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Objective:To investigate the relationship between the cardia morphology under magnetically controlled capsule gastroscopy and the clinical characteristics of subjects.Methods:A total of 216 subjects with gastrointestinal symptoms or receiving physical examination who underwent magnetically controlled capsule gastroscopy at the Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University from August 2022 to November 2022 were enrolled. All subjects took gastroesophageal reflux disease questionnaire (Gerd-Q) survey. Clinical data of subjects were collected, and images of cardia morphology under magnetically controlled capsule gastroscopy were recorded. The subjects were divided into 4 groups according to differrent cardia morphology based on the degree of relaxation. The clinical characteristics of each group were compared, and the influencing factors for cardia morphology were analyzed.Results:In non-swallowing state, 116 subjects showed good continuous closure of the cardia in plum shape (group A), 33 subjects radial closure of cardia (group B), 46 subjects slightly relaxed linear cardia (group C) and 21 subjects relaxed and continuous opening of cardia in the shape of cave (group D). The ages of subjects in group A, B, C and D were 35.00 (31.00, 42.00) years, 53.00 (37.50, 60.50) years, 61.50 (41.50, 68.25) years and 52.00 (39.00, 70.00) years, respectively, with significant differences ( H=44.348, P<0.001). The Gerd-Q scores of subjects in group A, B, C and D were 1.50 (1.00, 2.00), 3.00 (2.00, 6.50), 8.00 (5.75, 9.00) and 8.00 (7.50, 9.00), respectively, with significant differences ( H=90.788, P<0.001). The body mass index (BMI) of subjects in group A, B, C and D were 22.66 (19.53, 24.70) kg/m 2, 23.44 (21.41, 27.05) kg/m 2, 23.77 (21.19, 26.93) kg/m 2 and 23.73 (19.63,24.79) kg/m 2, respectively, with significant differences ( H=8.114, P=0.044). The degree of cardia relaxation was positively correlated with the age ( rs=0.456, P<0.001), Gerd-Q score ( rs=0.648, P<0.001) and BMI ( rs=0.146, P=0.032) of subjects. Conclusion:The magnetically controlled capsule gastroscopy provides good visualisation of cardia morphology in non-swallowing state. There is a positive correlation between the degree of cardia relaxation under magnetically controlled capsule gastroscopy in non-swallowing state and the subjects' age, Gerd-Q score, and BMI.
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Objective:To investigate the clinical application value and safety of magnetically controlled capsule gastroscopy (MCCG) in gastric and duodenal examination of children in comparison with conventional gastroscopy.Methods:Data of 160 outpatients or inpatients with abdominal pain accompanied by Helicobacter pylori infection aged 8-16 who underwent either MCCG or conventional gastroscopy in Shanghai Children's Hospital from March 2020 to March 2022 were retrospectively analyzed. Children were divided into the MCCG group ( n=80) and the conventional gastroscopy group ( n=80) according to different examination methods. The detection and examination time of lesions in upper gastrointestinal tract, tolerance and safety between the two groups were analyzed. Results:MCCG was successfully performed in 79 children and conventional gastroscopy was successfully performed in 78 children, respectively. The positive detection rates were 1.3% (1/79) and 1.3% (1/78) in the esophagus ( χ2=0.000, P>0.999), 87.3% (69/79) and 91.0% (71/78) in the stomach ( χ2=0.552, P=0.327) , 15.2% (12/79) and 19.2% (15/78) in duodenum ( χ2=0.450, P=0.533) with no significant difference between the two groups. There was no significant difference in the examination time [72.0 (41.0, 109.5) min VS 6.0 (4.3, 7.0) min, U=24, P<0.001] in the MCCG group and the conventional gastroscopy group. No adverse event occurred in either group. Conclusion:There is no significant difference in the detection rate of gastric and duodenal lesions between the MCCG group and the conventional gastroscopy group. MCCG is safe and stable, and can be used as an diagnostic tool for gastric and duodenal diseases in children.
