Diagnostic value of capsule endoscopy and small bowel CT virtual endoscopy in identifying small intes-tine diseases / 中国综合临床

Objective To explore the diagnostic value of capsule endoscopy and small bowel CT virtual endoscopy( CTVE) in identifying of small intestinal diseases. Methods Fifty?five cases patients of suspected small intestinal diseases who were treated by Capsule endoscopy and small bowel CTVE examination in the Affili?ated Hospital of North China University of Science&Technology and Kailuan Majiagou Mine Hospital from Janu?ary 2009 to December 2015 were chosen. The detection rate and diagnostic accuracy of small bowel disease were compared between the two methods. Results There was no significant difference in the detection rate of CTVE and capsule endoscopy( 80. 7% vs. 89. 5%,P=0. 719) . There was significant difference in the accuracy of CTVE and capsule endoscopy in the diagnosis of small intestinal non space occupying lesions ( 60. 7% vs. 89. 3%, P=0. 040) . The correct rate of diagnosis of small bowel lesions was 93. 1% in CTVE,and 51. 7% in capsule en?doscopy,there was statistically significant difference between the two ways( P=0. 032) . Conclusion Capsule endoscopy and CTVE are both non invasive tests,the operation is simple,safe,and the patients are easy to ac?cept,and they are both helpful in the diagnosis of small bowel diseases. Capsule endoscopy has an advantage in the diagnosis of small bowel lesions,while CTVE is superior to capsule endoscopy in terms of small bowel occup?ying lesions. Combined use of the two ways can improve the diagnostic rate of small bowel disease.

Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding

Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.

Lessons from Korean Capsule Endoscopy Multicenter Studies

Since its development, video capsule endoscopy (VCE) introduced a new area in the study of small bowel disease. We reviewed and discussed current issues from Korean capsule endoscopy multicenter studies. Main results are as follows: First, there was no significant difference in diagnostic yield according to the method of bowel preparation. Second, VCE represents a reliable and influential screening measure in patients with chronic unexplained abdominal pain and this technique could successfully alter the clinical course especially for patients with small bowel tumor. Third, the inter-observer variation in the expert group was lower than that in trainee group. Fourth, studies about the spontaneous capsule passage after retention showed 2.5% of retention rate and the size of lumen was an important factor of spontaneous passage. We need larger scale studies on the effect of bowel preparation methods on the diagnostic yield and further studies about the learning curve or unique capsule endoscopic findings for small intestinal diseases in Korean patients.

Endocápsula olympus: reporte inicial de su uso en Venezuela / Endocápsula olympus: initial report of its use in Venezuela

Introducción: En 2001 se introdujo la cápsula endoscópica de Given Imaging® como un método no invasivo que permite realizar enteroscopia total. Recientemente Olympus® desarrolló una cápsula endoscópica para intestino delgado con características diferentes en el sistema óptico, tiempo de carga de batería, tiempo de grabación y descarga de imágenes, además de contar con un sistema que monitorea en tiempo real la localización de la cápsula. Objetivo: Reportar la experiencia inicial con la Endocápsula Olympus® en Venezuela. Pacientes y métodos: De julio a septiembre de 2009 se evaluaron 24 pacientes con sospecha de patología del intestino delgado con este dispositivo. Se registraron datos demográficos, indicación del procedimiento, tiempo de pase gástrico, intestinal, hallazgos y complicaciones. Resultados: 24 pacientes: 11 masculinos y 13 femeninos. Las principales indicaciones fueron: sangrado digestivo oscuro (n=15) y diarrea crónica (n=4). El tiempo gástrico promedio fue de 71,03 + SD minutos y el intestinal de 267,9 + SD minutos. En 1 paciente la cápsula se colocó con el gastroscopio y en 3 no alcanzó el ciego (12,5%). En 11 casos el estudio fue normal (45,83%). Hubo hallazgos positivos en 13 (54,16%): angiectasias (n=6), enfermedad celiaca (n=1), tumor subepitelial ulcerado (n=1), intususcepción (n=1), sangre roja en ileon (n=1), erosiones (n=1), linfangiectasia (n=2). El 84,61% de los hallazgos se relacionaba con la indicación. No hubo complicaciones. Conclusión: La Endoscápsula Olympus® es útil en la evaluación del intestino delgado con un alcance diagnóstico similar al reportado en la literatura para la Cápsula de Given Imaging®. El menor tiempo requerido para cargar la batería, descargar imágenes y el sistema de tiempo real, la convierte en una alternativa para su uso en patología urgente. Estudios prospectivos comparativos son necesarios.

