Colon capsule endoscopy is feasible to perform after incomplete colonoscopy and guides further workup in clinical practice.

BACKGROUND: Colon capsule endoscopy (CCE) could be an option to examine the colon after incomplete colonoscopy. OBJECTIVE: To investigate the extent that CCE complements incomplete colonoscopy and guides further workup. DESIGN: Prospective, follow-up study. SETTING: Three tertiary-care centers. PATIENTS: Consecutive outpatients after colonoscopy failure; 1-year study period. INTERVENTION: Patients underwent CCE either immediately after colonoscopy or were rescheduled. Further investigations were guided by the results of CCE. Patients were followed as long as 2 years. RESULTS: We studied 75 outpatients; 39 had a screening colonoscopy. One third of the patients underwent CCE immediately after colonoscopy. Overall, CCE reached or went beyond the colon segment at which colonoscopy stopped in 68 patients (91%). CCE technically complemented difficult colonoscopy independently of whether same-day CCE was performed (24 [96%]) or was not performed (44 [88%]). CCE detected additional significant findings in 36% of the same-day CCE cases and in 48% of the rescheduled ones. Two patients in the same-day group and 13 in the rescheduled CCE group underwent further colon examination that revealed additional significant findings in 3 of them. Ten percent of the patients reported mild adverse events (AE). If needed, 63 participants (84%) were willing to repeat CCE. Follow-up has not identified symptomatic missed colon cancers. LIMITATIONS: Selected patient population, first-generation colon capsule, old preparation scheme. CONCLUSION: CCE performed immediately or at a scheduled date after colonoscopy failure is feasible and safe. CCE after incomplete colonoscopy appears to yield significant findings, guide further workup, and has high patient acceptance.

Quality of small bowel preparation for video-capsule endoscopy. Prospective comparison of two different preparations.

BACKGROUND/AIM: The best preparation for successful small bowel video-capsule endoscopy (VCE) is still unknown. The primary aim of our study was to compare sodium phosphate (PS) and polyethylene glycol (PEG) purge on the quality of small bowel preparation. METHODOLOGY: In this prospective, non-randomized, two centers study, we evaluated 47 and 48 consecutive outpatients who received PS and PEG preparations, respectively. Two independent investigators measured the proportion of small bowel transit time (SBTT) without clean mucosa. Two other investigators assessed bowel preparation independently, using a visual analogue scale (VAS). RESULTS: The proportion of SBTT without clean mucosa was similar for both preparations, in the proximal [3.8 (2.1-8.7) % vs. 4.85 (2.7-9.7) %, p = 0.24)] and in the distal half [31.9 (10.7-52.5) % vs. 22.9 (6.9-57.7) %, p = 0.48] of VCE recording. There was moderate - good correlation of VAS assessment of bowel preparation with the proportion of SBTT without clean mucosa in the proximal (r = 0.69, p < 0.001) and in the distal half (r = 0.76, p < 0.001) of the recording. The outcome measures of the studies were similar for both preparations. CONCLUSIONS: PS and PEG preparations result in similar quality of small bowel preparation and similar outcome measures of VCE studies. VAS assessment could be an alternative measure of bowel preparation in clinical practice.

PillCam Colon capsule endoscopy does not always complement incomplete colonoscopy.

