WEO Video Capsule Endoscopy (VCE) Library: clinical case 51

WEO Video Capsule Endoscopy (VCE) Library: Clinical Case 51

Introduction

This clinical case deals with an 81-year-old man with a history of occult gastrointestinal (GI) bleeding. He was admitted to the hospital for a new episode of melena combined with severe iron deficiency anemia. Both upper and lower GI endoscopies revealed normal results. Therefore, a small bowel video capsule endoscopy was performed following an appropriate bowel preparation, which included the intake of two liters of polyethylene glycol.

Patient Selection and Initial Screening

The first step in the VCE process is to select the name of the patient from the provided list. This screen offers various features for diagnosis, with the most useful being the "Express Selected Mode."

Capsule Examination and Landmark Analysis

The overview mode offers a global impression of the capsule examination and allows for the selection of landmarks:

• First gastric image
• First duodenal image
• First cecal image

At each stage, isolated images are assessed using different software functions, particularly forward and backward navigation. Adequate images are stored as thumbnails for further analysis. Individual frames can be enhanced, and a sequence of still images can be analyzed in playback view.

3D Tracking and Image Enhancement

Selection of a landmark activates the 3D tracking image display. Moving the capsule bar displays all small bowel images up to the first cecal image. Enhanced images provide detailed aspects of the terminal ileum, notably showing marked differences from the cecal mucosa.

Initial Diagnosis and Image Storage

The first diagnosis of an angioma is made by examining the red color overview. An enlarged image showed a hemostatic clip from a previous endoscopy and a jejunal angioma was clearly identified on the enhanced still image. These images can be stored along with the capsule aspect on the lower part of the screen. Multiple angiomas may appear as the capsule remains stationary, with the same angioma recorded from various aspects over minutes.

Detailed Capsule Image Review

The real diagnosis begins with a review of all capsule images in Express Selected Mode. Additional angiomas are identified and their images stored as thumbnails. Inappropriate thumbnail images can be removed. The software facilitates playback both forward and backward, allowing examination time of each abnormality to be recorded, and the 3D tracking image shows its approximate location in the GI tract. This case was resolved using only the Express Selected Mode, making the Skip Mode or Normal Mode unnecessary.

Video Review Considerations

To avoid missing important images and to reduce fatigue, it's recommended to stop the video frequently and use the software's video function. Multiple images are stored to document the capsule endoscopy report, which includes clear angiomas and minor vascular abnormalities differentiated from artifacts.

Report Generation and Standard Terminology

Images of key landmarks and small bowel abnormalities are labeled and selected for the report. Findings and procedures are recorded on the patient sheet together with the final summary and physician identification. Medical terms stored in the software aid in creating accurate reports, which can be saved and printed. Accurate reporting is essential, following the WEO standard terminology for describing findings. The approximate location of abnormalities is shown in the 3D tracking graph, helping determine whether to use the oral or anal route for future planned balloon enteroscopy.

Keywords

• Occult GI Bleeding
• Iron Deficiency Anemia
• Video Capsule Endoscopy
• Bowel Preparation
• Landmarks Selection
• Image Enhancement
• 3D Tracking
• Jejunal Angioma
• Thumbnail Images
• Express Selected Mode
• WEO Standard Terminology
• Balloon Enteroscopy

FAQ

Q: What was the initial symptom that led to the patient's hospital admission?
A: The patient was hospitalized due to a new episode of melena along with severe iron deficiency anemia.

Q: What preliminary tests were conducted before performing the video capsule endoscopy?
A: Normal results were found in both upper and lower GI endoscopies before proceeding to the video capsule endoscopy.

Q: Which bowel preparation was used before the video capsule endoscopy?
A: The bowel was prepared with two liters of polyethylene glycol.

Q: Why is the 3D tracking image important in capsule endoscopy?
A: The 3D tracking image helps display all small bowel images and pinpoint the approximate location of abnormalities within the GI tract.

Q: Which mode was primarily used to diagnose the angiomas in this case?
A: The Express Selected Mode was primarily used for diagnosing the angiomas.

Q: Why is accurate reporting important in video capsule endoscopy?
A: Accurate reporting is essential for correctly documenting findings, preparing for future procedures like balloon enteroscopy, and ensuring effective patient care.