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Bar-Gil Shitrit A, Koslowsky B, Livovsky DM, Shitrit D, Paz K, Adar T, Adler SN, Goldin E. A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy. Scand J Gastroenterol 2017; 52:328-333. [PMID: 27841040 DOI: 10.1080/00365521.2016.1253769] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD). AIM The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings. PATIENTS AND METHODS Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD. RESULTS Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD. CONCLUSIONS Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE. ClinicalTrials.gov Identifier: NCT01266629.
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Affiliation(s)
| | - Benjamin Koslowsky
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Dan M Livovsky
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - David Shitrit
- b The Department of Pulmonology , Meir Medical Center , Kfar Saba , Israel
| | - Kalman Paz
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Tomer Adar
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Samuel N Adler
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Eran Goldin
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
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Abstract
Multiple imaging modalities exist for inflammatory bowel disease. This article explores the use of plain radiographs, contrast radiologic imaging, computed tomography, MRI, ultrasound, and capsule endoscopy. History, technique, indications for use, limitations, and future directions are discussed for each modality.
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Abstract
Capsule endoscopy (CE) has been increasingly used for diagnosing disease of the small bowel. It is an attractive technique for assessing celiac disease (CD) because it is noninvasive and provides a close and magnified view of the mucosa of the entire small bowel. The aim of this paper is to update the current data on the use of CE for diagnosing villous atrophy and complications of CD.
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Abstract
OBJECTIVE Video capsule endoscopy (VCE) is an important tool for non-invasive imaging of the small bowel. Whether there is a dose-related effect of anemia severity on the diagnostic yield of VCE is unknown. The aim of this study was to determine the influence of anemia severity on VCE outcome measures. METHODS VCE studies from the Sacramento Veterans Affairs Medical Center for 300 consecutive patients were retrospectively screened. Those with anemia were selected. Patients were grouped as mildly, moderately or severely bleeding. Outcomes data including completion of study, diagnostic yield and further intervention were compared. RESULTS Of the 300 patients, 210 (70%) were found to have anemia. Overall 32 (15.24%) patients were mildly, 145 (69.05%) were moderately and 33 (15.71%) were severely bleeding. The diagnostic yield was significantly higher in severe (72.73%) relative to moderate (32.41%) and mild bleeding (12.50%); P = 0.0001. Significantly more angioectasias were detected in severely bleeding patients (42.42%) than in those bleeding moderately (14.48%) and mildly (0.00%), P = 0.0001. The ability of VCE to guide further intervention was significantly higher in patients bleeding severely (69.70%, P = 0.006). CONCLUSIONS Our data showed a significant increase in diagnostic yield with the increasing degree of anemia. Relative difference in hemoglobin rather than absolute values may be a better predictor. The ability of VCE to guide further intervention reached significance in severely bleeding patients. The hypothesis that use of VCE prior to esophagogastroduodenoscopy or colonoscopy in the severely bleeding group deserves to be evaluated.
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Affiliation(s)
- Dhavan A Parikh
- Department of Gastroenterology, UC Davis Medical Center, Sacramento, California 95817-1460, USA.
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Long MD, Barnes E, Isaacs K, Morgan D, Herfarth HH. Impact of capsule endoscopy on management of inflammatory bowel disease: a single tertiary care center experience. Inflamm Bowel Dis 2011; 17:1855-62. [PMID: 21830264 PMCID: PMC3116981 DOI: 10.1002/ibd.21571] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 10/11/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is performed to assess inflammatory bowel disease (IBD). We aimed to define the results of CE in subtypes of IBD and to determine whether CE results in management changes. METHODS A retrospective cohort study was performed of all CEs for IBD at a tertiary care center from 2003-2009. Descriptive statistics were used to compare IBD-specific medications, surgeries, and imaging studies in the 3 months prior and 3 months after CE. RESULTS Of 907 CEs performed from 2003-2009, 128 were for an indication of symptomatic IBD and 124 capsules left the stomach (86 for Crohn's disease [CD], 15 for indeterminate colitis [IC], 23 for pouchitis). Only 22.1% of CEs done for CD were normal, as compared to 53.3% for IC and 34.8% for pouchitis. Severe findings in CD consisted of multiple aphthae/ulcers (22.1%), stenosis (8.1%), and stenosis with immediate retention (17.4%). In CD, 61.6% had a change in medication in the 3 months after the CE, with 39.5% initiating a new IBD medication, most commonly budesonide or corticosteroids. In the 3 months following CE, 12.8% of patients with CD underwent surgery. Severe findings on CE in patients with CD, as compared to no/minimal findings, resulted in significant differences in medication changes (73.2% versus 51.1%, P = 0.04), addition of medications (58.5% versus 22.2%, P < 0.01), and surgeries (21.9% versus 4.4%, P = 0.01). CONCLUSIONS CE results in management changes in the majority of cases of symptomatic IBD, regardless of the subtype of IBD.