BACKGROUND: There are no data on the role of PillCam Colon capsule (PCC) endoscopy for examination of the colon in incomplete colonoscopy cases. OBJECTIVE: To evaluate whether PCC endoscopy can complete colon examination after failure of conventional colonoscopy to visualize the cecum. SETTING: Three tertiary centers. STUDY DESIGN: Retrospective case series. PATIENTS: Patients who underwent PCC endoscopy after incomplete colonoscopy from January to June 2008. INTERVENTIONS: Conventional colonoscopy and PCC endoscopy. RESULTS: By using PCC, we studied 12 patients who had incomplete colonoscopy. Six patients had an obstructing tumor of the left side of the colon, and, in 6 cases, there were technical difficulties to complete colonoscopy. PCC endoscopy visualized the rectum in 1 case. The capsule did not reach the site where colonoscopy stopped in 6 of the 12 cases, ie, 3 left sited tumors and 3 with technical difficulties. Moreover, in 1 of the 3 cases in which the capsule passed the site where colonoscopy stopped, poor bowel preparation precluded the accurate examination of the colon. Four patients underwent a third colon examination (3 barium enemas and 1 virtual CT colonoscopy). There were no adverse events related to PCC endoscopy. LIMITATIONS: A retrospective study and a selected patient population. Data may not be applicable to other settings. CONCLUSION: In this retrospective case series of patients with incomplete colonoscopy, PCC endoscopy did not always satisfactorily examine the colon.

Effects of ageing on small bowel video-capsule endoscopy examination.

OBJECTIVES: The effects of ageing on small bowel video-capsule endoscopy (VCE) studies have not been studied prospectively yet. METHODS: We prospectively investigated 120 consecutive VCE studies. Patients were divided into three age groups: <40, 40-64, and > or =65 yr. Two independent investigators examined the completion of the examination and measured the VCE gastric transit time (GTT), small bowel transit time (SBTT), and the proportion of VCE SBTT without clean intestinal mucosa. They also recorded study findings. RESULTS: We examined the videos of 32 (26.7%), 36 (30%), and 52 (43.3%) patients aged under 40, 40-64, and over 64 yr, respectively. VCE completion (cecum visualized) rate was similar in the three groups (81.2%, 77.8%, and 78.8%, respectively, P= 0.96). There was no difference in GTT (P= 0.22) and in SBTT (P= 0.8) among the three age groups. Although in univariate analysis, there was a trend (P= 0.057) for higher proportion of SBTT without clean mucosa in patients over 64 yr (22.65 [12.42-32.22]%) versus patients under 40 (12.65 [4.57-30.7]%) and patients aged 40-64 yr (12.55 [6.12-31.32]%), multivariate linear regression analysis has not confirmed this difference. Older patients had significantly less erosions and normal studies, but they had more angiodysplasias (P < 0.05). All four tumors were detected in the elderly. CONCLUSIONS: Ageing does not affect the completion rate and the quality of bowel preparation for VCE. However, elderly patients have fewer normal studies and more angiodysplasias and tumors in the small bowel.

Effect of three bowel preparations on video-capsule endoscopy gastric and small-bowel transit time and completeness of the examination.

OBJECTIVE: Video capsule endoscopy fails to visualize the caecum in about 20% of patients. The aim of this study was to investigate the effect of different bowel preparations on video capsule endoscopy gastric- (GTT) and small-bowel transit time (SBTT) and the rate of caecal visualization. MATERIAL AND METHODS: We retrospectively examined 186 consecutive capsule endoscopy videos undertaken over a 3-year period, excluding cases with diabetes mellitus or gastric surgery (n=28), cases with unknown bowel preparation and those with unreadable data CDs (n=27). Sixty-seven (36%) patients were prepared with a liquid diet (CL), 54 (29%) with sodium phosphate (PS) and 65 (35%) with polyethylene glycol (PEG). Two independent, experienced investigators examined the videos. RESULTS: No difference was found in GTT among CL, PS and PEG preparations (25, 6.7-116.2 min, 34.75, 4.1-125 min, 35, 6.1-128.6 min, respectively, p=0.29). The caecum was visualized in 56/67 (83.6%), 44/54 (81.5%) and 53/65 (81.5%) patients who received CL, PS and PEG, respectively (p=0.9). In the cases where capsule endoscopy reached the caecum, no difference was observed in SBTT among patients that received CL, PS and PEG (264.4+/-85.9 min, 296.7+/-79.5 min, 291.3+/-84 min, respectively, p=0.11). CONCLUSIONS: Bowel preparations for capsule endoscopy do not have a significant effect on gastric and small-bowel video capsule transit time and the rate of caecum visualization.

