Clinical and demographic features of patients undergoing video-capsule endoscopy management: A descriptive study.

BACKGROUND: Video-capsule endoscopy (VCE) is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases. VCE was implemented in Colombia in 2003, however current characterization of patients undergoing VCE in Colombia is limited, and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period. AIM: To describe the characteristics of patients undergoing VCEs and establish the main indications, findings, technical limitations, and other outstanding features. METHODS: A descriptive study was carried out using data from reports of VCE (PillCam SB3 system) use in a Gastroenterology Unit in Bogotá, Colombia between September 2019 and January 2023. Demographic and clinical variables such as indication for the VCE, gastric and small bowel transit times (GTT, SBTT), endoscopic preparation quality, and limitations were described [n (%), median (IQR)]. RESULTS: A total of 133 VCE reports were analyzed. Most were in men with a median age of 70 years. The majority had good preparation (96.2%), and there were technical limitations in 15.8% of cases. The main indications were unexplained anemia (91%) or occult bleeding (23.3%). The median GTT and SBTT were 14 and 30 minutes, respectively. The frequencies of bleeding stigma (3.79%) and active bleeding (9.09%) were low, and the most frequent abnormal findings were red spots (28.3%), erosions (17.6%), and vascular ectasias (12.5%). CONCLUSION: VCE showed high-level safety. The main indication was unexplained anemia. Active bleeding was the most frequent finding. Combined with artificial intelligence, VCE can improve diagnostic precision and targeted therapeutic interventions.

Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy.

INTRODUCTION: Angiodysplasias are responsible of 50% of small bowel bleeding. An endoscopic method that allows measuring its severity is not available. AIMS: The aim of the study was to validate a new endoscopic score with VCE to measure the severity of small bowel angiodysplasias (SBAD). METHODS: Four endoscopists independently reviewed VCE videos of 22 patients with SBAD. The score graded 3 variables: A - extent of lesions: E1, located in one half of the intestine and E2, in both halves; B - number of lesions: N1, <5; N2, 5-10; and N3, >10 lesions; C - probability of bleeding: P1, pale red spots; P2, bright red spots; P3, bleeding stigmata; and P4, active bleeding. Capsule Endoscopy Small Bowel Angiodysplasia Activity Index (CESBAI) was calculated as follows: E × 1 + N × 2 + P × 3. Interobserver variability was analyzed by Spearman's correlation and agreement Kappa statistic tests. RESULTS: The mean CESBAI scores by observers were O1= 11.6 ± 4.1; O2 = 11.3 ± 4.8; O3 = 11.1 ± 4.9; and O4 = 11.8 ± 4.2 (p > 0.05). Spearman's correlation values of CESBAI between every 2 observers were from 0.61 to 0.94 (p < 0.001) with a global correlation of 0.73 among all observers. Kappa values of CESBAI between every 2 observers ranged from 0.42 to 0.87 (p < 0.001) with a global agreement of 0.57 among all observers. All evaluators stated that the method was easy to use. CONCLUSIONS: CESBAI is a reliable and reproducible score. Nevertheless, these results must be validated in other studies with larger population before assessing its power for predicting bleeding recurrence.

Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia. / Concordancia diagnóstica entre la videocápsula endoscópica y enteroscopia mono y de doble balón en la hemorragia de intestino delgado en un hospital de alta complejidad en Bogotá, Colombia.

INTRODUCTION: Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. AIMS: To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. MATERIALS AND METHODS: A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. RESULTS: Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). CONCLUSIONS: The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.

