Capsule endoscopy in patients refusing conventional endoscopy.

Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon.

Esophageal capsule endoscopy in patients refusing conventional endoscopy for the study of suspected esophageal pathology.

AIM: Esophageal capsule endoscopy is a well tolerated procedure that does not require sedation and has proved its value for the study of the esophagus. The aim of our study was to assess the feasibility, accuracy, safety and acceptability of esophageal capsule endoscopy for the study of gastroesophageal reflux disease and esophageal varices in patients who refused conventional upper gastrointestinal endoscopy. PATIENTS AND METHODS: Thirty consecutive examinations performed in 28 patients (15 men/13 women; mean age: 58.5+/-12.4 years; range: 23-87 years) were reviewed. Twenty-five examinations were performed in 23 patients presenting with chronic gastroesophageal reflux disease symptoms and the remaining five were carried out in patients with cirrhosis for screening of esophageal varices. The procedures were done with the new PillCam ESO that harbors two viewing cupules and takes a total of 14 frames/s. Technical data (total recording time, esophageal transit time and Z-line visualization), clinical findings (Savary-Miller grade; presence and characteristics of esophageal varices or portal hypertension gastropathy), and patient's opinion (quality and comfort questionnaire) were analyzed. RESULTS: All the patients ingested and excreted the capsule without complications. Two examinations in the gastroesophageal reflux disease group were repeated; one was issued as a follow-up and the other because no images were recorded in the first capsule endoscopy. From the former, only the satisfaction questionnaire was analyzed. Mean total recording time and esophageal transit time were 1224 and 243.79 s, respectively (range: 2-1192 s). Complete study of the Z-line was possible in 23 examinations (23/29; 79.3%). Esophageal erosions were seen in 58.33% (14/24) of the examinations carried out in patients with gastroesophageal reflux disease. Nine out of 14 patients (64.29%) presented with grade I esophagitis and the other five (35.71%) with grade II esophagitis. Among the five patients with cirrhosis, small varices were visualized in one (1/5; 20%), while large varices with red spots were evidenced in the remaining three (3/5; 60%). All four patients showing esophageal varices were found to have portal hypertension gastropathy. In most examinations, patients found the capsule easy to swallow (28/30; 93.33%), asymptomatic (29/30; 96.66%), evaluated the procedure as comfortable (29/30; 96.66%), and would repeat it if necessary (30/30; 100%). CONCLUSIONS: Esophageal capsule endoscopy is an adequate alternative diagnostic method for the study of gastroesophageal reflux disease and for the screening of esophageal varices in patients refusing to undergo conventional upper gastrointestinal endoscopy.

Evaluación de la implantación de una guía de incorporación de nuevos medicamentos en un hospital / Evaluation of a guide for the introduction of new drugs in a hospital

Objetivo: La incorporación de nuevos fármacos en los hospitales tiene una gran repercusión en el uso racional de medicamentos del Sistema Nacional de Salud, aunque existe un apreciable grado de variabilidad entre diferentes centros, lo que genera problemas de equidad y accesibilidad. Para dar respuesta a estos problemas, en Andalucía se elaboró la Guía de Incorporación de Nuevos Fármacos (GINF) que propone un procedimiento estructurado de toma de decisiones, fundamentado en la evaluación de la evidencia disponible. Material y métodos: Se evalúan todas las solicitudes recibidas en la Comisión de Farmacia y Terapéutica del Hospital Virgen del Rocío de Sevilla, con la metodología propuesta en la guía GINF, desde enero de 2002 a julio de 2003. Se realiza un estudio descriptivo sobre las características de los fármacos, los solicitantes, la actividad de la Comisión, indicadores de calidad de las solicitudes, el proceso seguido y las decisiones. Resultados: Se evaluó el total de las 32 solicitudes recibidas, correspondientes a 26 fármacos. Se aprobaron 19 (73 por ciento), aunque, de éstos, 14 lo fueron de forma restringida o con un protocolo específico de utilización, 4 como equivalentes terapéuticos y sólo 1 sin ninguna restricción. El 72 por ciento de los solicitantes aportó los ensayos clínicos pertinentes, mientras que las estimaciones sobre el número de pacientes/año y otros datos para la evaluación económica fueron mucho más escasas. Conclusiones: Es posible mejorar el proceso de introducción de fármacos en los hospitales mediante una guía que facilite a los profesionales y las comisiones de Farmacia criterios explícitos y transparentes (AU)