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Affiliation(s)
- Millie D. Long
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology
| | - Edward Barnes
- University of North Carolina at Chapel Hill, Department of Medicine
| | - Kim Isaacs
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology
| | - Douglas Morgan
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology
| | - Hans H. Herfarth
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology
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Maglinte DDT, Kohli MD, Romano S, Lappas JC. Air (CO 2) Double-Contrast Barium Enteroclysis. Radiology 2009; 252:633-641. [DOI: 10.1148/radiol.2523081972] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Lam M, Mintchev M. Diamagnetically stabilized levitation control of an intraluminal magnetic capsule. Physiol Meas 2009; 30:763-77. [DOI: 10.1088/0967-3334/30/8/003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ersoy O, Akin E, Ugras S, Buyukasik S, Selvi E, Güney G. Capsule endoscopy findings in celiac disease. Dig Dis Sci 2009; 54:825-9. [PMID: 18649134 DOI: 10.1007/s10620-008-0402-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Accepted: 06/18/2008] [Indexed: 12/12/2022]
Abstract
Capsule endoscopy (CE) is a noninvasive imaging method used to evaluate intestinal mucosa. We aimed to examine intestinal mucosal changes in celiac disease (CD) with CE. Eight untreated patients who had anti-endomysial antibody-positive duodenal biopsy results consistent with CD were included in the study. Villous atrophy, scalloping, fissuring, and mosaic pattern (consistent with CD) were detected in seven patients; one patient was excluded for early meal consumption. No patchy involvement was found in the intestine or distal region of the intestine (ileum) in any of the patients. The common feature of all patients was that villous atrophy, scalloping, fissuring, and mosaic patterns detected in the proximal intestine gradually decreased towards the distal intestine. CE provided no diagnostic contribution to CD when compared with duodenal biopsy. It can be used to show villous atrophy in selected cases and to evaluate the extension of intestinal involvement in CD.
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Affiliation(s)
- Osman Ersoy
- Department of Gastroenterology, Ataturk Education and Research Hospital, Bilkent, Ankara, 06300, Turkey.
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Sidhu R, Sanders DS, Thomson M, McAlindon ME. Is this the end of an era for conventional diagnostic endoscopy? Clin Med (Lond) 2009; 9:39-41. [PMID: 19271599 PMCID: PMC5922630 DOI: 10.7861/clinmedicine.9-1-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- R Sidhu
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield.
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Capability of capsule endoscopy in detecting small bowel ulcers. Dig Dis Sci 2009; 54:136-41. [PMID: 18536988 DOI: 10.1007/s10620-008-0320-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 05/06/2008] [Indexed: 12/15/2022]
Abstract
Capsule endoscopy (CE) has proved to be the preferred modality for mucosal pathologies of the small bowel. We evaluated the capability of CE for detecting small bowel ulcers and the contribution of CE in establishing the diagnosis. From a total of 66 patients who had undergone normal upper and lower endoscopy and small bowel follow-through, CE revealed previously undiagnosed ulcer(s) in the small intestines of 22 patients. Final diagnoses of the ulcers of these 22 patients were Crohn's disease (n = 9), Behçet's disease (n = 2), nonspecific jejunoileitis (n = 2), vasculitis (n = 1), gastrointestinal stromal tumor (n = 1), adenocarcinoma (n = 1), lymphoma (n = 1), multiple myeloma (n = 1), Meckel's diverticulum (n = 1) and unknown (n = 3). Capsule endoscopy was extremely useful in establishing the diagnosis. In this study, proximal, distal and diffuse small bowel ulcers were determined at rates of 27.3, 59.0 and 13.7%, respectively. Capsule endoscopy facilitated the detection and assessment of ulcerated mucosal lesions located in the small bowel.