Capsule endoscopy retention as a helpful tool in the management of a young patient with suspected small-bowel disease.

Capsule endoscopy is an easy and painless procedure permitting visualization of the entire small-bowel during its normal peristalsis. However, important problems exist concerning capsule retention in patients at risk of small bowel obstruction. The present report describes a young patient who had recurrent episodes of overt gastrointestinal bleeding of obscure origin, 18 years after small bowel resection in infancy for ileal atresia. Capsule endoscopy was performed, resulting in capsule retention in the distal small bowel. However, this event contributed to patient management by clearly identifying the site of obstruction and can be used to guide surgical intervention, where an anastomotic ulcer is identified.

How adherent to treatment with azathioprine are patients with Crohn's disease in long-term remission?

BACKGROUND: Patients with longstanding quiescent Crohn's disease on azathioprine usually maintain an excellent quality of life but are also concerned about long-term safety. This may affect adherence to treatment. The aim of the present study was to assess the adherence to azathioprine in a cohort of patients with Crohn's disease in long-term remission. METHODS: Thirty patients with Crohn's disease in remission on azathioprine for > or =48 months were enrolled in the study. All were asked to record the number of azathioprine tablets they consumed daily. Notes were kept every other month for 6 months. Adherence was defined as consumption of > or =80% of medication. RESULTS: Most patients (18/28, 74.3%) were not adherent to treatment. The mean (+/-SD) daily dose of azathioprine in adherent and nonadherent patients was 145 +/- 45 mg and 102 +/- 20 mg, respectively. However, there were no significant differences between the 2 groups in the mean IBDQ score and mean Crohn's Disease Activity Index (CDAI) score, both throughout the entire study and at each time point of the study. Male gender, single status, and consumption of >5 concomitant medications were associated with nonadherence. CONCLUSIONS: Most patients with Crohn's disease in longstanding remission had low self-reported adherence to azathioprine. Both male gender and single status were associated with nonadherence to azathioprine, whereas disease factors were not related to self-reported adherence. Patients considered nonadherent to treatment maintained disease remission and a quality of life similar to patients who were adherent to treatment.

The long-term efficacy of azathioprine does not wane after four years of continuous treatment in patients with steroid-dependent luminal Crohn's disease.

BACKGROUND: The long-term effectiveness of azathioprine, in Crohn's disease (CD) patients remains a matter of debate. This study aims at assessing the effectiveness and safety of azathioprine in patients treated continuously for less or more than 4 years. METHODS: Patients with steroid-dependent Crohn's disease in remission on azathioprine (2-2.5 mg/kg) for between 2 and 8 years were assigned into two groups. Patients in Group A were being treated continuously for 2 to 4 years whereas patients in Group B for 4 to 8 years. Patients were followed every month for 1 year with physical examination and laboratory tests. Compliance with treatment was also assessed every month. Every 3 months the Crohn's Disease Activity Index (CDAI) was calculated and the quality of life (QOL) Inflammatory Bowel Disease Questionnaire (IBDQ) was completed. Colonoscopy with calculation of the Crohn's Disease Endoscopic Index of Severity (CDEIS) was performed at baseline and at the end of the study. The primary end point was relapse after 1 year. Secondary end points were safety of treatment, QOL, and endoscopic healing. RESULTS: Fifty-eight patients were included in Group A and 42 in Group B. The relapse rates per protocol were 19.6% and 11.9%, respectively (p: not significant). There were no significant differences overall and at each time point of the study between the two treatment groups regarding compliance with and safety of treatment, CDAI, IBDQ, and CDEIS scores. Multifactorial analysis did not identify any factor influencing the remission of disease in any patient group. CONCLUSIONS: Long-term treatment with azathioprine of steroid-dependent Crohn's disease is efficacious and safe.