Utility of video capsule endoscopy in clinical practice, experience at King Faisal Specialist Hospital and Research Center, Riyadh

Background: Video capsule endoscopy (VCE) is a valuable diagnostic tool for the evaluation of the small intestine. Evidence shows that it is effective in the diagnosis of occult bleeding and superficial lesions that are not radiographicallyobserved. We evaluated the efficacy and safety of the capsule endoscopy in the diagnosis and management of the common gastrointestinal disorders.Methods: A retrospective chart review of a total of 326 candidates who have met the inclusion criteria and who underwent VCE from the period from January 2006 till December 2018.Results: The main indication for Video Capsule Endoscopy was small bowel overt gastrointestinal bleeding with 106 cases (32.6%) followed by iron deficiency anemia with 104 cases (32%). Capsule retention rate was observed in 11 cases (3.4%) 4 of which were crohn抯 disease patients (22.2%). Overall diagnostic yield was 36%, 64% for overt gastrointestinal bleeding and 41% for occult gastrointestinal bleeding. The most common reported positive finding was Angiodysplasia in 19.9% of cases, followed by ulcers in 13.8% of cases, followed by polyps in 8.3% of cases and erosions in 8% of cases.Conclusions: Video capsule endoscopy proved to be an essential diagnostic tool in gastrointestinal bleeding. Advantages of VCE include; less labor, higher resolution examination of mucosa, relative safety, and noninvasiveness. On the other hand, it does not offer intervention capabilities when compared with enteroscopy and its interpretation was sometimes difficult and time consuming. Risk of capsule retention remains significant especially in patients suffering from crohn抯 disease.

Primary nonlymphoid gastrointestinal neoplasms in dogs in Rio Grande do Sul / Neoplasmas gastrointestinais primários não linfoides em cães no Rio Grande do Sul

Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79αcy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.(AU)

Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79αcy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.(AU)

Intussusception secondary to inflammatory myofibroblasts tumor of the small intestine. case report

ABSTRACT Introduction: Intussusception occurs when part of the intestine slides into an adjacent intestinal segment. Inflammatory myofibroblast tumor is a rare cause of this condition, and is observed in 5% -16% cases in adults. Case presentation: A 41-year-old woman presented with abdominal pain and distension. A exploratory laparoscopy was performed, finding ileocolic intussusception into the transverse colon. Due to uncontrollable bleeding, the procedure was converted to laparotomy; resection and latero-lateral ileocolic anastomosis were performed. Histopathology reported inflammatory myofibroblastic tumor, with a favorable postoperative evolution. The patient was discharged on the sixth postoperative day. Discussion: When located in the small intestine, 57% of the tumors that cause intussusception are benign, including the myofibroblastic tumor in this patient. The symptoms and signs associated with this neoplasm are cramp-like abdominal pain, nausea and vomiting. Although imaging studies may lead to suspect this diagnosis, in most cases it is made intraoperatively. Surgical resection of the affected intestinal segment is curative, with favorable prognosis. Conclusions: This case is considered as a rare cause of intussusception. It had a benign course and is still under study since its patho-physiology has not been fully understood.

RESUMEN Introducción. Se denomina intususcepción a la introducción de un segmento intestinal a otro distal, siendo esta la causa posterior del tumor miofibroblástico inflamatorio en el 5-16% de los adultos. Presentación del caso. Paciente femenino de 41 años con presencia de dolor y distensión abdominal. Se practica exploración quirúrgica laparoscópica, observando intususcepción ileocólica hasta colon transverso. Por sangrado no controlable se realiza conversión a laparotomía, se reseca y se realiza anastomosis ileocólica latero-lateral. La histopatología reporta tumor miofibroblástico inflamatorio, con evolución postquirúrgica favorable. Se da de alta al sexto día postquirúrgico. Discusión. En el intestino delgado, 57% de los tumores que originan intususcepción son benignos, como el tumor miofibroblástico que presentó la paciente reportada. Los síntomas y signos de esta neoplasia son dolor abdominal tipo cólico, náusea y vómito. Aunque los estudios de imágenes pueden dar una sospecha del diagnóstico, en la mayoría de los casos se hace intraoperatorio. La resección quirúrgica del segmento intestinal afectado es curativa, con pronóstico favorable. Conclusiones. El presente caso representa una causa poco frecuente de intususcepción intestinal, de curso benigno, la cual continúa en estudio ya que no se ha logrado entender por completo su fisiopatología.