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Toy E, Rojany M, Sheikh R, Mann S, Prindiville T. Capsule endoscopy's impact on clinical management and outcomes: a single-center experience with 145 patients. Am J Gastroenterol 2008; 103:3022-8. [PMID: 19086954 DOI: 10.1111/j.1572-0241.2008.02154.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is a new technology that has been shown to have superior diagnostic yield compared with other methods of evaluating the small bowel. However, there have not been many studies supporting capsule endoscopy's impact on clinical outcomes. This study is a chart review evaluating the diagnostic yield and the impact of CE on management and clinical outcomes. METHODS Retrospective chart review was performed on 145 patients who had undergone capsule endoscopy. Demographic characteristics, indication, prior diagnostic tests, capsule findings, interventions, and clinical outcomes up to 8 months following CE were evaluated. Indications included five main categories that were overt gastrointestinal (GI) bleed, occult GI bleed, abdominal pain, Crohn's disease, and iron deficiency anemia. Findings on capsule endoscopy were classified into angiodysplasias, ulcers, gastritis and/or duodenitis, ulcers suggestive of Crohn's and normal findings. Interventions performed based on capsule findings were recorded, which included the discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDS), further diagnostic or therapeutic studies, increase in medications, and surgery. Positive outcomes including stabilization or improvement of hemoglobin, decreased need for transfusions, improved symptoms of pain, and a decrease in medications based on interventions were assessed. RESULTS There were 145 patients who underwent CE. The indications for CE were overt GI bleed (38%), occult GI bleed (22%), abdominal pain (20%), Crohn's (12%), iron deficiency anemia (2.7%), and miscellaneous (4%). Eighty percent achieved completion and 6 patients had complications of capsule retention with 4 requiring surgery. The overall diagnostic yield was 69% and included findings of angiodysplasias (24%), intestinal ulcers (13%) gastritis or duodenitis (13.8%), ulcers suggestive of Crohn's disease (8.9%), and mass or polyp (3.4%). Based on capsule findings, 35.8% of patients had an intervention. Of the patients who received intervention, 71.7% had a positive clinical outcome (P= 0.032). CONCLUSIONS The high diagnostic yield of CE influences clinical management leading to improved outcomes. However, the utility of CE may be greater in patients who are referred for certain indications or have specific findings. Additional studies are needed to clarify the role of capsule endoscopy in the evaluation of various indications as well as identify factors associated with positive outcomes.
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Affiliation(s)
- Elaine Toy
- Division of Medicine and Gastroenterology, Kaiser Permanente, Sacramento, California 95825, USA
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Impact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients. Eur J Gastroenterol Hepatol 2008; 20:971-7. [PMID: 18787463 DOI: 10.1097/meg.0b013e3282fb2a53] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) sensitively detects the bleeding source in the small bowel. However, the influence of CE on long-term outcome is not well established. METHODS In five tertiary hospitals, all CE investigations were retrospectively identified dating back to 3 years. Patients with intestinal bleeding and negative bidirectional endoscopy were included, and relapse of bleeding was recorded. RESULTS A bleeding source was detected in 219 of 285 patients (76.8%); CE provided the diagnosis in 175 of 219 (79.9%) and other, repeated investigations in 44 cases (20.1%). Follow-up (mean+/-SD=20.7+/-9.4 months) in 240 patients identified rebleeding in 65 (27.1%), and readmission to a hospital in 42 (17.5%). Hospital readmission was most frequent in patients with angiectasias (31.3%, relative risk (RR)=5.0; 95% confidence interval (CI)=2.4-10.4). Other risk factors included patients being older than 60 years of age (RR=3.8; 95% CI=1.5-9.5), and anticoagulant medication (RR=3.0; 95% CI=1.5-6.0). Therapeutic measures had a mean recurrence rate of 3.7% in surgical candidates (Meckel's diverticulum, tumor), 40% in endoscopically treated and 16% in medically treated patients. In case all the detected angiectasias had been cauterized, the relapse rate was low (11.8%), but in incompletely treated patients, it was high (85.7%). Bleeding relapse was never lethal. CONCLUSION CE guides therapeutic measures and predicts the risk of recurrent bleeding in small intestinal bleeding. High risk of rebleeding in angiectasias is significantly reduced by the cauterization of all demonstrable lesions.
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Sandrasegaran K, Maglinte DDT, Jennings SG, Chiorean MV. Capsule endoscopy and imaging tests in the elective investigation of small bowel disease. Clin Radiol 2008; 63:712-23. [PMID: 18455564 DOI: 10.1016/j.crad.2008.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 01/02/2008] [Accepted: 01/20/2008] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy enables high-resolution depiction of small bowel mucosa and has been shown, by several studies, to have a high diagnostic yield in a variety of small bowel diseases. In this review, we critically assess the contributions of capsule endoscopy and imaging tests in common small bowel disorders. Radiological tests that only assess the small bowel mucosa will be less useful in the era of capsule endoscopy.
