A pilot study of capsule endoscopy for the diagnosis of radiation enteritis.

BACKGROUND/AIMS: Capsule endoscopy may be a useful diagnostic tool for radiation enteritis in select situations. We conducted this pilot study to test feasibility of capsule endoscopy in the diagnosis of radiation enteritis. METHODOLOGY: Patients who received chemoradiotherapy to treat pancreatic cancer were enrolled. To increase the diagnostic yield of radiation enteritis, capsule endoscopy was performed in patients having anemia or chronic abdominal pain after chemoradiotherapy. RESULTS: Fifteen patients were enrolled between June 2007 and December 2008. The mean age was 63.4 +/- 8.0 years. The median radiation dose was 5040cGy with range of 4500-5994cGy. The mean total operating time of capsule was 10h 12 min +/- 2h 37 min, and the complete examination rate to the cecum was 93.3%. Nine patients (60%) were suspected to have radiation enteritis, and of these, five (33.3%) had abnormal findings that strongly suggested radiation enteritis. Congested mucosa and erythematous mucosa were the most frequent abnormal lesions. No capsule retention or other complications occurred. CONCLUSIONS: Capsule endoscopy may safely and effectively diagnose radiation enteritis in patients previously treated with chemoradiotherapy on the upper abdomen, although a larger trial is needed to confirm this.

A Pilot Study of Sequential Capsule Endoscopy Using MiroCam and PillCam SB Devices with Different Transmission Technologies.

BACKGROUND/AIMS: Studies have investigated the use of different types of radiofrequency capsules for comparison or sequential capsule endoscopy, but none have compared the MiroCam device - which utilizes a novel data transmission technology - with other capsules. This study compared the feasibility of sequential capsule endoscopy using the MiroCam and PillCam SB devices, which employ different transmission technologies. METHODS: Patients with diseases requiring capsule endoscopy were enrolled. After a 12-hour fast, one randomly selected capsule was swallowed. The second capsule was swallowed once fluoroscopy had indicated that the first capsule had migrated below the gastric outlet. RESULTS: The total operating time in 24 patients was 702+/-60 min (mean+/-SD) for the MiroCam and 446+/-28 min for the PillCam SB (p<0.0001). The rate of a complete examination to the cecum was 83.3% for the MiroCam and 58.3% for the PillCam SB (p=0.031). Diagnostic yields for the MiroCam, PillCam SB, and sequential capsule endoscopy were 45.8%, 41.7%, and 50.0%, respectively. The agreement rate between the two capsules was 87.5%, with a kappa value of 0.74. Electrical interference in data transmission between the two capsules was not observed, but temporary visual interferences were observed in seven patients (29.2%). CONCLUSIONS: Sequential capsule endoscopy with the MiroCam and PillCam SB produced slight but nonsignificant increases in the diagnostic yield, and the two capsules did not exhibit electrical interference. A larger trial is necessary for elucidating the usefulness of sequential capsule endoscopy.

Self-expandable metal stents for recurrent malignant obstruction after gastric surgery.

BACKGROUND/AIMS: It is well known that endoscopic insertion of self-expandable metallic stents (SEMS) is safe and effective for the palliative treatment of malignant strictures involving the upper gastrointestinal tract. But, most previous studies focused on stent insertion for esophageal or gastroduodenal obstructions. Only a few cases of stent insertion for recurrent malignant obstruction after gastric cancer surgery have been reported in studies in fewer than 40 patients. The aim of this study was to evaluate the clinical effectiveness of the placement of SEMS in patients with anastomotic recurrence after gastric cancer surgery and compare the clinical outcome according to stent and operation type. METHODOLOGY: The data were collected from 47 patients in whom SEMS were placed by endoscopic approach for recurrent malignant obstruction after gastric cancer surgery. Technical and clinical success and complications according to operation and stent type were evaluated. Also, Overall survival and stent patency rates were calculated. RESULTS: Stent placement was technically successful in 45 of the 47 patients (95.7%). After stent placement, 91.5% of the patients showed improvement in their dietary intake level. A statistically significant improvement in overall Gastric Outlet Obstruction Scoring System between pre- and postprocedure was noted (p<0.001). Stent failure occurred in 13 patients (stent migration: 4; tumor overgrowth: 1; tumor ingrowth: 8). The median survival and stent patency period were 101 days and 63 days, respectively. CONCLUSIONS: SEMS insertion in patients with anastomotic recurrence of gastric cancer after gastric cancer surgery is technically feasible and clinically effective.

Hypoechoic foci on EUS are simple and strong predictive factors for neoplastic gallbladder polyps.

BACKGROUND: EUS is an accurate imaging modality for delineating gallbladder (GB) structures; however, its clinical use in differentiating neoplastic GB polyps from nonneoplastic polyps is limited. Thus, we sought to characterize neoplastic GB polyps by analyzing unique EUS features. Our analysis revealed variably shaped, relatively hypoechoic portions in the core of polyps compared with general background echogenicity. OBJECTIVE: Our purpose was to make a differential diagnosis between neoplastic and nonneoplastic GB polyps of less than 20 mm by use of EUS variables, including hypoechoic foci. DESIGN: Retrospective single-center study. SETTING: University teaching hospital. PATIENTS: Patients (n = 88) underwent preoperative EUS and cholecystectomy for GB polyps smaller than 20 mm. RESULTS: Hypoechoic foci were found in 30 of 33 patients (91%) with neoplastic polyps and 6 of 55 (11%) with nonneoplastic polyps. In a multivariate analysis, hypoechoic foci were the only significant predictive factor for neoplastic polyps (odds ratio [OR] 55.4, 95% CI, 8.26-371, P < .001); the sensitivity and specificity were 90% and 89%, respectively. In addition, polyps >15 mm had an increased risk of malignancy (OR 21.7, 95% CI, 2.35-201, P = .007), as did those with hypoechoic foci (OR 10.9; 95% CI, 1.01-117, P = .049). LIMITATIONS: Retrospective review of selected patients from a tertiary medical center. CONCLUSIONS: The presence of hypoechoic foci on EUS is a strong predictive factor for neoplastic polyps. EUS may be useful in developing a treatment strategy for GB polyps.