Poliposis hamartomatosa gastrointestinal con intususcepción intestinal, en paciente con Síndrome de PeutzJeghers: Presentación de un caso / Gastrointestinal Hamartomatous Polyposis with Intestinal Intususception in a Patient with Peutz-Jeghers Síndrome: A Case Report

Se trata del caso de una paciente de 17 años de edad, quien consulta por dolor abdominal posterior a un procedimiento endoscópico de resección de pólipo intestinal. La paciente tiene diagnóstico conocido de síndrome de Peutz Jeghers (SPJ), el cual se manifiesta por poliposis intestinal de tipo hamartomatoso e hiperpigmentación mucocutánea. En esta revisión se describen los principales hallazgos del SPJ en tomografía multicorte del abdomen, incluyendo la intususcepción que es una de las complicaciones más frecuentes de estos pacientes.

This article presents the case of a 17-year-old female patient with abdominal pain following an endoscopic procedure (polypectomy). The patient has a known diagnosis of Peutz-Jeghers syndrome (PJS), which is manifested by hamartomatous intestinal polyposis and mucocutaneous hyperpigmentation. This review presents the tomographic characterization of multiple gastric and intestinal polyps, including intussusception, which is one of the main complications in these patients.

Inhibitory effect of small interfering RNA on migration of human colorectal cancer cell line / 第二军医大学学报

Objective: To evaluate the inhibitory effect of small interfering RNA (siRNA) on migration of human colorectal cancer cell line. Methods: CXCR4 expression in colorectal cancer cell line SW480, SW620 and LoVo was determined by RT-PCR and Western blotting. Migratory responses of CXCR4 to stromal cell-derived factor 1 (SDF-1) were detected by cellular migration assays. The siRNA complementary to CXCR4 mRNA and its control, Non-silencing double-stranded RNA (Non-silencing dsRNA), were embedded in cationic liposome Lipofectin and transfected into SW480 cells at the final concentration of 150 nmol/L; semi-quantitative RT-PCR and Western blotting were performed to evaluate the CXCR4 mRNA and protein expression levels, respectively. The migration of transfected SW480 cells were measured quantitatively by Transwell migration assays. Results: CXCR4 expression was strong in SW480 cells, intermediate in SW620 cells, and weak in LoVo cells. In vitro cellular migration assays showed that the cell migration of SW480 and SW620 cells was more obvious than that of LoVo cells (P <0.01). The expression of CXCR4 mRNA and protein and the migration of siRNA-treated SW480 cells were significantly decreased compared with those of control group, liposome group and Non-silencing dsRNA group (P<0.01). Conclusion: CXCR4 siRNA can significantly inhibit the migration of human colorectal cancer cell line SW480 to SDF-1 by downregulating CXCR4 expression.

Imaging Findings of Mantle Cell Lymphoma Involving Gastrointestinal Tract

Clinical manifestations and imaging findings of mantle cell lymphoma involving gastrointestinal tract were evaluated. The subjects were 7 cases of mantle cell lymphoma involving the gastrointestinal tract. All cases were pathologically confirmed in our hospital during the period from April 1994 to July 2000. Five patients were male and 2 were female, and their age ranged from 49 to 63 years (average 57.4). The objectives were: 1) characteristics and distribution of multiple polyposis, 2) presence, location and enhancement pattern of bowel wall thickening or mass formation, 3) presence of splenomegaly, 4) presence and location of abdominal lymph node enlargement, 5) involved extra-abdominal organs, 6) combined cancer and location, and 7) other findings. All mantle cell lymphomas occurred in elderly persons, over 40 years, and most showed multiple polyposis (6/7), bowel wall thickening or mass formation (6/7), lymph node enlargements (6/7) and extra- abdominal involvement (5/7). All cases of polyposis involved the small bowel and colon, and the size of the polyps ranged from 0.1-4.0cm. Four of 6 patients showed combined sessile and polypoid polyps, while the other 2 showed only sessile polyps. Most of or some of the polyps in 3 patients showed small central ulcerations. Most of the patients (5/6) showed an uncountable number of polyps. Polyposis was predominant in the rectum, ascending colon, rather than other sections in the colon, and the ileum were almost always involved by polyposis. Bowel wall thickening or mass formation developed exclusively in the ascending colon, rectum or ileum. Extra- abdominal involvement developed either simultaneously or nonconcurrently with gastrointestinal involvement. Some of patients showed splenomegaly (3/7), appendiceal enlargement (2/7), and intussusception (1/7), and some had associated adenocarcinomas (3/7).