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Affiliation(s)
- K Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, USA.
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15
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Chan FS, Chu KM. Capsule Endoscopy for Gastrointestinal Bleeding of Obscure Origin. Asian J Surg 2008; 31:96-9. [DOI: 10.1016/s1015-9584(08)60066-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Rondonotti E, Villa F, Mulder CJJ, Jacobs MAJM, de Franchis R. Small bowel capsule endoscopy in 2007: indications, risks and limitations. World J Gastroenterol 2008. [PMID: 18069752 DOI: 10.3748/wjg.13.6140] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions). The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).
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Affiliation(s)
- Emanuele Rondonotti
- Universuta degli Studi di Milano, IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena, Unita Operativa di Gastroenterologia 3, Via Pace 9, Milano 20122, Italy.
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Bruining DH, Loftus EV. Technology Insight: new techniques for imaging the gut in patients with IBD. ACTA ACUST UNITED AC 2008; 5:154-61. [PMID: 18212778 DOI: 10.1038/ncpgasthep1028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/29/2007] [Indexed: 12/12/2022]
Abstract
Advances in techniques for imaging the gut continue to drive the rapid development of modalities for diagnosing and assessing the activity of IBD. Abdominal ultrasound and magnetic resonance enterography have shown great potential for the diagnosis of IBD and assessment of its distribution, with the benefit of avoiding radiation exposure and serving as a safe option for pregnant patients. CT enterography or CT enteroclysis, with neutral or negative contrast, seems to be a sensitive and specific modality for detecting disease in the small bowel. The role of CT or magnetic resonance colonography in patients with IBD remains uncertain and these modalities are now best reserved for patients who decline or cannot undergo standard endoscopic evaluations. Capsule endoscopy might be the most sensitive modality for the detection of mucosal small bowel disease, but its specificity remains in question. Double-balloon endoscopy is an exciting new tool that has the distinct advantage of enabling biopsy or treatment of lesions detected during the procedure. All these techniques are at the forefront of the rapidly evolving field of imaging the gut in patients with IBD.
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Affiliation(s)
- David H Bruining
- Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Spada C, Riccioni ME, Familiari P, Marchese M, Bizzotto A, Costamagna G. Video capsule endoscopy in small-bowel tumours: a single centre experience. Scand J Gastroenterol 2008; 43:497-505. [PMID: 18365916 DOI: 10.1080/00365520701797256] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Early diagnosis of small-bowel tumours is crucial for curative surgery. Although videocapsule endoscopy (VCE) has improved the diagnosis of small-bowel diseases, there are few data about the role of this examination in small-bowel malignancies. The aim of this study was to evaluate the diagnostic yield of VCE in small-bowel malignancies. MATERIAL AND METHODS From March 2001 to July 2006, 380 patients were studied by VCE in our centre. Data on 13 consecutive patients (3.4%) affected by small-bowel malignancy were retrospectively assessed from a prospectively collected database. Indications for VCE were: obscure gastrointestinal bleeding in 9 patients (70%), abdominal pain, coeliac disease, long-lasting fever and hepatic metastasis in the other 4 patients, respectively, (7.5%). Before VCE, patients had undergone 65 procedures, including oesophagogastroduodenoscopy, colonoscopy, push-enteroscopy, small-bowel radiographies, abdominal CT scanning, nuclear medicine bleeding-scan, positron emission tomography and octreoscan. RESULTS VCE detected jejunal polyps in 6 patients (46.2%), ulcerated stricture in 3 (23%), and erosions, stricture with ileal inflammation, submucosal nodule and active bleeding in 4 patients, respectively. The diagnosis was confirmed after surgery in 11 cases. One patient died of ischaemic myocardial infarction 3 days after VCE, before surgery. Histological examination showed lymphoma (n=3), small-bowel metastasis from colonic carcinoma (n=3), carcinoid tumour (n=3), gastrointestinal stromal tumour (GIST) (n=2), metastatic melanoma (n=1) and primary small-bowel adenocarcinoma (n=1). VCE had an influence on the diagnosis or management of 10/13 patients. CONCLUSIONS VCE is the diagnostic test with the highest yield for small-bowel malignancies, since it can detect small-bowel tumours that are often missed by traditional examinations.