Introduction: In 2001, the Given Imaging® endoscopic capsule was introduced as a noninvasive method that allows total enteroscopy. Olympus® recently developed a small bowel capsule endoscopy with different characteristics in the optical system, battery charging time, recording and image download times, in addition to a system that monitors real-time location of the capsule. Objective: To report the initial experience with Olympus® Endocapsule in Venezuela. Patients and methods: 24 patients with suspected small bowel pathology were evaluated between July and September 2009 using Olympus® Endocapsule. Demographic data, indication for the procedure, gastric time pass, intestinal transit, findings and complications were recorded. Results: 24 patients: 11 male and 13 female. The main indications were obscure gastrointestinal bleeding (n = 15) and chronic diarrhea (n = 4). The average gastric time was 71.03 + SD minutes and intestinal time was 267.9 + SD minutes. In 1 patient the capsule was placed with the gastroscope and in 3 it did not reach the cecum (12.5%). In 11 cases the study was normal (45.83%). There were positive findings in 13 (54.16%) angiectasias (n=6), celiac disease (n=1), subepithelial ulcerated tumor (n=1), intussusception (n 1), red blood in the ileum (n=1), erosions (n=1), lymphangiectasia (n=2). 84.61% of the findings were related to the indication. There were no complications. Conclusion: The Olympus® Endocapsule is useful for diagnosis of small intestine and has a diagnostic yield similar to that reported in the literature for the Given Imaging videocapsule. The shorter time required for charging the battery, download images and the real time system, makes it an alternative for using in emergency conditions. Comparative prospective studies are needed.

A new approach of estimating insertion depth with double-balloon enteroscopy / 中华消化内镜杂志

Objective The aim of this study was to evaluate the accuracy of calculating the insertion length of the overtube for estimating the insertion depth of the scope at double-balloon enteroscopy (DBE).Methods Patients with intestinal lesions found at DBE and confirmed by surgery were included. The advancing distance of the enteroscope at DBE was estimated by either cumulative length of push/pull cycle or calculation of the overall insertion length of the overtube. The accuracy of these two methods was evaluated with reference to surgery. Results Data from 51 patients who had their lesions found at DBE and treated by surgery were included in the study. DBE included 41 antegrade and 10 retrograde procedures. The average difference in the evaluation of the length of enteroscopic insertion between the two methods was 17 cm ( range 0-60 cm) on antegrade DBE and 12 cm (range 0-30 cm) on retrograde DBE. Furthermore, regardless of insertion route of DBE procedure, the mean differences between the insertion length evaluated by the two methods and surgical findings were 19 cm (range 0-50 cm) and 17 cm (range 0-60 cm), respectively, which was not significantly different ( P ＞ 0. 05 ). Conclusion The new method of calculating the length of the overtube passage is the same accurate and much simpler than the traditional method in estimating the insertion depth of the enteroscope at DBE, which is appliable in clinical practice.

Spiral enteroscopy in diagnosis and managements of small bowel diseases / 中华消化内镜杂志

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of smallbowel diseases.Methods The data of 8 patients who underwent spiral enteroscopy from July to September 2009 were retrospectively studied.The variables including maximal insertion depth,total procedure time,complications,and outcome were evaluated.Results The average maximal depth of intubation was 2.2 m beyond the Ligament of Triez (0-3.6 m beyond Ligament of Triez),with a mean procedure time at 41 min (25 to 77 min).Small bowel Crohn's disease was diagnosed in 2 cases with biopsy suggesting active inflammation and granular formation.Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia.Jejunal ulcer was detected in 1 patient.Multiple polyps were found in 1 patient after jejunal anastomosis,which were then treated with endoscopic argon plasma coagulation (APC).No abnormalities were found in 3 other patients.No complications occurred during and after the procedure.The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy.Conclusion Spiral enteroscopy is simple and convenient to operate,which is of great potential in clinical use.

