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.

Colonic Angioectasia in an Adolescent Boy with Hoyeraal-Hreidarsson on Long-Term Anabolic Steroid Therapy / 대한소아소화기영양학회지

Androgen therapy has proven efficacy in treating patients with bone marrow failure who are not candidates for bone marrow transplantation. Herein, we report on a case of colonic angioectasia secondary to oxymetholone use in an adolescent patient with Hoyeraal-Hreidarsson syndrome (HHS). A 13-year-old Caucasian male with HHS characterized by cerebellar hypoplasia, developmental delay, microcephaly, esophageal strictures and myelodysplasia presented with severe hematochezia from colonic angioectasia secondary to long-term oxymetholone therapy. These vascular lesions resolved spontaneously once this anabolic steroid was discontinued. While androgen therapy is often recommended for certain anemias and myelodysplastic syndromes, clinicians should be aware of the potential complication in developing these perceived uncommon colonic angioectasias. Moreover, pediatric gastroenterologists should familiarize themselves in identifying these vascular lesions by colonoscopy, especially among the high risk groups on long-term anabolic steroid therapy.

Experiencia con argón plasma en lesiones del tracto gastrointestinal en dos instituciones de Bogotá / Experience in the use of argon plasma in gastrointestinal tract lesions in two institutions in Bogotá

La terapia de coagulación con argón plasma (APC) ha tomado importancia en la última década en la endoscopia gastrointestinal, y está posicionada como una técnica efectiva en el tratamiento de lesiones del tracto digestivo. Su efectividad fue inicialmente reportada en el tratamiento paliativo de neoplasias gastrointestinales y, posteriormente, su uso se ha extendido para múltiples indicaciones, entre ellas el tratamiento de sangrado debido a angiodisplasias, proctitis por radioterapia y hoy en día es utilizada para control de hemorragia gastrointestinal en lesiones vasculares como Dieulafoy. En la actualidad su uso se ha extendido, con el advenimiento de la enteroscopia, a lesiones del intestino delgado en especial las angioectasias. En este estudio se describe la experiencia de dos instituciones con el uso endoscópico del APC, y se exponen las indicaciones y efectividad del tratamiento. Métodos: Entre noviembre del 2007 y abril del 2009, la terapia con argón plasma se utilizó para el tratamiento de 65 pacientes con patologías del tracto digestivo con fin terapéutico, ya fuera curativo o paliativo con un total de 134 sesiones. El tratamiento se efectuó en dos centros de cuarto nivel de atención, el Hospital Universitario San Ignacio y la Clínica de Marly en Bogotá - Colombia. Resultados: El tratamiento con APC se realizó en 65 pacientes, utilizando en total 134 sesiones de argón. Las indicaciones para su uso son similares a las reportadas en la literatura: proctitis actínica, angiodisplasias, ectasia vascular antral y control de sangrado por lesiones tumorales. Se utilizó además en control de sangrado por lesión vascular de Dieulafoy y en el control de hemorragia por úlcera péptica sangrante con vaso expuesto. No se presentaron complicaciones mayores, lo que respalda lo expuesto en la literatura en relación a que es una técnica efectiva y segura para el manejo de diversas patologías del tracto digestivo.Conclusiones: La experiencia recogida en este estudio descriptivo demuestra el posicionamiento de la técnica del APC en nuestro medio, con una amplia gama de indicaciones sobre patologías del tracto digestivo y un excelente margen de efectividad y seguridad. Si se tienen presentes las indicaciones y recomendaciones para su aplicación, el uso del argón es una técnica sencilla, útil y efectiva.

In the last decade Argon Plasma Coagulation therapy (APC) has become important in gastrointestinal endoscopy. It is regarded as an effective technique in the treatment of lesions in the gastrointestinal tract. Its effectiveness was initially reported in the palliative treatment of gastrointestinal neoplasm, but its use has subsequently been extended to multiple indications such as treatment of bleeding angiodysplastic lesions, proctitis via radiotherapy and for gastrointestinal hemorrhage control of lesions such as Dieulafoy’s lesion. With the advent of enteroscopy its use has been extended to small intestinal lesions, especially to Angioectasias. This study describes indications and effectiveness of treatment in the experience of two institutions that make endoscopic use of APC.Methods: Between November, 2007 and April, 2009 Argon Plasma therapy was used in a total of 134 sessions for either curative or palliative treatment of 65 patients with digestive tract pathologies. Treatments were performed in two level four attention centers, the San Ignacio University Hospital and the Marly Clinic, both located in Bogotá, Colombia. Results: 65 patients received APC treatment in a total of 134 sessions. Indications for its use were similar to those reported in the literature: actinic proctitis, angiodysplasia, antral vascular ectasia and control of bleeding due to tumoral lesions. It was also used to control bleeding from vascular lesions such as Dieulafoy’s lesion and for hemorrhage control for bleeding peptic ulcers with exposed vessels. The absence of greater higher complications validates reports in the literature that this is a safe and effective technique for management of several digestive tract pathologies. Conclusions: The experience collected in this descriptive study shows that the addition of the APC technique in our environment provides a high range of indications about digestive tract pathologies with good effectiveness and safety margin. Reasonable use of Argon Plasma Coagulation therapy (APC), keeping in mind indications and recommendations for its application, is a simple, useful and effective technique

Endoscopic Treatment of Bleeding Angioectasia of the Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: Angioectasia of the gastrointestinal tract have been recognized with increasing frequency as an important cause of acute and chronic gastrointestinal bleeding. The purpose of this study is to define the response of endoscopic treatment for bleeding angioectasia of upper gastrointestinal tract and to evaluate long term efficacy of endoscopic treatment. METHODS: A clinical study was done on 18 patients (20 cases) of angioectasia bleeding of upper gastrointestinal tract who admitted to Yeungnam University hospital from January 1989 to October 1998. Endoscopic therapy was done by electrocauterizaton, laser therapy, O-band ligation. In cases of failure to achieve hemostasis after endoscopic retreatment, we have done operation or used antifibrinolytic agent. RESULTS: The mean age was 60.6+/-11.2 years (range 31-77 years). Bleeding control was succeeded in 19 cases and one case was failed by endoscopic therapy. This patient was operated. Recurred bleeding was observed in 4 patients during long term follow-up period. Bleeding was controlled after endoscopic re-treatment in two of four patients. The other patients (Osler-Weber-Lendu syndrome 2 patients) were periodically required of transfusion after endoscopic therapy. Tranexamic acid was given to these patients. CONCLUSIONS: Endoscopic therapy for bleeding angioectasia could reduce bleeding or make it stop, but repeated treatment was often necessary for multiple angioectasia. Tranexamic acid may be a useful treatment for refractory bleeding due to multiple angioectasia, such as Osler-Weber-Lendu syndrome.