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Lam M, Mintchev MP. Diamagnetically-stabilized levitation control of an intraluminal magnetic capsule. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:5615-5619. [PMID: 19163990 DOI: 10.1109/iembs.2008.4650487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Controlled navigation promotes full utilization of capsule endoscopy for reliable real-time diagnosis in the gastrointestinal (GI) tract, but intermittent natural peristalsis can disturb the navigational control, destabilize the capsule and take it out of levitation. A real-size magnetic navigation system that can handle peristaltic forces of up to 1.5 N was designed utilizing the computer-aided design (CAD) system Maxwell 3D (Ansoft, Pittsburg, PA), and was verified using a small-size physical experimental setup. The proposed system contains a pair of 50-cm in diameter, 10,000-turns copper electromagnets with a 10-cm by 10-cm ferrous core driven by currents of up to 300 Amperes and can successfully maintain position control over the levitating capsule during peristalsis. The addition of Bismuth diamagnetic casing for stabilizing the levitating capsule was also studied.
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Affiliation(s)
- Michael Lam
- Department of Electrical and Computer Engineering, University of Calgary, Alberta, Canada T2N1N4
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Rondonotti E, Villa F, Mulder CJJ, Jacobs MAJM, Franchis RD. Small bowel capsule endoscopy in 2007: indications, risks and limitations. World J Gastroenterol 2007; 13:6140-9. [PMID: 18069752 PMCID: PMC4171222 DOI: 10.3748/wjg.v13.i46.6140] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/25/2007] [Accepted: 10/26/2007] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions). The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).
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Bruining DH, Loftus EV. Current and future diagnostic approaches: from serologies to imaging. Curr Gastroenterol Rep 2007; 9:489-496. [PMID: 18377802 DOI: 10.1007/s11894-007-0065-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Advances in serologic markers and imaging modalities continue to revolutionize diagnostic approaches to inflammatory bowel disease (IBD). Autoimmune and antimicrobial antibodies demonstrate diagnostic value in those patients with a moderate pretest probability of disease. Emerging data also support the use of antimicrobial antibody levels as a predictive tool for small bowel complications and the need for future surgery. In addition to being a prognostic marker in patients with acute severe colitis, serum C-reactive protein has been shown to correlate with clinical, endoscopic, and radiologic measures of disease activity. Capsule endoscopy and double-balloon endoscopy allow for visualization of the entire small bowel, and double-balloon endoscopy also has the capability to treat lesions. CT enterography is beginning to replace small bowel follow-through because of its high sensitivity and specificity for disease of the small intestine. Both CT and magnetic resonance enterography detect luminal and extraluminal abnormalities, with MRI serving as a safe imaging option in cases of pregnancy and renal insufficiency. These newer modalities add to the armamentarium clinicians can use for evaluation of IBD.
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Affiliation(s)
- David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
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CT features of jejunal pathology. Clin Radiol 2007; 62:1154-62. [PMID: 17981162 DOI: 10.1016/j.crad.2007.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 05/11/2007] [Accepted: 05/16/2007] [Indexed: 12/21/2022]
Abstract
The imaging of duodenal and ileal diseases is well documented in radiological literature but the jejunum has been relatively neglected. The aim of this review is to outline the current methods of investigation of the jejunum, and provide a comprehensive review of common pathologies affecting the jejunum, with particular emphasis on investigation by computed tomography.
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Maglinte DDT, Sandrasegaran K, Chiorean M, Dewitt J, McHenry L, Lappas JC. Radiologic Investigations Complement and Add Diagnostic Information to Capsule Endoscopy of Small-Bowel Diseases. AJR Am J Roentgenol 2007; 189:306-12. [PMID: 17646455 DOI: 10.2214/ajr.07.2253] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of our study was to review how commonly performed radiologic examinations compare with capsule endoscopy in the investigation of small-bowel diseases, to analyze the limitations of capsule imaging, and to propose an algorithm for use of specific radiologic examinations to complement wireless capsule endoscopy. CONCLUSION The diagnostic yield of capsule endoscopy is superior to that of radiologic examinations except air double-contrast enteroclysis for mucosal details. Radiologic investigations find new applications in clinical practice by complementing capsule endoscopy to overcome its limitations.
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine and Indiana University Hospital, 550 N University Blvd., UH 0279, Indianapolis, IN 46202-5253, USA.
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Abstract
Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.
