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Pasha SF, Pennazio M, Rondonotti E, Wolf D, Buras MR, Albert JG, Cohen SA, Cotter J, D'Haens G, Eliakim R, Rubin DT, Leighton JA. Capsule Retention in Crohn's Disease: A Meta-analysis. Inflamm Bowel Dis 2020; 26:33-42. [PMID: 31050736 DOI: 10.1093/ibd/izz083] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The main factor that limits wider utilization of capsule endoscopy (CE) in Crohn's disease (CD) is the potential risk of retention. The aim of this systematic review was to evaluate capsule retention rates in adult and pediatric CD and determine if retention risk is reduced in established CD (ECD) with patency capsule (PC) or magnetic resonance/computed tomography (MR/CT) enterography. METHODS Studies of CD patients undergoing CE that reported retention were identified. Pooled estimates for retention rates and relative risk in ECD to suspected CD (SCD) were calculated. All hypothesis tests were 2-sided; statistical significance was set at a P value of <0.05. RESULTS In the overall CD cohort, retention rates were 3.32% (95% confidence interval [CI], 2.62%-4.2%): 4.63% (95% CI, 3.42%-6.25%) and 2.35% (95% CI, 1.31%-4.19%) in ECD and SCD, respectively. Retention rates were 3.49% (95% CI, 2.73%-4.46%) and 1.64% (95% CI, 0.68%-3.89%) in adult and pediatric CD, respectively. Retention risk in adult ECD was 3.4 times higher than SCD, but there was no difference in retention risk in pediatric ECD compared with SCD. Retention rates in ECD were decreased after patency capsule (2.88%; 95% CI, 1.74%-4.74%) and MR/CT enterography (2.32%; 95% CI, 0.87%-6.03%). CONCLUSIONS In comparison with older literature, this meta-analysis demonstrates lower CE retention rates in SCD and ECD. Retention rates in pediatric CD were lower than in adult CD. Retention rates in adult ECD were higher than SCD, but there were no differences between pediatric ECD and SCD. Retention rates in ECD were lower after negative PC or MR/CT enterography.
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Affiliation(s)
| | - Marco Pennazio
- Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Torino, Italy
| | | | - Douglas Wolf
- Atlanta Gastroenterology Associates, Atlanta, Georgia, USA
| | - Matthew R Buras
- Division of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jörg G Albert
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Stanley A Cohen
- Children's Center for Digestive Health Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jose Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Geert D'Haens
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - David T Rubin
- The University of Chicago Medicine, Chicago, Illinois, USA
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Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc 2017; 85:1157-1168.e2. [PMID: 28069475 DOI: 10.1016/j.gie.2016.12.024] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Video capsule endoscopy (VCE) has become a major diagnostic tool for small-bowel evaluation. However, retention of the video capsule endoscope remains a major concern. METHODS We performed a systematic review of VCE retention rates by using Pubmed and SCOPUS (1995-2015). We included studies that enrolled at least 10 patients, included VCE retention rates, and separated retention rates by indication. We used Comprehensive Meta-Analysis (Version 3.0) to calculate pooled prevalence rates with 95% confidence intervals (CIs) and assessed heterogeneity by using the Cochran Q statistic. RESULTS We included 25 studies (N = 5876) for patients undergoing VCE for evaluation of potential small-bowel bleeding, 9 studies (N = 968) for patients with suspected inflammatory bowel disease (IBD), 11 studies (N = 558) for patients with established IBD, and 8 studies for patients (N = 111) undergoing VCE for evaluation of abdominal pain and/or diarrhea. We used a random effects model and found that the pooled retention rate was 2.1% for patients with suspected small-bowel bleeding (95% CI, 1.5%-2.8%). Retention rates were 3.6% (95% CI, 1.7%-8.6%) for suspected IBD, 8.2% (95% CI, 6.0%-11.0%) for established IBD, and 2.2% (95% CI, 0.9%-5.0%) for abdominal pain and/or diarrhea. Based on subgroup analysis, subsequent VCE completion rates after performance of a patency capsule or CT enterography in patients with IBD to exclude retentions due to strictures was 2.7% (95% CI, 1.1%-6.4%). Reasons for retention were provided in 60 (77%) studies. The most common reasons for retention were small-bowel strictures, although etiology was not provided in all studies. CONCLUSION VCE retention occurs in approximately 2% of patients undergoing evaluation for small-bowel bleeding and is most likely due to small-bowel strictures. Retention rates in patients with suspected or known IBD were approximately 4% and 8%, based on our meta-analysis. These rates decreased by half in those studies that used either a patency capsule or CT enterography to assess patency before performing VCE.