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Objective:To evaluate the safety and effectiveness of capsule endoscopy for the diagnosis of intestinal diseases in children.Methods:Clinical data of 113 pediatric patients who received capsule endoscopy in Xi'an Children's Hospital from October 2018 to September 2020 were retrospectively analyzed. The completion rate, passage time of stomach and small intestine, lesion detection rate, adverse reactions and complications of capsule endoscopy were analyzed.Results:Among 113 pediatric patients, 78 (69.03%) were male and 35 (30.97%) were female. The age was (99.8±44.7) months (9-195 months), and 31 (27.43%) were under 7 years old. The minimum weight was 9 kg and the minimum height was 70 cm. Eighty-seven pediatric patients (76.99%) swallowed capsules orally (the oral group) with the minimum age of 4 years and 3 months. Capsules were implanted in 26 pediatric patients (23.01%) under gastroscopy (the gastroscopic group), with the maximum age of 9 years and 2 months. Unexplained abdominal pain (47.79%) and unexplained gastrointestinal bleeding (31.89%) were common in the pediatric patients. The completion rate of capsule endoscopy was 97.35% (110/113), and the detection rate of lesions in small intestine was 31.81% (35/110). The passage time of small intestine in the gastroscopic group was significantly longer than that of the oral group (461.04±129.27 min VS 288.23±107.84 min, t=5.646, P<0.01). There was no significant difference in the passage time of stomach or small intestine among different genders, different ages or different endoscopic examination results ( P>0.05). The positive results of capsule were not correlated with the method of ingestion ( P=0.401, OR=2.562, 95% CI:0.284-23.077), gender ( P=0.154, OR=2.352, 95% CI:0.726-7.616), age ( P=0.949, OR=1.007, 95% CI:0.816-1.242), examination reason ( P=0.246) or small intestine passage time ( P=0.219, OR=1.003, 95% CI:0.998-1.008). No complications such as capsule retention occurred in any pediatric patient. Conclusion:Capsule endoscopy in children is noninvasive, rapid and simple, which can improve the diagnostic rate of small intestinal diseases in children, and can be further promoted in pediatric patients.
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Objective:To explore the feasibility of 400 mL Sprite Zero ? in gastric preparation for magnetically controlled capsule endoscopy (MCE) . Methods:A randomized controlled trial at the Department of Gastroenterology of Changhai Hospital, Naval Medical University from December 16th, 2019 to January 15th, 2020 was conducted. The patients and healthy volunteers who intended to receive MCE were randomly divided into the Sprite Zero ? (S) group and the water (W) group at 1∶1. For subjects in the W group, 800 mL water was taken 10 minutes before swallowing the capsule. And for subjects in the S group, 400 mL Sprite Zero ? was taken. The primary endpoint was gastric filling score and the secondary endpoint included the fullness score, gastric transit time (GTT), small bowel transit time (SBTT), completion rate (CR) for small bowel examination and the diagnostic yield. Results:A total of 102 subjects were enrolled, 52 subjects in the S group and 50 subjects in the W group. The median score of gastric filling was 4 at 0-5 min, >5-10 min and >10-15 min after taking the capsule in both groups, with less median liquid consumption in the S group than the W group (500 mL VS 950 mL, P<0.001). The S group showed lower median fullness score (7.0 scores VS 7.5 scores, P=0.030) and higher proportion of patients with GTT less than 30 minutes [69.57% (16/52) VS 27.59% (8/29), P=0.030] compared with the W group. The CR of small bowel examination in the S group was 100.00%, higher than that of the W group (89.66%, P=0.245). Conclusion:Compared with 800 mL water, 400 mL Sprite Zero ? can fully fill the stomach with more comfort. It has the potential to accelerate gastric emptying and improve the CR of small bowel examination, which is feasible for the gastric preparation.
