Capsule endoscopy examination identifies different leading causes of obscure gastrointestinal bleeding in patients of different ages.

BACKGROUND/AIMS: We aimed to investigate the diagnostic applications of capsule endoscopy examination patients in obscure gastrointestinal bleeding and to analyze the etiology of obscure gastrointestinal bleeding in patients of different ages. MATERIAL AND METHODS: A total of 385 patients with obscure gastrointestinal bleeding, aged 17-91 years, were assigned into three groups as: elderly (>65 years), middle-aged (41-65 years) and young adults (17-40 years). Gastrointestinal examinations were carried out in each participant with the use of a capsule endoscopy diagnostic system. RESULTS: Overall, the detection rates for positive capsule endoscopy findings in the elderly, middle-aged and young adult groups were 66.94%, 62.29% and 61.80%, respectively, and the diagnostic rates were 48.76%, 45.14% and 53.93%, respectively. No significant difference existed in either rate between the different age groups. The commonest pathological changes detected were vascular malformations, intestinal tumors, Crohn's disease, non-specific enteritis, and small intestine ulcer, but the distribution of these causes for obscure gastrointestinal bleeding varied between the different age groups. The top three common reasons for obscure gastrointestinal bleeding in the elderly group were vascular malformations, small intestine ulcers and small intestine tumors, while in the middle-aged group vascular malformation, small intestine tumor and non-specific enteritis were the most common. The young adults were most likely to have Crohn's disease, small intestine tumors or non-specific enteritis. CONCLUSIONS: Capsule endoscopy examination not only shows potential diagnostic value for obscure gastrointestinal bleeding, but it also helps to identify the leading causes of obscure gastrointestinal bleeding in all age groups.

[Double balloon endoscopy in diagnosis of patients with obscure gastrointestinal bleeding].

OBJECTIVE: To assess the diagnostic value of double balloon endoscopy (DBE) for obscure gastrointestinal bleeding (OGIB) METHODS: The data of 103 OGIB patients who underwent DBE from January 2007 to September 2010 in the First Affiliated Hospital, Zhejiang University School of Medicine were retrospectively analyzed. RESULTS: DBE was successfully performed in all 103 patients without complications. Of 103 patients, 66(64.1 %) had positive DBE findings and 28 had surgery procedures(27.2 %). Ninety-four patients finally acquired positive diagnosis, including small intestine tumor(31.1 %), angiodysplasia(22.3 %), exulceratio simplex(9.7 %), Crohn's disease(6.8 %), diverticulum(4.9 %), abdominal purpure(4.9 %), etc. Lesions occurred more frequently in proximal small intestine than in distal small intestine (56.3 % Compared with 30.1 %, P<0.001). CONCLUSION: DBE is a safe, effective and reliable procedure for the diagnosis of OGIB.

Double-balloon enteroscopy for obscure gastrointestinal bleeding: a single center experience in China.

AIM: To evaluate the diagnostic value of double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB). METHODS: The data about 75 OGIB patients who underwent DBE in January 2007-June 2009 in our hospital were retrospectively analyzed. RESULTS: DBE was successfully performed in all 75 patients without complication. Of the 75 patients, 44 (58.7%) had positive DBE findings, 22 had negative DBE findings but had potential bleeding at surgery and capsule endoscopy, etc. These 66 patients were finally diagnosed as OGIB which was most commonly caused by small bowel tumor (28.0%), angiodysplasia (18.7%) and Crohn's disease (10.7%). Lesions occurred more frequently in proximal small bowel than in distal small bowel (49.3% vs 33.3%, P = 0.047). CONCLUSION: DBE is a safe, effective and accurate procedure for the diagnosis of OGIB.

Diagnosis of obscure gastrointestinal hemorrhage with capsule endoscopy in combination with multiple-detector computed tomography.

AIM: To demonstrate the clinical efficacy of combination capsule endoscopy (CE) and multiple-detector computed tomography (MDCT) diagnostic imaging in the identification of gastrointestinal hemorrhages. METHODS: In the present study, 123 patients with gastrointestinal hemorrhages of obscure origin (GHOO) were examined with CE in combination with MDCT. The results were compared with findings of surgical pathology. RESULTS: Of the 123 patients, 57.72% (71/123) of the patients exhibited positive CE findings compared with 30.08% (37/123) on MDCT alone (P < 0.01). When used in combination, 65.85% (81/123) of patients scored positively. The detection rate due to the combination of diagnostic imaging was significantly higher than that of MDCT alone (P < 0.01), but was not significantly higher than that of CE alone (P > 0.05). Integrating the two diagnostic platforms improved the diagnosis of stromal tumors, hemangioma, Crohn's disease, vascular anomaly, Meckel's diverticulum, and ancylostomiasis. There was no significant difference in the positive detection rate between CE and MDCT when confirmed by surgical pathology. CONCLUSION: The contribution of CE is critical in the diagnosis of GHOO, given the fact that there is a significant difference in the detection rate between CE and MDCT, but there is no significant difference in the rate between CE plus MDCT and CE alone.

Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding.

AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE findings. RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common finding in the entire cohort, these accounted for 30% of clinically significant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleeding group, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

[Clinical value of wireless capsule endoscopy in diagnosis of small bowel disease in children].

OBJECTIVE: The pathological change of small bowel is difficult to examine because it is anatomically unique. The development of wireless capsule endoscopy provides an unique opportunity to visualize the entire small bowel in a minimally invasive manner. The aim of this study was to assess the safety and clinical value of wireless capsule endoscopy in children. METHODS: During the last 4 years (June, 2004-June, 2008), 46 times of wireless capsule endoscopy were performed in 43 patients with suspected small bowel disease, including obscure gastrointestinal bleeding (n = 11), recurrent abdominal pain (n = 20), chronic diarrhea (n = 9), protein losing enteropathy (n = 2), recurrent vomiting (n = 1). Of the 43 cases, 28 were male and 15 were female, the age ranged from 6 to 18 years, 8 of these cases were < 10 years old. The weight of the patients ranged between 15 kg and 60 kg. The average time of capsule passing through the stomach and the small intestine, the tolerance to and complication of wireless capsule endoscopy in patients, the image quality of capsule endoscopy, and the cleanliness of small intestine after fasting for 8 hours were observed and recorded. RESULT: All the patients could easily swallow the capsule and had good tolerance. The overall success rate was 94% (43/46). The median time of capsule passing through the stomach and small intestine was 73 min (range, 3 - 600 min) and 246 min (range, 73 - 413 min), respectively. The diagnostic yield of pathological change in small intestine was 90% (37/41), and the diagnostic accordance rate was 84% (31/37). Based on the wireless capsule endoscopy, diagnostic findings included Crohn's diseases (15), lymph follicular hyperplasia (4), nonspecific enteritis (4), vascular malformations (3), small bowel tumour (2), primary intestinal lymphangiectasia (2), gastrointestinal motility disorders (2), Meckel's diverticulum (1), angioma (1), small intestinal worm disease (1), duodenal ulcer (1), and polyposis syndromes (1). The capsule of 1 patient remained in the stomach. The cleanliness of small intestine after 8 hours fasting was good. And the capsule endoscopy can show high quality small intestine image. CONCLUSION: Wireless capsule endoscopy is a noninvasive, safe and useful tool for the investigation of the small intestine in children, especially for obscure gastrointestinal bleeding and Crohn's disease.

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction.

AIM: To evaluate the effectiveness and safety of capsule endoscopy (CE) in patients with recurrent subacute small bowel obstruction. METHODS: The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through. RESULTS: CE made a definitive diagnosis in 12 (38.7%) of 31 cases: four Crohn's disease (CD), two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine, one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three (9.7%) of 31 patients, and was caused by CD (2) or tumor (1). Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 mo. No case had an acute small bowel obstruction caused by performance of CE. CONCLUSION: CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.

Patients with nonalcoholic fatty liver disease display increased serum resistin levels and decreased adiponectin levels.

AIM: Resistin and adiponectin are recently discovered protein hormones, which are produced and secreted by adipocytes. Nonalcoholic fatty liver disease (NAFLD) is a metabolic syndrome, which is associated with obesity. The aim of this study was to evaluate the changes of serum adiponectin and resistin in patients with NAFLD and to determine the relationship between serum adipokine levels and clinicopathologic parameters of NAFLD. METHODS: Forty-three patients with NAFLD and 43 controls were enrolled in this pair-matched study. Body weight, height, body mass index, abdominal wall fat thickness, waist circumference, hip circumference, and the percentage of body fat were measured. Additionally, serum lipid, glucose, alanine aminotransferase, aspartate aminotransferase, adiponectin, and resistin were determined in all individuals. Serum adiponectin and resistin levels were determined using ELISA kits. RESULTS: Serum adiponectin levels were significantly lower in patients with NAFLD compared to the control group (control: 2.01+/-1.10 mg/l vs. NAFLD: 1.38+/-0.65 mg/l, P<0.01). Serum resistin levels were significantly elevated in patients with NAFLD compared to the control group (control: 4.70+/-3.30 ng/ml vs. NAFLD: 9.20+/-7.20 ng/ml, P<0.05). Serum adiponectin concentration was negatively correlated with the waist circumference (rho=-0.425), body mass index (rho=-0.329), percentage of body fat (rho=-0.256), abdominal wall fat thickness (rho=-0.226), and fasting blood glucose concentration (rho=-0.242), but was positively correlated with HDL (rho=0.226). Serum resistin concentration was positively correlated with waist circumference (rho=0.237). No correlation was found between resistin levels and blood pressure, fasting blood glucose concentration, triglyceride, total cholesterol, and HDL. CONCLUSION: NAFLD patients had lower adiponectin levels and higher resistin levels. A positive correlation was found between resistin and waist circumference, whereas a negative correlation was found between adiponectin and waist circumference, body mass index, percentage of body fat, abdominal wall fat thickness, and fasting blood glucose concentration. These data suggested that hypoadiponectinemia and hyperresistinemia might be involved in the development of NAFLD.

