, Schade RR, Soldevilla-Pico C, Tabasco-Minguillan J, Abu-Elmagd
K, Furukawa K, Kadry Z, Demetris A, Tzakis A, Todo S. Endoscopy Is Essential
for Early Detection of Rejection in Small Bowel Transplant Recipients.
Transplantation Proceedings 1994;26:1414-15
2 Scotti-Foglieni T, Tinozzi SD, Abu-Elmagd K, Starzl TE. Enteroscopy of the
transplanted small bowel. In Rossini FP, Gay G (editors) Atlas of Enteroscopy.
Springer, Milan, 1998:151-169
3 Meron G The development of the swallowable video-capsule (M2A ® ).
Gastrointestinal Endoscopy 2000;52:817-819
4 Lewis BS, Swain P Capsule endoscopy in the evaluation of patients with
suspected small intestinal bleeding: the results of the first clinical trial.
Gastrointestinal Endoscopy 2001;53:AB70
5 Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Luchetti R, Dezi
A, Capurso L, de Franchis R, Rossini FP. Wireless capsule endoscopy in
patients with obscure gastrointestinal bleeding: preliminary results of the
Italian multicentre experience. Digest Liver Dis. 2001;33 (Suppl. 1): A2