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Objective:To explore the influencing factors of the image cleanliness scores of magnetically-controlled capsule endoscopy (MCE) and the methods to improve cleanliness scores.Methods:Data of patients undergoing MCE from October 2017 to August 2020 in Peking University First Hospital were analyzed retrospectively. The cleanliness scores at six regions of the stomach (cardia, fundus, body, angularis, antrum, and pylorus) were recorded (1-4 points), and the sum of the scores from these six regions was also calculated. Clinical features [gender, age, body mass index, indication, use of esophagus cap, and medication of proton pump inhibitors(PPI)], and gastric preparation regimens (one dose of pronase: simethicone 5 mL + pronase 20 000 U + sodium bicarbonate 1 g; or two doses of pronase: simethicone 5 mL + pronase 40 000 U + sodium bicarbonate 2 g) were collected. Cleanliness scores were defined as poor (group P, total cleanliness scores≤18) and as good (group G, total cleanliness scores>18). Clinical features, indication, use of esophagus cap and PPI, and preparation regimes were compared. Factors influencing cleanliness scores were analyzed.Results:A total of 238 consecutive patients with median age of 61.5 (54.0, 76.3) years were recruited according to inclusion criteria, among whom 68(28.6%) were female. There were 35 patients (14.7%) in group P with median age of 67.0 (56.0, 83.0) years. There were 203 patients(85.3%)in group G with median age of 61.0 (53.0, 75.0) years. No significant differences were found in age, sex, body mass index or esophagus cap use( P>0.05). Indications of abdominal symptoms or digestive system diseases( OR= 2.899, 95% CI: 1.258-6.681, P=0.012) and PPI use ( OR=3.168, 95% CI: 1.261-7.959, P=0.014) were more likely to yield a low cleanliness score. Gastric preparation regimen with two doses of pronase ( OR=0.201, 95% CI: 0.067~0.603, P=0.004)was more likely to avoid a low cleanliness score. Conclusions:Indications of digestive system diseases or abdominal symptoms and PPI use may decrease the cleanliness scores of MCE, while gastric preparation with double doses of pronase may improve it.
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Objective:To investigate the clinical application value of magnetically controlled capsule endoscopy (MCCE) for risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Methods:Clinical data of elderly patients taking enteric-coated aspirin and undergoing MCCE from January 2018 to December 2020 in Beijing Chaoyang and Beijing Anzhen Hospital, Capital Medical University were analyzed. Patients were divided into low-risk group (scores ≤ 3) and moderate/high risk group (scores >3) to study the risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Results:A total of 66 patients (aged 60-81 years, 45 males and 21 females) were enrolled and 17 patients developed bleeding. The indicators of low-risk ( n=51) and moderate/high risk groups ( n=15) were as follows: the incidences of upper gastrointestinal bleeding were 17.6% and 53.3%( P<0.001), gastric ulcer 5.9% and 26.7% ( P<0.001), median gastric Lanza score 2.0 and 2.0( P=0.621), duodenal ulcer 2.0% and 18.8% ( P<0.001), median duodenal mucosal injury score 1.0 and 1.0( P=0.936), respectively. Receiver operator characteristic curve showed that the area under the curve of risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin by MCCE was 0.855. Conclusion:Risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin can be used to predict the risk of upper gastrointestinal bleeding, but the scoring rules need to be further improved. Moderate and high-risk patients should undergo MCCE to monitor aspirin related upper gastrointestinal mucosal injury.
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Objective To evaluate clinical remission in patients with small bowel Crohn's disease (SBCD) who have received infliximab(IFX) therapy and to evaluate capsule endoscopy combined with ileocolonoscopy for mucosal healing at 14th week of IFX therapy.Methods Clinical data of 23 SBCD patients who received IFX were retrospectively analyzed.Laboratory indices [routine blood tests,C-reactive protein (CRP)and albumin],Crohn's disease activity index (CDAI),Lewis score (LS),Crohn's disease simplified endoscopic score (SES-CD),side effects and complications were compared before IFX treatment and at 14th week of IFX therapy.Results In 23 SBCD patients,both CDAI and CRP levels significantly decreased (P＜0.01) while body mass index (BMI) and albumin levels increased at 14th week (P＜0.05),compared with those before treatment.The clinical remission rate at 14th week was 91.3％ (21/23).There were 8/23 (34.8％)SBCD patients achieving mucosal healing in small bowel,12/21 (57.1％) in terminal ileum and colon,and 7/21 (33.3％) in both small bowel and colon.Twelve patients achieved both clinical remission and biochemical remission at 14th week and all of them achieved mucosal healing in both terminal ileum and colon (SES-CD ≤ 2).However,there were 5 (41.7％) of them still with small bowel inflammation (LS＞ 135).Conclusion IFX plays a role in promoting clinical remission and mucosal healing in SBCD patients.Mucosal healing of CD patients in terminal ileum and other parts of small intestine are not synchronized.For CD patients with small bowel and colon involved,the evaluation of the whole gastrointestinal tract by capsule endoscopy combined with ileocolonoscopy is recommended on condition that they have no intestinal obstruction or severe stricture.
