Routine Double-Headed Capsule Endoscopy for Small-Bowel Assessment

Using a double-headed (DH) device has been found to reduce the miss rate of capsule endoscopy (CE) in the investigation of small-bowel (SB) pathology compared with a single-headed model. These findings were reported in a study published in Digestive and Liver Disease.

A team of investigators from the Royal Infirmary of Edinburgh, conducted a multicenter, prospective, observational study to examine the potential benefits of using a DH capsule for SB assessment when compared with the conventional single-headed (SH) technique. From August 2017 to April 2018, researchers performed CE examinations at 4 tertiary referral centers in the United Kingdom using the MiroCam^® MC2000 model instead of a conventional SH. This model is a DH capsule with 2 cameras, enabling a 340° view (170° from each head). An expert reviewer reported one head (L/R), which was selected at random. Another expert reviewer reported anonymized and randomized DH recordings or reread them after a 4-week interval. For each CE, reviewers compared the overall findings between SH and DH examinations.

Investigators analyzed a total of 204 CEs. The 4 main indications were SB bleeding (n=94); SB inflammation or inflammatory bowel disease (IBD) reassessment (n=84); SB neoplasia, including suspicious radiological imaging (n=15); and other reasons (eg, celiac disease [n=11]).

For SB bleeding, 27/94 (28.7%) CE examinations reported differences between SH and DH readings. In 17 (18.1%) CE examinations, these findings were considered clinically significant. Single-headed CE missed angiectasias (5 patients), SB inflammation (7 patients), esophagitis (2 patients), and SB masses (2 patients). In addition, the extent of angiectasias for one patient was greater on the DH reading.

For IBD, 30/84 (35.7%) CE examinations reported differences between SH and DH readings. In 11 (13.1%) CE examinations, these findings were considered clinically significant. In 5 CE examinations the SH reading missed signs of active inflammation and in 6, assessment of extent/severity differed.

For SB neoplasia, 2/15 (13.3%) CE examinations reported differences between SH and DH readings. Polypoid mass in the SB was initially missed by SH CE, and in another, a SB diverticulum was missed.

For the other indications, 1/11 (9.1%) differences were found; however, this finding did not represent any clinical significance.

This study was limited by possible interobserver disagreement bias, a second reviewer not always being present, and the speed of reading the videos may differ among the participating centers. Lastly, the constant capture frame rate of the MiroCam could potentially influence the miss rate of an SH capsule.

These data indicated that the use of a DH capsule is superior to the SH model in detecting SB pathology. Findings from this 9-month British study suggested the use of DH CE for SB assessment has the potential to enhance diagnostic certainty.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Yung DE, Robertson AR, Davie M, et al. Double-headed small-bowel capsule endoscopy: real-world experience from a multi-centre British study. Dig Liver Dis. Published online February 8, 2021.