Estudio de intestino delgado: experiencia en el uso de Cápsula Patency en la prevención de retención de Video-cápsula Endoscópica / Small bowel study: experience using Patency Capsule for prevention of video capsule endoscopy retention

Introduction: Video capsule endoscopy (VCE) is a useful test for the evaluation of the small bowel mucosa. The main complication of VCE is retention, so in patients with risk factors it is recommended to evaluate the permeability of the digestive tract with Patency Capsule (PC). We describe patients evaluated with PC before the study with VCE. Methods: Descriptive observational study of 96 patients referred for VCE. A clinical survey and images identified that 7 of these patients (7.3%) had retention risk factors, so they were previously requested PC. Results: 2 of the 7 patients evaluated with PC did not excrete the device, so the use of VCE was contraindicated; the subsequent study concluded Crohn's disease (CD) and jejunal stenosis due to retractable mesenteritis in these cases. Of the remaining 89 patients, not evaluated with PC, 1 (1.1%) developed retention of the VCE at an ulcerated stenosis, and was subsequently diagnosed as CD. Conclusion: In our study, we confirmed the usefulness of PC as a method to assess the risk of retention of VCE in patients with risk factors for ID stenosis.

Introducción: La video-cápsula endoscópica (VCE) es un examen útil para el estudio de patologías del intestino delgado (ID). La principal complicación de la VCE es la retención, por lo que en pacientes con factores de riesgo se recomienda evaluar la permeabilidad del tubo digestivo con Cápsula Patency (CP). Se presenta una serie de casos evaluados con CP previo al estudio con VCE. Métodos: Estudio observacional descriptivo de 96 pacientes derivados para realización de VCE. Mediante encuesta clínica e imágenes se identificó que 7 de estos pacientes (7,3%) tenían factores de riesgo de retención, por lo que se les solicitó previamente CP. Resultados: 2 de los 7 pacientes evaluados con CP no expulsaron el dispositivo por lo que se contraindicó el uso de VCE; el estudio posterior concluyó Enfermedad de Crohn (EC) y estenosis yeyunal por mesenteritis retráctil en estos dos casos. De los 89 pacientes restantes, no evaluados con CP, 1 (1,1%) presentó retención de la VCE a nivel de una estenosis ulcerada diagnosticada posteriormente como EC. Conclusión: En nuestra casuística se confirma la utilidad de la CP como un método para evaluar el riesgo de retención de VCE en pacientes con factores de riesgo de estenosis de ID.

Linfangiectasias en yeyuno como causa de sangrado digestivo oscuro manifiesto / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding

El sangrado digestivo oscuro constituye entre 10 y 20% de todas las causas de sangrado digestivo. La etiología está claramente relacionada con el grupo etario en que se presente. Las linfangiectasias del yeyuno son una causa rara de sangrado digestivo, pero puede llegar a ser de alta mortalidad en caso de que no se detecte tempranamente. Reportamos un caso de un paciente joven sin historia previa de enfermedad, con sangrado digestivo manifestado por melenas, con anemización severa, con estudios endoscópicos iniciales normales, en quien hacemos abordaje con estudios para intestino delgado (video cápsula endoscópica y enteroscopia anterógrada de doble balón), con los que hacemos el diagnóstico y es llevado a cirugía, con adecuada evolución clínica y curación de la enfermedad. (Acta Med Colomb 2015; 40: 158-161).

Obscure gastrointestinal bleeding is between 10 to 20% of all causes of gastrointestinal bleeding. The etiology is clearly related to the age group in which it is presented. Lymphangiectasia in jejunum is a rare cause of gastrointestinal bleeding, but can have high mortality if not detected early. A case of a young patient with no history of previous disease presenting gastrointestinal bleeding manifested by melaena, with severe anemia and normal initial endoscopic studies, is presented. The diagnosis was made by endoscopic video capsule and antegrade double-balloon enteroscopy and surgery was performed with adequate clinical evolution and cure of the disease. (Acta Med Colomb 2015; 40: 158-161).

