Postcapsule Endoscopy

As with all examinations where there is a human factor involved, perceptive errors are inevitable. The clinical significance of diminutive red spots without positive evidence of bleeding and the superficial mucosal 'scratches' shown by WCE are increasingly being questioned [1]. A mucosal 'scratch' is a nonspecific and will need fur-

Fig. 7. A neutral enteral contrast CTEs (a) performed within two weeks of each other in a 54-year-old female with suspected Crohn's disease. Fluoroscopic study showed aphtae in small bowel loops (arrowheads). b Double contrast carbon dioxide-barium small bowel fluoroscopic enteroclysis. CTE of same loop (arrowhead) showed no abnormality. Note incidental abdominal wall mesh on image b (arrow)

Fig. 6. Axial CT (a) and positive contrast CTE (b, c) in a 48-year-old male presenting with vomiting and weight loss. CT showed no obstruction or mass. Wireless capsule enteroscopy performed after CT was unsuccessful because the capsule was trapped in proximal small bowel. CTE showed annular mass (arrowhead, b) in proximal jejunum proven to be adenocarcinoma and capsule trapped in distal duodenum (arrow, c)

Fig. 7. A neutral enteral contrast CTEs (a) performed within two weeks of each other in a 54-year-old female with suspected Crohn's disease. Fluoroscopic study showed aphtae in small bowel loops (arrowheads). b Double contrast carbon dioxide-barium small bowel fluoroscopic enteroclysis. CTE of same loop (arrowhead) showed no abnormality. Note incidental abdominal wall mesh on image b (arrow)

ther characterization to make a precise diagnosis in some instances. We have unpublished data of an air double contrast barium enteroclysis carried out following WCE and interpreted by experienced endoscopists to assess the extent of, or to characterize Crohn's disease. This has shown the limitations of WCE in characterizing superficial ulcers and their precise location [22]. In one instance, radiologic examination showed a giant Meckel's diverticulum with ulcerations in the junction of the diverticulum to the ileum. In another patient, NSAID ulcers and diaphragm disease were shown by air enteroclysis and ascribed by WCE to Crohn's disease. Patients with persistent symptoms or bleeding with negative WCE require accurate ra-diologic investigations (Fig. 5). We have diagnosed a Meckel's diverticulum with a prior negative WCE. NSAID ulcers were shown by air double-contrast barium enteroclysis. Where the indication is a question of submucosal mass on WCE, CTE with neutral enteral and iv contrast is appropriate.

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