ABSTRACT
BACKGROUND AND AIM: Capsule endoscopy is fast becoming the procedure of choice for small bowel imaging, especially to investigate the cause of unexplained gastrointestinal (GI) bleeding. We report our experience with capsule endoscopy in 24 cases with various indications. METHODS: In patients with unexplained GI bleeding or chronic anemia, the cause could be established in nine of 12 cases (75%), which included angioectasiae, leiomyomata and parasitic infestation. RESULTS: The yield of capsule endoscopy was highest in patients presenting with chronic diarrhea and suspicion of small bowel mucosal disease, where Crohn's disease and tuberculosis could be diagnosed. However, in patients with unexplained abdominal pain, capsule endoscopy was found to be least useful because 5/7 patients in the study were normal, emphasizing the importance of case selection. Overall, capsule endoscopy yielded a positive diagnosis in 16 of the 24 cases (66.6%). CONCLUSIONS: The experience of capsule endoscopy in a tropical clinical setting is no different from elsewhere, although certain conditions like worm infestation are more likely to be detected in this environment.
Subject(s)
Endoscopy, Gastrointestinal/methods , Gastrointestinal Hemorrhage/etiology , Intestinal Diseases/complications , Intestinal Diseases/diagnosis , Adolescent , Adult , Aged , Female , Gastrointestinal Hemorrhage/pathology , Humans , India , Intestinal Diseases/pathology , Male , Middle AgedSubject(s)
Cyanoacrylates/administration & dosage , Embolization, Therapeutic , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Contrast Media , Cyanoacrylates/therapeutic use , Drug Combinations , Enbucrilate/administration & dosage , Humans , Iodized Oil/administration & dosageABSTRACT
BACKGROUND: Endoscopic ultrasound is widely used following endoscopy for evaluation of suspected submucosal lesions and may guide further management of patients. PATIENTS AND METHOD: A total of 181 consecutive patients with suspected submucosal lesion in the upper gastrointestinal tract were diagnosed by endoscopic ultrasound between 1990-97. We evaluated: 1) the potential of endoscopic ultrasound criteria to predict histological type of submucosal lesions in 69 patients with available histology, 2) the ability of endoscopic ultrasound alone or with clinical presentation, to predict malignancy in 86 patients with available histology or follow-up of >12 months. RESULTS: Sensitivity and specificity for diagnosing 44 gastrointestinal stromal tumours were 95 and 72%, respectively, while 25 miscellaneous lesions were diagnosed correctly in only 56% by endoscopic ultrasound. Diagnosis of malignancy, using any two of three endoscopic ultrasound criteria (heterogeneous echotexture, size >3 cm, irregular margins) showed a sensitivity of 80% and specificity of 77%, giving accurate endoscopic ultrasound diagnosis in 16/20 malignant and 51/66 benign submucosal lesion. Heterogeneous echotexture, size >3 cm, and irregular margins showed a relative risk of 7.2, 5.4 and 4.6, respectively, for presence of malignancy. The presence of symptoms, potentially suggesting malignancy (dysphagia, gastrointestinal bleeding, pain and weight loss), had a relative risk of 4.2, however this did not increase the accuracy of diagnosing malignancy based on endoscopic ultrasound criteria alone. CONCLUSION: The accuracy of endoultrasound is high in diagnosing gastrointestinal stromal tumours, which show a significant potential of malignancy. Endoscopic ultrasound morphology appears to be helpful in selection of patients for surgical or conservative treatment. The accuracy of endoscopic ultrasound in differential diagnosis of non-gastrointestinal stromal tumour lesions is limited.
Subject(s)
Endosonography , Gastrointestinal Neoplasms/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Child , Diagnosis, Differential , Female , Gastrointestinal Neoplasms/pathology , Humans , Male , Middle Aged , Sensitivity and SpecificitySubject(s)
Calcinosis/genetics , Genetic Predisposition to Disease , Pancreatitis/genetics , Trypsin Inhibitor, Kazal Pancreatic/genetics , Trypsin , Trypsinogen/genetics , Adult , Base Sequence , Calcinosis/complications , Calcinosis/diagnosis , Chronic Disease , DNA Mutational Analysis , Diabetes Complications , Female , Humans , Male , Middle Aged , Mutation , Pancreatitis/complications , Pancreatitis/diagnosis , Pancreatitis/pathology , PhenotypeABSTRACT
OBJECTIVE: To assess the acceptability, safety and effectiveness of an oral sodium phosphate solution (Exelyte) for colon preparation prior to colonoscopy, compared with a polyethylene glycol solution (Peglec). METHOD: A colonoscopist-blinded, prospective, randomized, observational clinical study. PATIENTS: One hundred patients undergoing colonoscopy for various indications were randomized (n = 50 each) to receive either 90 mL of oral sodium phosphate mixed with 300 mL clear liquid and then consume about 4-5 glasses of water, or 2 liters of polyethylene glycol solution. RESULT: Sodium phosphate showed a safety profile similar to that of polyethylene glycol. However, patients tolerated it better. The colonoscopist reported similar cleansing of bowel in both groups. CONCLUSION: Oral sodium phosphate is well tolerated, is safe and provides bowel cleansing similar to that with a polyethylene glycol solution.