Intestinal smooth muscle tumor: diagnosis and management

The study involved 12 cases with intestinal smooth muscle tumor underwent operation at Viet Duc Hospital from 1990 to 1995. Findings: intestinal smooth muscle tumor occupied about 16% of intestinal malignant tumors. Most of cases were not diagnosed before surgery. Common clinical signs are abdominal pain, digestive troubles and weigh loss. The tumor can be touched by hand. Most of patients were removed the tumor and the related intestinal segment. Post-operation, there was not death or dehiscence of the anastomosis. Rate of infection is 8.3%. There were not any patients received chemotherapy and radiotherapy.

Diagnosis and treatment of intestinal lipoma / 中国普通外科杂志

Objective To analyze the main clinical manifestations of intestinal lipoma and discuss the treatment of intestinal lipoma.Methods The clinical data of 19 patients with intestinal lipoma treated in our hospital in recent 15 years were analyzed retrospectively.CT,ultrasonography,and colonoscopy were used in diagnosis.Local intestinal resection by laparoscopy and laparotomy were employde.Results Intestinal lipoma presented with a variety of symptoms including intestinal bleeding,abdominal pain,anemia,intussusception,and bowel obstruction.In 17 of the intestinal lipoma patients,the main clinical manifestations were change of bowel habits,abdominal pain and bloody stool;13 of them had intestinal intussusception or obstruction,and two patients were asymptomatic.Sixteen patients underwent colonoscopy,and seven of them were correctly diagnosed.Seventeen patients received surgical resection and recovered.The diameter of mass was 3-6.5 cm.The pathologic exam showed submucosal lipoma in 12 cases,two cases showed ulcer formation with erosion,2 cases had intermural lipoma and one case had atypical lipoma with potential malignant transformation.Two asymptomatic patients diagnosed by colonoscopic biopsy werre only followed up at regular intervals.Conclusions Imaging diagnosis and colonoscopy are helpful in the preoperative diagnosis of intestinal lipoma.The method of treatment is based on the size of the tumor and presence or absence of pedicle.Endoscopic electrosection is often used for tumor mass less than 3 cm in diameter,otherwise local intestinal resection is the treatment of chocie.

Reproduction of a murine model of liver metastasis of human primary malignant lymphoma of small intestine by continuous screening in vivo / 解放军医学杂志

Objective A liver metastasis model of human primary malignant lymphoma of small intestine was reproduced in nude mice in an attempt to provide an ideal animal model for elucidating the mechanism of liver metastasis of primary small intestinal lymphoma.Methods A piece of surgically obtained liver metastatic tissue of small intestinal lymphoma was implanted into the mucous membrane of small intestine in nude mice to reproduce the model.After metastasis of this tumor to the liver occurred,a portion of the metastais was transplanted into the mucous membrane of small intestine of another nude mouse.This process was repeated 4 times in order to obtain a cell line with the characteristics of high malignant lymphoma metastasis to liver.The survival rate of the experimental animals,regional invasion rate and metastasis rate were observed,and the morphological characteristics(light microscopy,electron microscopy and immunohistochemistry),karyotype analysis and DNA content of the neoplastic cells were also determined.Results A liver metastasis model of human primary malignant lymphoma of small intestine in nude mice(termed HSIL-0402)was successfully reconstructed,by repeated implantation of liver metastatic tumor in vivo.Histopathology showed HSIL-0402 tumor was a high grade non-Hodgkin's lymphoma.Immunohistology showed the cells were CD19,CD20,CD45 and CD79a positive,but negative for CD3 and CD7.The modal number of chromosome was between 56-69.DNA index(DI)was 1.61?0.37,which showed heteroploid.So far,HSIL-0402 had been maintained for 27 passages in nude mice,exhibiting 100% of transplantability,liver metastatic rate,and resuscitation rate after liquid nitrogen cryopreservation.Lymph node metastasis and celiac seeding occurred in 67.4% and 61.7% of a total of 156 observed animals.The HSIL-0402 model displayed various manifestations reminiscent of highly metastatic invasive behavior in nude mice,including invasive growth,hematogenous metastasis,lymph node metastasis and celiac seeding.Conclusion The present study successfully re-established a spontaneous liver metastasis model of human primary malignant lymphoma of small intestine in nude mice,HSIL-0402,which provides an ideal animal model for the researches on biological mechanism of liver metastasis and anti-metastasis therapy of human primary small intestinal lymphoma.