Usefulness of Capsule Endoscopy in Children with Suspected Small Bowel Disease / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of our study is to investigate the diagnostic value and safety of capsule endoscopy (CE) in the pediatric patients with small bowel (SB) disease. METHODS: We retrospectively reviewed the records of 29 children (mean age: 11.8 year) who underwent CE at Seoul National University Children's Hospital between November 2004 and April 2009. RESULTS: Six (20%) of the total 29 patients could not swallow the capsule (mean age: 10.5 years), so the capsule was endoscopically placed into the stomach of these 6 patients. The CE examination for the entire SB was finished in 89.6% of the patients. The indications for CE studies were obscure gastrointestinal bleeding (OGIB) or anemia in 14 patients, intestinal polyposis in 8, abdominal pain in 4 and Crohn's disease in 3. The diagnostic yield of CE was 35.7% for OGIB or anemia, 37.5% for intestinal polyposis, 25% for abdominal pain and 33.3% for Crohn's disease. One patient had capsule retention during our CE investigations. CONCLUSIONS: CE is a safe and valuable tool for the detection of SB Crohn's disease, the focus of OGIB and the presence of SB polyps in pediatric patients.

Diagnostic and Therapeutic Usefulness of Double Balloon Enteroscopy: Single Center Experience / 대한소화기내시경학회지

BACKGROUND/AIMS: Until recently, only indirect procedures were available to provide images of the small bowel. Double-balloon enteroscopy (DBE) has the ability to obtain tissue for diagnosis and endoscopic interventions. This study was designed to determine the usefulness of DBE in patients with small bowel diseases by evaluating diagnostic yields and the impact on treatment. METHODS: From November, 2004 to November, 2006 a total 81 patients with suspected small bowel disease were investigated by DBE. We analyzed the diagnostics and therapeutics rates according to the indications of DBE. RESULTS: A total of 114 DBE procedures were performed. Gastrointestinal bleeding (64.2%) was the most common indication, followed by chronic abdominal pain/diarrhea (29.6%). A diagnosis was obtained in 44 of 52 patients with gastrointestinal bleeding and 17 of 24 patients with chronic abdominal pain/diarrhea. DBE resulted in therapeutic intervention in 17 patients with gastrointestinal bleeding and 13 patients with chronic abdominal pain/ diarrhea. DBE was diagnostic in 75.3% of the patients and played a role in the subsequent treatment of 37.0% of the patients. CONCLUSIONS: DBE was a useful and safe method for diagnosis and treatments in patients with small bowel diseases.

The Usefulness of Capsule Endoscopy in Diagnosis of Small Bowel Diseases / 영남의대학술지

BACKGROUND: This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. MATERILAS AND METHODS: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. RESULTS: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1 %), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. CONCLUSION: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

Clinical Application of Capsule Endoscope

Wireless capsule endoscopy is currently the outstanding technical innovation in diagnostic gastrointestinal endoscopy. Especially for small bowel diseases this new technique offers several potential advantages over traditional diagnostic tools. The Given Diagnostic Imaging System (Given Imaging Ltd, Norcross, GA) consists of 3 components : the M2A capsule, an external receiving antenna with an attached portable hard drive, and a personal computer workstation for review and interpretation of images. The M2A capsule is a single-use device measuring 11x 26 mm and weighing 3.7 g. It is made of a biocompatible plastic and contains a complimentary metal oxide silicon chip camera, lens, light source, battery, and radio telemetry transmitter. Images are transmitted at 2 per second to an antenna array worn on the abdomen and stored on a Walkman-sized data recorder. The Given system was approved by the Food and Drug Administration in August 2001. The method has chiefly been used in patients with obscure gastrointestinal bleeding, and in some cases has allowed additional diagnoses to be made in comparison with push enteroscopy, with a positive influence on patient management. Contraindications to performance of capsule endoscopy include known or suspected GI obstruction, strictures or fistula, and presence of a cardiac pacemaker, defibrillator, or other implanted electromedical device. The M2A capsule is probably just the first in a long line of wireless endoscopic devices. There are already prototypes of self-propelled devices. Soon to come will real-time imaging, devices to image the proximal GI tract and colon, and devices that can take biopsies or provide therapy.