Videocápsula endoscópica, experiencia de diez meses en el servicio de gastroenterología del HNAAA

La videocápsula endoscópica (VCE) permite el estudio del intestino delgado, solucionando el vacio que existía antes de su aparición. Material y Método. Se revisan 33 casos de pacientes a quienes se realizó VCE en el servicio de Gastroenterología del Hospital Nacional Almanzor Aguinaga Asenjo, entre los meses de junio 2010 a marzo 2011. Resultados. Se encontró que la principal indicación para el examen fue la hemorragia digestiva de origen oscuro, la edad media de solicitud del examen fue de 57 años y el 51,5% de los resultados fueron normales, mientras que el porcentaje restante se distribuyó entre lesiones nodulares de intestino delgado, pólipos y tumoraciones, principalmente. Conclusiones. La VCE es un método seguro, con un mínimo de contraindicaciones que se puede realizar de manera ambulatoria y cuyos hallazgos se complementan con el estudio de enteroscopia de doble balòn, que permite la toma de muestras para el estudio anatomopatológico.(AU)

The video capsule endoscopy (VCE) allows the study of the small bowel, solving the emptiness that was before his appearance. We reviewed 33 cases of patients who underwent VCE in the Service of Gastroenterology in Almanzor Aguinaga Asenjo Hospital between the months of June 2010 to March 2011. It was found that the main indication for the examination was obscure gastrointestinal bleeding, the average age of the review application was 57 years and 51,5% of the results were normal while the remaining percentage was distributed in nodular lesions of small bowel, polyps and tumors, mainly. The VCE is a safe procedure with minimal contraindications that can be performed on an outpatient and whose findings are complemented by the study of double-balloon enteroscopy, which allows sampling for histology.(AU)

Experiencia clínica del uso de la videocápsula endoscópica en el diagnóstico de patología del intestino delgado / Clinical experience of using the video capsule endoscopy (VCE) as a diagnostic method in small intestine pathology

La videocápsula endoscópica (VCE), se introdujo en Colombia en junio de 2003 como método diagnóstico de las enfermedades del intestino delgado; realizamos un estudio observacional, retrospectivo, descriptivo, con 100 pacientes referidos para la práctica de VCE. Objetivos. Presentar la experiencia clínica de la utilización de la VCE en nuestra población, determinar las indicaciones más frecuentes para el estudio del intestino delgado con VCE en nuestro país, definir las patologías encontradas en el grupo de pacientes estudiados, describir los hallazgos de videocápsula en relación a los síntomas de los pacientes. Metodología. Se realizó un análisis descriptivo de las variables identificadas y estudiadas, se analizó el comportamiento de los datos, se calcularon las medidas de tendencia central y de dispersión de las variables en mención. Resultados. En el 97% de los exámenes la indicación fue el estudio del sangrado digestivo oscuro oculto o manifiesto, la patología diagnosticada con mayor frecuencia fue la patología vascular (angiectasias) del intestino delgado, seguida por las patologías inflamatoria (úlceras), parasitaria y tumoral. Conclusiones. El examen de VCE es de gran ayuda en el estudio del sangrado digestivo oscuro ya sea oculto o manifiesto y debe considerarse en nuestro medio de primera elección luego de la realización de endoscopia digestiva alta con visualización de la segunda porción duodenal (2) y de colonoscopia con ileoscopia (2), si el paciente no presenta síntomas obstructivos.

The VCE was introduced in Colombia in June 2003 as a method to diagnose diseases in the small intestine. We ran comprehensive observations with a series of 100 cases and created a retrospective and descriptive study of patients referred to us for the practice of VCE. Objectives. To present the clinical experience in the use of the VCE in our population. To determine the most frequent findings for the study of the small intestine with VCE in our country. To define the pathologies found in the group of patients studied, describe the video capsule findings in relation to the symptoms. Methodology. We conducted a descriptive analysis of the identified and studied variables, looking at the behaviour of the data the central trend and dispersion of the variables was calculated. Results. In 97% of the cases, the indication was for the study of occult or overt obscure digestive bleeding. The most frequent diagnosed pathology was the vascular pathology (angiectasias) of the small intestine; followed by the inflammatory pathology (ulcers) with tumours and parasite. Conclusion. The video capsule endoscopy exam is of great help in the study of obscure digestive bleeding whether it is occult or overt. It should be considered in our country as the primary choice after the upper digestive endoscopy with visualisation of the second duodenal portion (2) and the colonoscopy with ileoscopy (2) if the patient doesn’t present obstructive symptoms.