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Le VH, Hernando LR, Lee C, Choi H, Jin Z, Nguyen KT, Go G, Ko SY, Park JO, Park S. Shape memory alloy-based biopsy device for active locomotive intestinal capsule endoscope. Proc Inst Mech Eng H 2016; 229:255-63. [PMID: 25834001 DOI: 10.1177/0954411915576946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recently, capsule endoscopes have been used for diagnosis in digestive organs. However, because a capsule endoscope does not have a locomotive function, its use has been limited to small tubular digestive organs, such as small intestine and esophagus. To address this problem, researchers have begun studying an active locomotive intestine capsule endoscope as a medical instrument for the whole gastrointestinal tract. We have developed a capsule endoscope with a small permanent magnet that is actuated by an electromagnetic actuation system, allowing active and flexible movement in the patient's gut environment. In addition, researchers have noted the need for a biopsy function in capsule endoscope for the definitive diagnosis of digestive diseases. Therefore, this paper proposes a novel robotic biopsy device for active locomotive intestine capsule endoscope. The proposed biopsy device has a sharp blade connected with a shape memory alloy actuator. The biopsy device measuring 12 mm in diameter and 3 mm in length was integrated into our capsule endoscope prototype, where the device's sharp blade was activated and exposed by the shape memory alloy actuator. Then the electromagnetic actuation system generated a specific motion of the capsule endoscope to extract the tissue sample from the intestines. The final biopsy sample tissue had a volume of about 6 mm(3), which is a sufficient amount for a histological analysis. Consequently, we proposed the working principle of the biopsy device and conducted an in-vitro biopsy test to verify the feasibility of the biopsy device integrated into the capsule endoscope prototype using the electro-magnetic actuation system.
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Affiliation(s)
- Viet Ha Le
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | | | - Cheong Lee
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Hyunchul Choi
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Zhen Jin
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Kim Tien Nguyen
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Gwangjun Go
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Seong-Young Ko
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Jong-Oh Park
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Sukho Park
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
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Engineering Micromechanical Systems for the Next Generation Wireless Capsule Endoscopy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:741867. [PMID: 26258143 PMCID: PMC4518149 DOI: 10.1155/2015/741867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/15/2015] [Accepted: 06/24/2015] [Indexed: 02/02/2023]
Abstract
Wireless capsule endoscopy (WCE) enables the detection and diagnosis of inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. However treatment of these pathologies can only be achieved through conventional means. This paper describes the next generation WCE with increased functionality to enable targeted drug delivery in the small intestinal tract. A prototype microrobot fabricated in Nylon 6 is presented which is capable of resisting peristaltic pressure through the deployment of an integrated holding mechanism and delivering targeted therapy. The holding action is achieved by extending an “anchor” spanning a 60.4 mm circumference, for an 11.0 mm diameter WCE. This function is achieved by a mechanism that occupies only 347.0 mm3 volume, including mechanics and actuator. A micropositioning mechanism is described which utilises a single micromotor to radially position and then deploy a needle 1.5 mm outside the microrobot's body to deliver a 1 mL dose of medication to a targeted site. An analysis of the mechanics required to drive the holding mechanism is presented and an overview of microactuators and the state of the art in WCE is discussed. It is envisaged that this novel functionality will empower the next generation of WCE to help diagnose and treat pathologies of the GI tract.
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Kelley SR, Lohr JM. Retained wireless video enteroscopy capsule: a case report and review of the literature. JOURNAL OF SURGICAL EDUCATION 2009; 66:296-300. [PMID: 20005505 DOI: 10.1016/j.jsurg.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 10/08/2009] [Accepted: 10/10/2009] [Indexed: 05/28/2023]
Abstract
Capsule enteroscopy, which is a wireless noninvasive approach to evaluation of the small intestine, consists of an 11 x 26-mm capsule containing a miniature video camera, batteries, illuminating light-emitting diodes, a transmitter, and an antenna. The components inside the capsule are encased by a slippery, nonbiodegradable, plastic housing, which weighs less than 4 g. Information obtained from the imager, approximately 2 frames per second, is transmitted by way of radiotelemetry to an array of sensors taped to the abdomen, which connect to a data recorder worn on a belt around the waist. The batteries are designed to last roughly 7-8 hours, providing enough energy to generate approximately 50,000 to 60,000 detailed images. The clinical review of the imagery is made available after completion of the study when images are downloaded from the data recorder to a computer with dedicated software.