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Gastric disease is a great burden in China; chronic gastritis, gastric ulcer, and gastric cancer incidences are the highest in the world.However,the screening rate of gastric disease in China is low because endoscopy and other screening methods are not accepted widely and they consume large amounts of manpower and material resources.The screening of gastric cancer has not been implemented,leading to high mortality because of gastric cancer. In recent years, the rapid development of magnetic-controlled capsule endoscopy provides a painless,highly accepted screening method for gastric cancer and other diseases.This article aims to introduce clinical applications of magnetic-controlled capsule endoscopy in screening and early diagnosis of stomach diseases.
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Objective To study the relationship between jejunal-ileum lesions and terminal ileum lesions of patients with isolated small intestinal Crohn disease, and to compare the clinical and endoscopic features of patients having normal terminal ileum with those having abnormal terminal ileum in isolated small intestinal Crohn disease. Methods The data of patients diagnosed as having isolated small intestinal Crohn disease and successively receiving colonoscopy and small bowel capsule endoscopy in Nanfang Hospital of Southern Medical University from January 2008 to October 2015 were retrospectively analyzed. The patients were divided into normal terminal ileum group and abnormal terminal ileum group according to the result of colonoscopy. The clinical and endoscopic features of the two groups were compared. Results The data of 62 patients were collected, and jejunal-ileum lesions were found in all of the patients under small bowel capsule endoscopy. According to the result of colonoscopy, 40 patients ( 64. 5%) were grouped to the abnormal terminal ileum group and 22 patients ( 35. 5%) to the normal group. The patients in the normal terminal ileum group had a shorter disease duration than those of the abnormal group [ 68. 2%( 15/22) VS 12. 5%( 15/40) , P=0. 021] . The sex and age distribution, smoking history, clinical feature, upper gastrointestinal involvement, perianal lesion, disease behavior, Crohn disease activity index, inflammation markers and nutriture between the two groups had no statistical difference ( P>0. 05) . Conclusion The terminal ileum lesions found by colonoscopy cannot predict small bowel lesions for Crohn disease. Small bowel capsule endoscopy is helpful for the detection of small intestinal lesions in Crohn disease. We should pay more attention to evaluating the small bowel lesions when the patients with Crohn disease have a short duration and normal terminal ileum.
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Objective To study the relationship between jejunal-ileum lesions and terminal ileum lesions of patients with isolated small intestinal Crohn disease, and to compare the clinical and endoscopic features of patients having normal terminal ileum with those having abnormal terminal ileum in isolated small intestinal Crohn disease. Methods The data of patients diagnosed as having isolated small intestinal Crohn disease and successively receiving colonoscopy and small bowel capsule endoscopy in Nanfang Hospital of Southern Medical University from January 2008 to October 2015 were retrospectively analyzed. The patients were divided into normal terminal ileum group and abnormal terminal ileum group according to the result of colonoscopy. The clinical and endoscopic features of the two groups were compared. Results The data of 62 patients were collected, and jejunal-ileum lesions were found in all of the patients under small bowel capsule endoscopy. According to the result of colonoscopy, 40 patients ( 64. 5%) were grouped to the abnormal terminal ileum group and 22 patients ( 35. 5%) to the normal group. The patients in the normal terminal ileum group had a shorter disease duration than those of the abnormal group [ 68. 2%( 15/22) VS 12. 5%( 15/40) , P=0. 021] . The sex and age distribution, smoking history, clinical feature, upper gastrointestinal involvement, perianal lesion, disease behavior, Crohn disease activity index, inflammation markers and nutriture between the two groups had no statistical difference ( P>0. 05) . Conclusion The terminal ileum lesions found by colonoscopy cannot predict small bowel lesions for Crohn disease. Small bowel capsule endoscopy is helpful for the detection of small intestinal lesions in Crohn disease. We should pay more attention to evaluating the small bowel lesions when the patients with Crohn disease have a short duration and normal terminal ileum.