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Affiliation(s)
- Osman Ersoy
- Hacettepe University, School of Medicine, Department of Gastroenterology, Ankara 06100, Turkey
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25
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Ersoy O, Sivri B, Arslan S, Batman F, Bayraktar Y. How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions? World J Gastroenterol 2006; 12:3906-10. [PMID: 16804980 PMCID: PMC4087943 DOI: 10.3748/wjg.v12.i24.3906] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions.
METHODS: Capsule endoscopic (CE) examination by using M2A capsule endoscope TM (Given Imaging, Yoqneam, Israel) was performed in thirty nine patients (26 males, 13 females) with suspected small intestinal lesions. The composing of the patients was as follows: obscure gastrointestinal bleeding in twenty three patients, known Crohn’s disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin.
RESULTS: In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding (73.9%). Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn's disease, CE revealed better evaluation of the disease extension. In 3 of 8 (37.5%) patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal.
CONCLUSION: In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn’s disease.
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Affiliation(s)
- Osman Ersoy
- Hacettepe University, School of medicine, Department of Gastroenterology, Ankara, Turkey
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Rajesh A, Maglinte DDT. Multislice CT enteroclysis: technique and clinical applications. Clin Radiol 2006; 61:31-9. [PMID: 16356814 DOI: 10.1016/j.crad.2005.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 07/26/2005] [Accepted: 08/03/2005] [Indexed: 11/15/2022]
Abstract
Computed tomography (CT) enteroclysis was introduced to overcome the individual deficiencies of barium enteroclysis and abdominal CT. The use of multislice CT technology has made the procedure a feasible extension of the intubation infusion method of small bowel examination. This review is an update of the technique and clinical application of CT enteroclysis with illustrations.
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Affiliation(s)
- A Rajesh
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
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27
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Maglinte DDT. Small bowel imaging- a rapidly changing field and a challenge to radiology. Eur Radiol 2006; 16:967-71. [PMID: 16395533 DOI: 10.1007/s00330-005-0054-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 10/03/2005] [Accepted: 10/07/2005] [Indexed: 12/16/2022]
Abstract
There was a time when the small bowel follow-through (SBFT) was the primary method of diagnosing diseases of the small intestine. Enteroclysis was reinvented in the 70's and with the SBFT remained the dominant methods of investigating the mesenteric small intestine to the late 90's. Since the introduction of the first commercial computed tomography (CT) scanner in 1973, the ability of monoslice CT to diagnose different causes of intestinal obstruction and inflammatory bowel diseases emerged. The introduction of helical CT technology in 1989 and subsequently multichannel CT further changed small bowel imaging. Faster acquisition of a large volume of data with thinner collimation allowed multiplanar reformatting a distinct advantage in evaluating an organ which is longer than wide. The introduction of magnetic resonance (MR) imaging with its increased soft tissue contrast, lack of ionizing radiation, and the ability to acquire ultrafast sequences has made MR imaging an important tool in small bowel imaging (1).
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine, 550 N. University Blvd, UH 0279, Indianapolis, 46202-5253, USA.
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Kodsi R, Tangorra M, Mayer I, Li JJ, Tenner S. Rapid alternating recorder exchange in capsule endoscopy allows early detection of bleeding source in acute GI bleeding of obscure origin. Gastrointest Endosc 2005; 62:982-4. [PMID: 16301052 DOI: 10.1016/j.gie.2005.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 08/23/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Robert Kodsi
- Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Mount Sinai School of Medicine, Brooklyn, NY 11219, USA
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29
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Maglinte DDT. Capsule imaging and the role of radiology in the investigation of diseases of the small bowel. Radiology 2005; 236:763-7. [PMID: 16118159 DOI: 10.1148/radiol.2363041868] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Tacheci I, Rejchrt S, Drastich P, Lata J, Stehlik J, Novotny A, Spicak J, Dite P, Zavoral M, Lukas M, Bures J. Endoscopie par capsule — expérience initiale en République tchèque: étude rétrospective multicentrique. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf03003280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Capsule endoscopy represents a significant advance in the investigation of small bowel diseases and the beginning of wireless endoscopic imaging. Capsule endoscopy involves swallowing a video capsule endoscope, which is painless and relatively safe. Its use has been established for suspected small bowel bleeding, and the role of capsule endoscopy in the investigation of inflammatory bowel disease, iatrogenic disease, polyposis syndromes and coeliac disease is evolving. It is likely that in many instances it will become the next test after standard endoscopic evaluation. Early data suggest that capsule endoscopy improves outcome in patients with suspected small bowel bleeding, but more data are required on outcomes for the other indications.
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Affiliation(s)
- M L Remedios
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia
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