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Affiliation(s)
- Scott R Kelley
- Department of Surgery, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH 45220, USA.
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Repici A, Barbon V, De Angelis C, Luigiano C, De Caro G, Hervoso C, Danese S, Preatoni P, Pagano N, Comunale S, Pennazio M, Rizzetto M. Acute small-bowel perforation secondary to capsule endoscopy. Gastrointest Endosc 2008; 67:180-3. [PMID: 17981271 DOI: 10.1016/j.gie.2007.05.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/31/2007] [Indexed: 12/22/2022]
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Gu JL, Ge ZZ, Gao YJ, Chen HY, Hu YB, Xiao SD. Influence of capsule endoscopy on the clinical outcomes of patients with obscure gastrointestinal bleeding: an analysis of 115 cases. Shijie Huaren Xiaohua Zazhi 2007; 15:3871-3876. [DOI: 10.11569/wcjd.v15.i36.3871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the accuracy of the diagnosis of OGIB by capsule endoscopy and the effectiveness of this technique in obtaining a suitable clinical outcome.
METHODS: From May 2002 to June 2005, 99 patients were enrolled in our study of capsule endoscopy for OGIB. We analyzed the degree of consistency between findings by capsule endoscopy and the clinical results, the outcome of treatments based on its diagnosis, the occurrence of re-bleeds and the re-examinations of the patients through records of consultations, emergencies or hospitalizations and telephone follow-up.
RESULTS: Capsule endoscopy successfully detected 89.9% of cases of OGIB. At a mean follow-up of 18.4 (6-41) months, lesions detected by capsule endoscope in 63 (63.6%) patients were verified. Among these patients, capsule endoscopy accurately diagnosed 90.5% (57/63) of OGIB cases, and this was not significantly different from the accuracy of diagnosis before validation (P = 0.36). Specific interventions were undertaken in 50.5% (50/99) of cases based on the findings of capsule endoscopy. The success rate of these specific strategies was 82% (41/50). Interventions based on positive findings in the small bowel are clearly more effective than those based on probable-positive findings (P = 0.01).
CONCLUSION: Capsule endoscopy has a high accuracy for the diagnosis of OGIB; this technique can efficiently guide further strategies and, in a relatively major proportion of cases, affect the clinical outcomes of these patients, especially bleeding caused by tumors, ulcers and angiodysplasia.
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Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding--enteroscopy and capsule endoscopy. Gastroenterol Clin North Am 2005; 34:719-34. [PMID: 16303579 DOI: 10.1016/j.gtc.2005.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The last frontier in luminal endoscopy has been conquered. Bleeding lesions in the small intestine can present a frustrating clinical problem, but recent advances have made investigating the small bowel easier and less invasive. Capsule endoscopy and double balloon enteroscopy are two new technologies that promise to lower the barrier to evaluation of the entire small intestine. Recent studies show that capsule endoscopy improves outcomes in patients who have OGIB. Although outcome studies regarding double balloon enteroscopy have not been performed, the opportunity to treat lesions throughout the small bowel without resorting to surgery is a tremendous advance. These improvements suggest that the corner may have been turned in the diagnosis and management of small bowel bleeding. Perhaps to the next generation of gastroenterologists, small bowel bleeding will not be obscure.
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Chang PK, Holt EG, De Villiers WJ, Boulanger BR. A New Complication from a New Technology: What a General Surgeon Should Know about Wireless Capsule Endoscopy. Am Surg 2005. [DOI: 10.1177/000313480507100519] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wireless capsule endoscopy has revolutionized the diagnostic evaluation of the small intestine and is increasingly used by gastroenterologists. However, complications can occur with this seemingly safe procedure. We report two cases of Crohn's disease in which capsule endoscopy was performed with retention of the capsules. Both patients were taken to the operating room electively after careful preoperative planning to address both the surgical aspect of Crohn's disease and the retained capsule. We reviewed the literature on the use of wireless capsule endoscopy in patients with Crohn's disease and discuss the approach to a new surgical complication.