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Objective To compare the role of CTE and CE on the diagnosis of small bowel diseases and evaluate their advantages in patients with different indications.Methods Patients underwent both CTE and CE(interval time <2 weeks)at our institution in recent 3 years were enrolled.The positive detection rates,lesion properties and characteristics of CTE and CE were compared.The diagnostic accuracy of combined method was also analyzed.Results A total of 47 patients were enrolled and the indications included suspected or established Crohn′s disease (28 cases),unexplained abdominal pain (14 cases), obscure gastrointestinal bleeding(3 cases),insufficient small bowel obstruction(1 case)and protein losing enteropathy(1 case).Diagnostic yield of CTE and CE for whole small bowel disorders showed no significant difference(CE 83.0% VS CTE 78.7%,P =0.791).For suspected or established CD,CE had a higher diagnostic accuracy than CTE (78.6% VS 35.7%,P =0.002 ),especially in detecting lesions in the jejunum(CE 50.0% VS CTE 7.1%,P =0.002).The diagnostic accuracy reached 100.0% when two meth-ods were combined.For unexplained abdominal pain,no significant difference was found in the diagnostic ac-curacy of CE and CTE(CTE 42.8% VS CE 50.0%,P =1.000).Diagnostic accuracy of combining CTE and CE was 85.7%.Conclusion CTE and CE are both valuable in detecting small bowel lesions.For pa-tients with suspected or established CD,CE is better than CTE.For patients with unexplained abdominal pain,a combination of CTE and CE may be a better strategy than use CTE or CE alone.
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Objective To evaluate the risk factors,treatment and follow-up of capsule retentions after capsule endoscopy examination.Methods A total of 1 100 capsule enteroscopic examinations,performed at our hospital from October 2006 to March 2013,were retrospectively studied.The positive findings of lesions, clinical indications of capsule endoscopy,treatment and follow-ups were recorded.Results The incidence of capsule retentions was 1.18%(n =13).The rates of capsule retentions in OGIB,suspected Crohn′s disease (CD),known CD,suspected tumors and chronic abdominal pain were 0.95%,4.0%,10.5%,7.1% and 0.3%,respectively.In 11 patients,the capsule was removed by means of double-balloon enteroscopy,the cap-sule was removed surgically in one patient,and spontaneous expulsion occurred in another patient after 1 year of treatment.Risk factors for capsule retention were known or suspected CD and suspected tumor(OR =11.44, P =0.02;OR =5.59,P =0.02),and suspected tumor was also a risk factor(OR =7.42,P =0.04).Conclu-sion Capsule endoscopy is a safe procedure with low risk of capsule retentions.Advantages and disadvantages of capsule endoscopy examinations should be considered carefully when high-risk patients are involved.
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Objective To investigate the optimal time for capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) .Methods Data of 76 patients with OGIB underwent capsule endoscopy from January 2013 to December 2014 were retro‐spectively analyzed .They were classified into two groups :emergency capsule endoscopy and non‐emergency capsule endoscopy .The demographic and clinical features and outcomes of capsule endoscopy ,complications and the times of hospital stays and hospitaliza‐tion expenses were compared .Results The overall diagnostic yield of capsule endoscopy was 48 lesions(63 .15% ) .The overall di‐agnostic yield of emergency capsule endoscopy group was 73 .68% (28/38) ,which was significantly higher than that in non‐emer‐gency capsule endoscopy group(52 .63% ,20/38) ,with statistical difference (P< 0 .05) .Conclusion Emergency capsule endoscopy have a higher rate of detection ,patients with OGIB should receive capsule endoscopy as soon as possible .