Is adult celiac disease really uncommon in Chinese?

Celiac disease (CD) is a type of intestinal malabsorption syndrome, in which the patients are intolerant to the gliadin in dietary gluten, resulting in chronic diarrhea and secondary malnutrition. The disease is common in Europe and the United States, but only sporadic reports are found in East Asia including China. Is CD really rare in China? We examined 62 patients by capsule endoscopy for chronic diarrhea from June 2003 to March 2008. Four patients with chronic diarrhea and weight loss were diagnosed to have CD. Under the capsule endoscopy, we observed that the villi of the proximal small bowel became short, and that the mucous membrane became atrophied in these four patients. Duodenal biopsies were performed during gastroscopy and the pathological changes of mucosa were confirmed to be Marsh 3 stage of CD. A gluten free diet significantly improved the conditions of the four patients. We suspect that in China, especially in the northern area where wheat is the main food, CD might not be uncommon, and its under-diagnosis could be caused by its clinical manifestations that could be easily covered by the symptoms from other clinical situations, particularly when it came to subclinical patients without obvious symptom or to patients with extraintestinal symptoms as the initial manifestations.

Effect of small bowel preparation with simethicone on capsule endoscopy.

BACKGROUND: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. METHODS: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. RESULTS: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). CONCLUSION: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

OMOM capsule endoscopy in diagnosis of small bowel disease.

OBJECTIVE: To assess the diagnostic efficiency of OMOM capsule endoscopy (CE) in a group of patients with different indications. METHODS: Data from 89 consecutive patients (49 males, 40 females) with suspected small bowel disease who underwent OMOM CE (Jinshan Science and Technology Company, Chongqing, China) examination were obtained by retrospective review. The patients' indications of the disease consisted of the following: obscure gastrointestinal bleeding (OGIB), abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. RESULTS: CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for patients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea (85.7% vs 53.3%, P<0.005). Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. CONCLUSION: OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB (small bowel) CE (Given Imaging, Yoqneam, Israel).

The value of endoscopic ultrasonography on diagnosis and treatment of esophageal hamartoma.

OBJECTIVE: To examine the values of endoscopic ultrasonography (EUS) on diagnosis and treatment of esophageal hamartoma. METHODS: We compared and analyzed various kinds of imaging examinations such as barium esophagram, contrast-enhanced computed tomography (CT) and conventional gastroscopy in retrospectively reviewing the clinical data of an esophageal hamartoma patient seen in our clinic in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Having received various imaging examinations, this patient was finally diagnosed with esophageal hamartoma and underwent gastroscopic resection of hamartoma with the diagnostic information obtained from EUS. The patient had been regularly followed up for 13 months after treatment. RESULTS: Barium esophagram, CT and conventional gastroscopy detected the lesion, but were unable to distinguish it from common esophagopolypus and other submucosal lesions, and unable to determine etiopathogenisis. EUS detected the hamartoma and identified its internal structure, echo, exact size, depth of invasion, origin and the relationship between adjacent tissues and organs, differentiating the lesion from other submucosal tumors and clearly defining the diagnosis. EUS-guided fine needle aspiration (FNA) also helped to identify the etiological diagnosis. CONCLUSION: EUS was superior to other imaging means in diagnosis and treatment of hamartoma.

[Diagnostic values of double-balloon enteroscopy and abdominal computed tomography in small bowel disease].

OBJECTIVE: To evaluate the diagnostic values of double-balloon enteroscopy (DBE) and abdominal computed tomography (CT) in small bowel disease. METHODS: Seventy eight DBE procedures were carried out in 70 patients, 40 males and 30 females; aged 47.7 (16 - 83) with suspected small bowel disease, all of whom received gastroscopy, colonoscopy, and abdominal CT examination at the same time. The diagnostic value of DBE was compared with that of CT. RESULTS: Seventeen kinds of small bowel lesions were detected, mainly including Crohn's disease, adenocarcinoma, gastrointestinal stroma tumor, vascular deformity, lymphoma, diverticulum, and polyp. There were no complications and all procedures were tolerated well. The mean duration of procedure was 110 min (30 - 240 min). Nineteen patients received surgical intervention. The diagnostic yield rate of DBE was 57.1% (40/70), significantly higher than that of CT (31.4%, 22/70, P < 0.01). The positive diagnosis rate of DBE combined with CT was 62.9% (44/70), not significant different from that of the DBE alone (P > 0.05). CONCLUSION: DBE shows a significantly higher diagnostic yield than CT in patients with suspected small bowel disease, and thus should be selected for the initial diagnosis. DBE Combined with CT did not increase the diagnostic yield. However, CT not only provides direction of intubation for DBE, but also clearly depicts the small bowel wall and extraenteric alterations. DBE and CT compliment each other in examining the patients with suspected small bowel disease.

