Mata A et al. (2005) A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes. Gastrointest Endosc 61: 721–725

Results from a prospective trial comparing the effectiveness of wireless capsule endoscopy (CE) with that of barium contrast series suggest that CE is a highly accurate technique for small-bowel polyp detection in patients with adenomatous polyposis syndromes, many of which are associated with an increased risk of cancer.

On the basis of pathologic characteristics and genetic evaluation, 24 consecutive patients with either familial adenomatous polyposis (n = 20) or Peutz–Jeghers syndrome (n = 4) were enrolled. Small-bowel follow-through (SBFT) barium contrast series were initially performed, followed by CE a week later, in a blinded design. Polyp frequency and distribution were analyzed.

SBFT identified small-intestinal lesions in three patients (12%) with Peutz–Jeghers syndrome. CE also detected small-bowel polyps in these three patients, and in a further four patients with familial adenomatous polyposis (seven patients in total, 29%). CE also proved superior in whole-series analysis, detecting jejunal and ileal polyps missed by SBFT in 15% of asymptomatic familial adenomatous polyposis patients. In patients with Peutz–Jeghers syndrome, CE detected a greater number of lesions overall, and the authors suggest CE would be an effective routine surveillance modality in this patient population at high risk of gastrointestinal malignancies, without the cumulative radiation dose imposed by SFBT.

The main advantages of CE, in comparison with other approaches, are that it is painless, minimally invasive, allows the small bowel to be examined in its entirety and can be carried out without sedation in the outpatient setting. The authors speculate that innovations in CE such as active control of the capsule and the possibility of obtaining biopsy specimens might contribute further to its utility in gastrointestinal polyposis syndromes.