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Small-bowel capsule endoscopy in patients with Meckel`s diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study

Published:December 23, 2022DOI:https://doi.org/10.1016/j.gie.2022.12.014
Small-bowel capsule endoscopy in patients with Meckel`s diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study
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      Abstract

      Background and study aim

      Meckel`s Diverticulum (MD) may remain silent or be associated with complications like gastrointestinal (GI) bleeding. The main aim of this study was to evaluate indicative small bowel capsule endoscopy (SBCE) findings and the secondary aim to describe clinical presentation in patients with MD.

      Patients and Methods

      This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021.

      Results

      69 patients with a confirmed MD were included. Mean age was 38.9 (± 20.5) years with a male to female ratio of approximately 3:1. GI bleeding or iron deficiency anemia were present in nearly all patients. Mean hemoglobin was 7.63 (± 1.8) g/dl with a transfusion requirement of 52.2%. Typical CE findings were double lumen (n=49; 71%), visible entrance into MD (n=49, 71%), mucosal webs (n=30, 43.5%) and bulges (n=19, 27.5%). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n=36). In 63.8% of patients (n=44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n=27). Mean percentage SB transit time for first indicative image of MD was 57% of the total SB transit time.

      Conclusion

      Diagnosis of MD is rare and sometimes challenging and a preoperative gold standard does not exist. In SBCE the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

      Key words

      List of abbreviations:

      Capsule Endoscopy (CE), Colon Capsule Endoscopy (CCE), Computed Tomography (CT), Device Assisted Enteroscopy (DAE), Esophagogastroduodenoscopy (EGD), Gastrointestinal (GI), Interquartile range (IQR), International CApsule Endoscopy Research (I-CARE), Iron Deficiency Anemia (IDA), Meckel`s Diverticulum (MD), Magnetic Resonance Imaging (MRI), Regional Transit Abnormality (RTA), Standard Deviation (SD), Small Bowel (SB), Small Bowel Capsule Endoscopy (SBCE), Small Bowel Follow Through (SBFT), Suspected Small Bowel Bleeding (SSBB), Ultrasound (US)
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      Article info

      Publication history

      Accepted: December 14, 2022
      Received in revised form: November 29, 2022
      Received: August 23, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures

      P. Baltes: Speaker Fees from Medtronic; study support from Ankon

      X. Dray: Speaker Fees from MSD, Pfizer, Medtronic, Bouchara Recordati, Fujifilm,Alfasigma, and Norgine; consultant for Alfasigma, Norgine, and Pentax; co-founder of and shareholder in Augmented Endoscopy; training and travel support from Ankon

      C. Spada: Consultant Fees from Medtronic

      H. Beaumont: speaker fees from Medtronic

      E. Rondonotti: Speaker honoraria from Fujifilm Co., member of Fujifilm Co. expert group, Medtronic Co. consulting agreement

      J. Plevris: lecture honoraria from Jinshan group and Research support from Fujifilm

      R. Leenhardt: Cofounder and shareholder of Augmented Endoscopy, Lecture for Abbvie

      M. Keuchel: Speaker and Consultant Fees from Medtronic; Speaker Fees from Olympus, study support from Ankon

      Collaborators of the I-CARE Meckel group:

      • Cristina Carretero, Clínica Universidad de Navarra, Pamplona, Spain

      • Gian Eugenio Tontini, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy

      • Ervin Toth, Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden

      • Artur Nemeth, Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden

      • Reena Sidhu, Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Department of Infection, Immunity and Cardiavascular Diseases, University of Sheffield, United Kingdom

      • Anastasios Koulaouzidis, Department of Social Medicine & Public Health, Pomeranian Medical University Szczecin, Poland

      • Abraham Eliakim, Gastroenterology Department, Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel

      • Marco Pennazio, University Division of Gastroenterology, University Hospital City of Science and Health Turin, Turin, Italy

      • Ekaterina Tikhomirova, Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation

      • Hubert Zebski, Praxis für Gastroenterologie, Bremen, Germany

      • Chris-Henrik Wulfert, Department of General Surgery, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany

      • Florentin Stachow, Clinic for Internal Medicine, Johanniter-Krankenhaus Geesthacht, Geesthacht, Germany

      • Garrelt Janssen, Praxis für Gastroenterologie, MVZ im Johannes-Hospital, Varel, Germany

      Disclosures:

      C. Carretero: Consultant Fees from Medtronic

      E. Tontini: Speaker honoraria from Pentax, Medtronic, NTC Pharma; consultant fees from NTC Pharma, F. Hoffmann-La Roche Ltd

      E. Toth: Medtronic (consultancy and lecture fee), Olympus (consultancy and lecture fee), ANX Robotica (research material), Norgine (research and travel support)

      Identification

      DOI: https://doi.org/10.1016/j.gie.2022.12.014

      Copyright

      © 2022 by the American Society for Gastrointestinal Endoscopy

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