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Objective To investigate the diagnositic role of second generation colon capsule endoscopy in colorectal diseases.Methods After colon preparation procedure,fourteen volunteers were observed with second generation colon capsule endoscopy.During the examination,stomach and small bowel transit time,the colorectal examination time and the positive founding were recorded.Capsule excretion rate,the colon cleaning level and rate of adverse events also were assessed.Results Colorectal diseases including colon polyp,colon protrusion lesion and internal hemorrhoid were found in 7 volunteers.Stomach diseases including erosive gastritis and gastric ulcer in 10 volunteers.Small bowel diseases including small bowel polyp,ileum ulcer and small bowel protrusion lesion in 6 volunteers.Thirteen capsule were excreted within 480 minutes.The average colorectal examination time was 310 ± 125 minutes.The average stomach and small bowel transit time were 82 ± 39 minutes and 121 ± 73 minutes,respectively.The overall colon cleanliness was adequate in 7 patients.There are no severe adverse events during the examination.Conclusion The second generation capsule endoscopy can observe the colorectal mucosal changes and it might be considered as an adequate tool for colorectal diseases screening and diagnosis.
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Objective To study the application of intra-luminal ultrasonography (intra-small intestinal ultrasonography,ISIU) in demonstration of normal small intestine and diagnosis of small bowel lesions.Methods From December 2011 to December 2012,ISIU was performed in 50 patients who were screened by capsule endoscopy,gastroscopy,colonoscopy,and double-balloon enteroscopy to observe the normal tissue structures and lesions of the small intestine.Additional abdominal ultrasound (US) and spiral CT (SCT) were applied in patients with identified lesions in small intestine.Results ISIU was completed in 47patients out of 50 enrolled ones.A total of 10 lesions in small intestine were detected,all of them were identified by ISIU,while in which only 1 was found by US and 3 by SCT.Normal small intestinal wall demonstrated 6 layers under ISIU,with slight difference between jejunum and ileum.Conclusion ISIU provides high-resolution image of the structure at all levels of the normal small intestine,and can clearly observe lesion source and internal echo,and thus help to improve the rate of diagnosis of diseases of the small intestine.
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ObjectiveTo evaluate the clinical value of capsule endoscopy (CE) image screening system developed by our group.MethodsBetween March 2011 and June 2011,50 patients (29 males and 21 females with a mean age of 45.7(45.7 ± 4.1 ) ) underwent CE in our department.CE images were reviewed,and processed by the screening system at the rate of 50％,60％,70％,80％ and 90％,respectively.After reviewing the remaining and the deleted frames,the endoscopists calculated the remaining rate of the lesions by recording the number of lesions of all patients and the number of remaining lesions.The procedure time and the total number of the frames of each case were also recorded.ResultsA total of 39 patients of 50 had lesions and the detection rate was 78％.91 lesions were detected in the 39 patients,most of whom had more than 2 lesions.When the prescribed deletion rate was less than or equal to 60％,the lesion remaining rate reached 100％,with a mean frames of the cases of 46 242,and the mean processing time of 15.62 min.ConclusionWith all the lesions remained,the system can delete 60％ similar frames in a very short time,which greatly reduces the diagnosis time and workload for endoscopist,and improves the efficiency of capsule endoscopy.
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ObjectiveTo investigate the long-term (＞1 year) rebleeding rate after capsule endoscopy (CE)-guided intervention in patients with obscure gastrointestinal bleeding (OGIB) and to identify the risk factors of rebleeding.MethodsA total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled.Follow-up data were obtained by reviewing medical records,CE database and contacting the patients or their relatives by telephone.We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model.ResultsThe medium follow-up was 52 months (range13-112 months).Significant lesions were found in 202 patients (65.8％).The overall rebleeding rate after interventional therapy induced by CE findings was 28.0％ (86/307).CE positive patients had higher rebleeding rate than CE negative patients (37.6％ vs 9.5％,log-rank test,P=0.000),while specific therapy could prevent rebleeding,compared with nonspecific therapy (32.9％ vs 23.0％,P=0.042).95.3％ (82/86) rebleeding occurred within 24 months after CE.Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years,CE positive findings,lowest hemoglobin (Hb) level 3 months before CE ≤7 g/dl,receiving nonspecific therapy after CE,hypertension,administration of anticoagulants,antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding.Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding,which can reduce the occurrence of rebleeding and improve OGIB patients' prognosis.Those high risk OGIB patients should be followed up for at least 24 months after CE.
