Chinese Guideline on Magnetically Controlled Capsule Gastroscopy (Condensed Edition, 2021, Shanghai) / 胃肠病学

With the development and popularization of endoscopic technology and the concept of digestive system cancer screening, the clinical application of magnetically controlled capsule gastroscopy (MCCG) is further highlighted. In recent years, various types of MCCG and optimization technology are widely used and developed rapidly. It is of great guiding significance to develop relevant guidelines. Based on clinical evidence, this guideline fully consulted experts’ opinions to make statements and recommendations on the aspects of definition, diagnostic accuracy, application population, technical optimization, inspection process and quality control of MCCG. The quality of evidence and the strength of recommendations were evaluated, and the guideline is expected to better guide the standardized application and scientific innovation of MCCG for the reference of clinical medical staff.

Videoendoscopia digestiva superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del estado venezolano de Mérida / Upper gastrointestinal video endoscopy at the Diagnostic Medical Center of High Technology "Las heroínas de Mérida" of Mérida state in Venezuela

Se efectuó un estudio descriptivo y transversal de los 1 742 pacientes mayores de 18 años en los que se realizó de forma satisfactoria la videoendoscopia del tracto digestivo superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del Estado Mérida (Venezuela), desde el 2008 hasta el 2011, con vistas a describir los hallazgos a través de dicho procedimiento. En la casuística predominaron el sexo femenino (63,3 %) y el grupo etario de 46-61 años, con una edad promedio de 55,8 años; además, 30,6 % de las pruebas resultaron normales. El dolor epigástrico (48,6 %), la dispepsia (43,5 %) y el reflujo gastroesofágico (8,6 %) fueron las principales causas de remisión, en tanto la gastritis (32,4 %) constituyó el diagnóstico endoscópico más frecuente, específicamente sus variedades eritematosa y eritemato-erosiva, con 66,0 y 13,0 %, respectivamente. Del total, 10 pacientes presentaron cáncer gástrico y 9, cáncer esofágico. Se pudo concluir que el procedimiento permitió el diagnóstico preciso de las enfermedades del tracto digestivo superior, así como una atención terapéutica adecuada.

A descriptive and cross-sectional study was conducted in 1 742 patients over 15 years, in whom the video endoscopy of upper gastrointestinal tract was successfully performed at the Diagnostic Medical Center of High Technology "Las Heroínas de Mérida" of Mérida state (Venezuela), from 2008 to 2011, with the purpose of describing the findings through this procedure. Female sex (63.3%) and age group of 46-61 years with a mean age of 55.8 years predominated in the case material, and 30.6% of the tests were normal. Epigastric pain (48.6%), dyspepsia (43.5%) and gastroesophageal reflux (8.6%) were the main reasons for referrals, while gastritis (32.4%) constituted the most frequent endoscopic diagnosis, specifically its erythematous and erythematous-erosive varieties, with 66.0 and 13.0%, respectively. Of the total, 10 patients had gastric cancer and 9, esophageal cancer. It was concluded that the procedure allowed accurate diagnosis of upper gastrointestinal tract diseases as well as an appropriate therapeutic care.

Usefulness of MR Imaging for Diseases of the Small Intestine: Comparison with CT

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.

CT Evaluation of Target-like Bowel Wall Thickening

PURPOSE: The purpose of this study was to evaluate the CT features of target-like bowel wall thickenings and to correlate target layers with histopathologic layers. MATERIALS AND METHODS: We retrospectively analyzed 37 target-like bowel wall thickenings with inner high-, middle low- and outer high attenuated layers on CT scan. Bowel lesions included 15 cases of ischemic lesion, 12 of inflammation, four of carcinomatosis, four of trauma, and two of radiation enteritis. Target-like bowel wall thickenings were classified into three types : with inner most thickened high-attenuated layer(type I); with middle most thickened low-attenuted layer(type II), and with outer most thickened high-attenuated layer(type III). We analyzed the characteristic CT features of these bowel lesions and correlated target and histopathologic layers in resected bowel specimens. RESULTS: Target-like bowel wall thickening was type I in 18 cases(49%), type II in 13 cases(35%), and type III in 6 cases(16%). Type I ischemic bowel lesions and inflammations were most common, and were found in 60% and 67% of cases, retrospectively. All cases of trauma were type II and radiation colitis was type III. Histopathologic findings showed that each layer of target lesions did not exactly correlate with histopathologic layers. However, the inner high attenuated layer correlated with mucosa and some submucosa, the middle low-attenuated layer correlated with most submucosa and some muscularis, and the outer high-attenuated layer correlated with muscularis, serosa, and periserosal mesentery. CONCLUSION: CT features of target-like bowel wall thickenings showed type characteristics according to bowel lesions. Histopathologic comparison and analysis were considered helpful for the differential diagnosis of bowel lesions.

The Value of CT in detecting Pathologic Bowel Perforation

PURPOSE: To evaluate the usefulness of CT for assessing the location and cause of pathologic gastrointestinal perforation. MATERIALS AND METHODS: A retrospective analysis of abdominal CT was performed in 27 perforations of 26 patients with underlying gastrointestinal pathology. Fifteen benign and 12 malignant perforations consisted of five gastric cancers, one gastric ulcer, ten duodenal bulb ulcers, two bowel adhesions, one jejunal metastasis from lung cancer, one ileocolic Crohn's disease, one radiation colitis and six colon cancers. CT scans were evaluated for 1) diagnosis of bowel perforation, 2) assessment of the cause and site of perforation, and, in particular, differentiation between benignancy and malignancy, and 3) complications and their extent. RESULTS: CT easily detected varying amounts of free air or fluid collection, and infiltration or abscess formation adjacent to the main lesion, and the diagnosis of gastrointestinal perforation was therefore easy. In 11 of the 12 malignancies (92%), primary tumor was diagnosed, but detection of the site of perforation was possible in only seven cases (7/12, 58%). The 15 benign lesions revealed nonspecific CT findings, and the perforation site could be presumed in six (6/15, 40%). In one case of Crohn's disease, the primary cause was visualized. Among six colonic cancers, four pericolic abscesses and two fistulas to adjacent organs were found, but there was no evidence of diffuse peritonitis. CONCLUSION: CT was helpful to lead to optimal treatment of pathologic gastrointestinal On CT, the detectability of perforation, primary benign or malignant lesion, perforation site and extent of complication was high, and this modality was therefore a useful indicator of the optimal treatment for pathologic gastrointestinal perforations.