The clinical evaluation of OMOM capsule endoscopy / 中华消化内镜杂志

Objective To determine the function and clinical significance of OMOM capsule endos-copy. Methods To review the history and outcomes of 65 patients underwent capsule endoscopy from Oct. to Dec. 2004. Results OMOM capsule endoscopy failed to pass the pylorus within the effective working time in one case. The significant pathological findings were revealed in 47 patients among 64 patients (73. 4% ). Inflammatory small bowel diseases in 21 patients including Crohn's disease in 3 patients, small intestinal pol-yps in 8 patients including one Peutz-Jeghers syndrome, angiodysplasia in 9, diverticula in 3, hookworm in 3, submucosal tumor in 3 including one myosarcoma finally diagnosed by operation. OMOM capsule endosco-pies have working time 473 min (360-630) averagely. The duration from oral to anus was 1723 min (690-2370 min) averagely. Conclusion The capsule endoscopy is a highly useful technique in detecting small in-testinal diseases. It can be recommended as part of the routine work-up in patients with obscure bleeding.

Application of double-balloon push enteroscopy in the diagnosis of small bowel disorders / 中华消化内镜杂志

Objective To evaluate the diagnostic efficacy of double-balloon push enteroscopy in small bowel disorders. Methods From July 2003 to March 2004, 38 patients with presentation of gastrointestinal upset and underwent a previous negative gastroscopy, colonoscopy, gastrointestinal barium and/or angiography were enrolled in this study. Enteroscopy via oral or rectum was done in 30 patients while in the other 8 patients full access to the small bowel was attempted by the two-way method, firstly via upper GI and then the lower GI. Results Positive diagnostic yield was made in 33 patients (86. 8% ). These disorders included Crohn's disease (7/38) , multiple ulcerations (5/38) , arteriovenous malformation (4/38) , multiple diverticula (4/38) , varices (3/38) , malignant stromal tumor (2/38) , ileitis (2/38) , and 1 case in each of moderate-differentiated adenocarcinoma, Ankylostoma duodenale, ascariasis, eosinophilic enteritis, anas-tomotic stricture and tuberculosis. The procedures were carried out satisfactorily in all patients but 2 failed from the intolerance of patients. Complication never occurred. Conclusion Double-balloon push enteroscopy has the superiority in direct visualization of whole small intestine with high positive findings and safety but with high technical demand in manipulation.

Study on capsule endoscopies in diagnosing small bowel diseases / 中华消化内镜杂志

Objective To evaluate the diagnostic potential of capsule endoscopies (CE) for suspected small bowel diseases. Methods From September 2002 to June 2003, 23 patients (12 males, 11 females ) , age ranged 10 to 75 years old, with suspected small bowel diseases, were referred to our department to perform CE using Given M2A Video Capsule System. All patients had undergone previous negative endo-scopic evaluation at least once with esophago-gastro-duodenoscopy and total colonoscopy. Additional diagnostic work-up including small bowel enteroclysis, selective angiography, scintigraphy and puch enteroscopy, were performed, totally 36 procedures. Two endoscopists independently reviewed capsule images to arrive a consensus diagnosis. The initial diagnostic yield was quantified, and the value of CE was assessed. Of the 23 patients, 18 suffered from obscure gastrointestinal bleeding, 3 abdominal pain, and 2 chronic diarrhea. Results Twenty-four studies in 23 patients were evaluated. During CE patients have not complained of any uncomfortable feeling, only one patient had repeated the procedure because the capsule lodged at the inferior segment of esophagus near the Z line. Of the 23 patients, 20 had positive findings with a diagnostic yield of 86. 8% . The positive findings included inflammatory lesions in 10 patients (Crohns disease 7 , aphthous ulcer 3 ) , vascular abnormalities 9 ( phlebectasis 6, angioma 2, angiodysplasia 1) , submucosal nodulation 2 , diverticula 2, jejunal stromal tumor 1. Four of 23 patients had more than one lesion. Diagnosis of 6 patients was confirmed by surgery and /or pathology. Nineteen capsules passed in the direction with the camera facing forward, while the other 4 backward. Generally, it delayed in passing through the pylorus and ileocecal valves. Capsules reached cecum in 17 patients (73. 9% ) . Conclusion CE provided clearly the small intestinal images, and is an efficient tool in diagnosing small bowel diseases with a high diagnostic yield.