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ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.
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ObjectiveTo evaluate the applicable value of attitude control system combined with attitude controllable intelligent capsule endoscope for stomach examination.MethodsA total of 15 patients were recruited to the study.Manipulability of movement and posture change of capsule endoscope,diagnostic efficacy for such locations as gastric cavity,bulb and descending duodenum,image quality and patients'compliance were assessed.ResultsThe procedure was completed in 14 patients.One failed due to downfall of the endoscope to duodenum within 5 min. Mean operation time was ( 23.7 ± 6.5 ) min ( from 5 to 30 min).Ten cases of superficial gastritis,one case of superficial gastritis with bile regurgitation and 1 case of ulceration of the duodenal bulb were diagnosed.No abnormalities were found in 3 others.Endoscopic images were of high quality and only a few were influenced by gastrointestinal peristalsis.All patients showed compliance with no discomfort.Capsule endoscopes were discharged within 2 or 3 days.ConclusionAttitude control system combined with attitude controllable intelligent capsule endoscope in stomach examination is feasible and valuable in clinic.
ABSTRACT
CONTEXT: Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring. OBJECTIVES: To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. METHODS: A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. RESULTS: Successful pH data over 48-h was obtained in 95 percent of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4 percent) that would be missed if only day 1 was analyzed. Three patients (18.7 percent) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4 percent. CONCLUSION: Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.
CONTEXTO: A doença do refluxo gastroesofágico é uma das doenças digestivas mais comuns e importante causa de desconforto para os pacientes. O diagnóstico desta condição clínica pode requerer monitoramento ambulatorial do pH esofágico. OBJETIVOS: Determinar o espectro diagnóstico do sistema de monitoramento ambulatorial do pH esofágico com cápsula telemétrica por um período de 48 horas no diagnóstico da variabilidade diária da exposição ácida anormal e sua associação com sintomas. MÉTODOS: Foram incluídos 100 pacientes adultos, consecutivos, com sintomas relacionados com a doença do refluxo gastroesofágico, que realizaram pHmetria com cápsula telemétrica por 48 horas entre 2004 e 2009. A cápsula foi posicionada e implantada a 5 cm da borda superior do esfíncter esofágico inferior, definida pela manometria esofágica. Foram analisados os seguintes parâmetros: (1) tempos percentuais de exposição ácida no esôfago distal; (2) probabilidade de associação dos sintomas com o refluxo ácido. Foram comparados os resultados entre o 1º e o 2º dia de monitoramento, assim como o eventual ganho diagnóstico obtido após a inclusão do 2º dia no monitoramento. RESULTADOS: Sucesso na obtenção dos dados do pH esofágico durante 48 horas foi obtido em 95 por cento dos pacientes. Aproximadamente 25 por cento dos pacientes apresentaram sintomas relacionados à implantação da cápsula, variando entre sensação de presença de corpo estranho à dor torácica. A análise dos resultados do estudo de 48 horas mostrou-se estatisticamente significante quando comparada com as análises isoladas do dia 1 e do dia 2. O estudo do dia 2 identificou sete pacientes (30.4 por cento) que teriam sido perdidos se somente o dia 1 fosse analisado. Três pacientes (18.7 por cento) dos 16 pacientes com exposição ácida normal no esôfago distal em ambos os dias, apresentaram probabilidade de associação com o sintoma positivo, que gerou incremento no ganho diagnóstico com este método diagnóstico de 43.4 por cento. CONCLUSÕES: O monitoramento do pH esofágico com a cápsula telemétrica é seguro, bem tolerado e não requer sedação. A extensão do período de estudo para 48 horas representa significativo aumento no ganho diagnóstico em pacientes com doença do refluxo gastroesofágico.