A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: a case report.

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.

[A clinical study on the diagnostic value of capsule endoscopy and multiple-detector computer tomography in obscure gastrointestinal bleeding].

OBJECTIVE: To evaluate the diagnostic value of capsule endoscopy (CE) and multiple-detector computer tomography (MDCT) in obscure gastrointestinal bleeding. METHODS: The diagnostic value of CE was compared with that of MDCT in patients with obscure gastrointestinal bleeding. 60 patients (35 men, 25 women; mean age 53.8 years, range 17 - 84 years) with obscure gastrointestinal bleeding were enrolled in the study. All underwent gastroscopy and colonoscopy, but definite diagnosis was not made, then all of them underwent MDCT followed by CE. RESULTS: Natural excretion of the capsule occurred in 58 (96.7%) patients. CE identified positive findings in 36 (60.0%) patients and MDCT identified positive findings in 23 (38.3%) patients, P < 0.01. One patient was found to have 2 lesions simultaneously with CE. CE combined with MDCT identified positive findings in 40 (66.7%) patients. When this result was compared with that of CE, P > 0.05; whereas, compared with MDCT, P < 0.01. 28 patients underwent operations at last; the lesions accounting for bleeding all located in small intestine (16 in jejunum, 12 in ileum). CONCLUSIONS: Diagnostic yield of CE was higher than that of MDCT in patients of obscure gastrointestinal bleeding. Combining CE with MDCT did not increase the diagnostic yield in obscure gastrointestinal bleeding. However, MDCT showed more extraintestinal lesions, it is suggested that patients with obscure gastrointestinal bleeding be examined not only with CE but also MDCT.

[Clinical value of capsule endoscopy in obscure gastrointestinal bleeding].

OBJECTIVE: To investigate clinical diagnostic value of capsule endoscopy in obscure gastrointestinal bleeding. METHODS: Capsule endoscopy were performed in 90 patients with obscure gastrointestinal bleeding, which was defined as negative finding by gastroscopy and colonoscopy in our hospital. RESULT: In 90 patients, 2 of them accepted second examination. Eighty-seven of 92 (94.57%) patients accepted of capsule endoscopy successfully including 21 of 25 (84.0%) in group of acute massive bleeding and 66 of 67 (98.51%) in recurrent melena (P <0.05). In above patients, 74 of 87 (85.06%) had positive findings and the false negative rate was 17.24%. The detectable rate in acute massive bleeding and recurrent melena was 80.95% and 86.36%, respectively (P >0.05), and the false negative rate of that was 23.81% and 15.15%, respectively (P >0.05). CONCLUSION: Capsule endoscopy can be performed safely and well-toleratedly for visualizing the small bowel in patients with obscure gastrointestinal bleeding, which induces a highly detectable rate compared with other methods for detecting obscure gastrointestinal bleeding.

Diagnostic value of endoscopic ultrasonography for gastrointestinal leiomyoma.

AIM: To investigate the clinical pathologic features of gastrointestinal leiomyoma and the diagnostic value of endoscopic ultrasonography (EUS) on gastrointestinal leiomyoma. METHODS: A total of 106 patients with gastrointestinal leiomyoma diagnosed with EUS were studied. The location, size and layer origin of gastric and esophageal leiomyomas were analyzed and compared. The histological diagnosis of the resected specimens by endoscopy or surgery in some patients was compared with their results of EUS. RESULTS: The majority of esophageal leiomyomas were located in the middle and lower part of the esophagus and their size was smaller than 1.0 cm, and 62.1 % of esophageal leiomyomas originated from the muscularis mucosae. Most of the gastric leiomyomas were located in the body and fundus of the stomach with a size of 1-2 cm. Almost all gastric leiomyomas (94.2 %) originated from the muscularis propria. The postoperative histological results of 54 patients treated by endoscopic resection or surgical excision were completely consistent with the preoperative diagnosis of EUS, and the diagnostic specificity of EUS to gastrointestinal leiomyoma was 94.7 %. CONCLUSION: The size and layer origin of esophageal leiomyomas are different from that of gastric leiomyomas. Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients.