Impact clinique chez les patients explorés par vidéocapsule PILLCAM SB®: suivi à 1 an des patients inclus consécutivement dans 2 centres français en 2003
Clinical impact of patients examined by PILLCAM SB® videocapsule: oneyear followup of patients consecutively included in two French centers in 2003
Exploration of the small intestine by vidéocapsule endoscopy (EVC) is becoming general practice and its diagnostic yield is well established. Its impact on the treatment or management of patients with suspected intestinal pathology is little known and should be defined to determine its level of reimbursement under the new Common Classification of Medical Acts (Classification Commune des Actes Medicaux, or CCAM), of the French healthcare system. Our objective was to define the immediate and long term diagnostic and therapeutic value of EVC.
59 and 33 patients were consecutively included in 2003 from two second generation French centers in their first year of using EVC, less than three years after the arrival of the method in France. These 92 patients were examined for anaemia (n = 63), obscure digestive bleeding (n = 20), enteropathy and suspected Crohn’s disease (n = 6) or suspicion of or assessment of intestinal tumour (n−3). EVC was carried out, after 12 hours of fasting and preparation with one to two litres of polyethylene glycol, with the Pillcam SB (Given Imaging) capsule. Diagnostic and therapeutic impact was established through questioning the general practitioners and gastroenterologists within a median delay of 12 months postexamination.
The immediate diagnostic yield was 40% (36/92), or 33% and 52%, in the two centers. The diagnostic and therapeutic yield was 63% at one year, or 66% and 64%, in the two centers. The PPV and NPV were 100% and 94%, respectively.
The diagnostic yield obtained in second generation centres is similar to that of the pioneer centers. The good NPV of EVC supports the proposal that EVC should be used first after a negative assessment by esophagogastroduodenal and colonic video endoscopy and that the assessment should be stopped or oriented towards a target other than the small intestine if results from EVC are negative. These results and NPV are further supported by integrating the followup of negative explorations in patients followedup one year after exploration by EVC.
M. EL ALAOUI, P.N. D’HALLUIN, Christian BOUSTIÈRE, J.F. BRETAGNE, Denis HERESBACH
small intestine, unexplained occult digestive hemorrhage, vidéocapsule