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Affiliation(s)
- Phillip K. Chang
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Elizabeth G. Holt
- Division of Gastroenterology, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Willem J.S. De Villiers
- Division of Gastroenterology, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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Abstract
Few advances in the history of gastroenterology have made as dramatic an impact on the diagnosis of gastrointestinal disease as the development and rapid clinical implementation of wireless capsule endoscopy. Less than 4 years after the landmark publication, capsule endoscopy is widely considered an essential component of the diagnostic workup of obscure gastrointestinal bleeding, and its role is expanding in the diagnosis of small bowel diseases such as Crohn's disease. This review appraises the available literature and highlights practical aspects of capsule endoscopy of interest to the clinician. We discuss safety concerns, optimal preparation for the procedure, diagnostic utility as compared to conventional methods, indications for capsule endoscopy, and outcomes.
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Affiliation(s)
- Gil Y Melmed
- Divison of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:2925-2926. [DOI: 10.11569/wcjd.v12.i12.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Sears DM, Avots-Avotins A, Culp K, Gavin MW. Frequency and clinical outcome of capsule retention during capsule endoscopy for GI bleeding of obscure origin. Gastrointest Endosc 2004; 60:822-7. [PMID: 15557969 DOI: 10.1016/s0016-5107(04)02019-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule endoscopy is now commonly performed for GI bleeding of obscure origin. Regional transit abnormality refers to slowed capsule movement during capsule endoscopy. The frequency and clinical outcome of capsule retention and regional transit abnormalities are unknown. METHODS Initial capsule endoscopies performed at a single institution in 52 patients with GI bleeding of obscure origin were reviewed retrospectively. For patients with capsule retention or regional transit abnormality, preprocedural characteristics, and post-procedural outcomes were recorded. OBSERVATIONS Capsule retention occurred in 7 patients, all of whom remained asymptomatic. Regional transit abnormality was noted in 3 patients. Sources of bleeding were localized in all cases. Seven patients underwent surgery. Stricture induced by non-steroidal anti-inflammatory drugs was the major cause of retention. In all patients, anemia resolved during follow-up. CONCLUSIONS Capsule retention and regional transit abnormality occurred in almost 20% of patients who had capsule endoscopy for GI bleeding of obscure origin. These capsule movement abnormalities led to the diagnosis of bleeding sources and thereby influenced patient management. A history of non-steroidal anti-inflammatory drugs use may be associated with an increased risk of capsule retention.
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Affiliation(s)
- Dawn M Sears
- Division of Gastoenterology, Scott and White Memorial Hospital, Texas A&M Health Sciences Center, Temple, USA
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Ge ZZ, Hu YB, Xiao SD. Capsule endoscopy in diagnosis of small bowel Crohn's disease. World J Gastroenterol 2004; 10:1349-52. [PMID: 15112357 PMCID: PMC4622781 DOI: 10.3748/wjg.v10.i9.1349] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 07/20/2003] [Accepted: 08/16/2003] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate the effectiveness of wireless capsule endoscopy in patients with suspected Crohn's disease (CD) of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of M2A Given Capsule. METHODS From May 2002 to April 2003, we prospectively examined 20 patients with suspected CD by capsule endoscopy. The patients had the following features: abdominal pain, weight loss, positive fecal occult blood test, iron deficiency anaemia, diarrhoea and fever. All the patients had normal results in small bowel series (SBS) and in upper and lower gastrointestinal endoscopy before they were examined. Mean duration of symptoms before diagnosis was 6.5 years. RESULTS Of the 20 patients, 13 (65%) were diagnosed as CD of the small bowel according to the findings of M2A Given Capsule. The findings detected by the capsule were mucosal erosions (2 patients), aphthas (5 patients), nodularity (1 patient), large ulcers (2 patients), and ulcerated stenosis (3 patients). The distribution of the lesions was mainly in the distal part of the small bowel, and the mild degree of lesions was 54%. CONCLUSION Wireless capsule endoscopy is effective in diagnosing patients with suspected CD undetected by conventional diagnostic methods. It can be used to detect early lesions in the small bowel of patients with CD.
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Affiliation(s)
- Zhi-Zheng Ge
- Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Second Medical University, Shanghai 200001, China.
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