HONOLULU — Video capsule endoscopy doesn't cut the mustard for evaluation of small bowel polyps in patients with familial adenomatous polyposis, Dr. Robert F. Wong reported at the annual meeting of the American College of Gastroenterology.
Despite recent suggestions to the contrary by some video capsule endoscopy (VCE) enthusiasts, push enteroscopy remains the preferred method for evaluation of patients with familial adenomatous polyposis (FAP), based on the results of his prospective comparative study, said Dr. Wong of the University of Utah, Salt Lake City.
The study showed that VCE seriously underestimated the number of small bowel polyps in patients with FAP. Moreover, VCE proved inaccurate both for the diagnosis of large polyps—the ones with the greatest potential for malignant transformation—and for estimating the size of a patient's largest polyp, he added.
Dr. Wong reported on 32 patients with clinically diagnosed FAP who underwent VCE followed immediately by push enteroscopy and lower endoscopy. The VCE results were interpreted by two experienced blinded readers, whereas standard endoscopies were reported by a single gastroenterologist blinded to the VCE results.
All patients had multiple polyps in the small bowel. VCE detected a median of 38 and 54 per patient, depending upon the reader, while standard endoscopy identified a median of 123. VCE had poor accuracy for detecting polyps of 1 cm or larger. It misclassified three patients as having large polyps who didn't, and three others as not having large polyps who did.
Asked if he sees a role for video capsule endoscopy in FAP, Dr. Wong replied, “If the question is whether a patient has small bowel polyps or not—a yes or no question—I think it's useful. But in terms of accurate determination of polyp burden or whether a patient has large polyps, I don't think it's particularly useful.”