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Kasia C, Appannagari A, Joshi A, Venu M. Safety of wireless capsule endoscopy in patients with implantable cardiac devices. JGH Open 2020; 4:241-244. [PMID: 32280771 PMCID: PMC7144758 DOI: 10.1002/jgh3.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 01/12/2023]
Abstract
Background and Aim Wireless capsule endoscopy (WCE) has become an increasingly utilized imaging modality for the evaluation of gastrointestinal bleeding. There is a paucity of data evaluating the safety and use of WCE in patients with implantable cardiac devices. Methods A retrospective chart review of all patients who had a WCE at Loyola University Medical Center in Maywood, IL, USA completed between January 2007 and December 2016 identified patients with internal cardiac devices and obscure gastrointestinal bleeding. Patient WCE footage was viewed in its entirety before creating a final report to ensure no gaps in footage and video quality. Results No patient complaints were documented during the 8‐h procedure duration, and there were no cardiac abnormalities noted on telemetry. There were no device‐related complications documented in the 30‐day postprocedure time period. Postprocedure analysis of the WCE recordings demonstrated no interference in WCE image quality (loss of images or gaps in video) or duration. Conclusions There is no significant interference between WCE and implantable cardiac devices, and it appears to be safe to use.
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Affiliation(s)
- Christopher Kasia
- Department of Internal MedicineLoyola University Medical Center Maywood Illinois USA
| | - Anoop Appannagari
- Division of Gastroenterology and NutritionLoyola University Medical Center Maywood Illinois USA
| | - Anjali Joshi
- Division of CardiologyLoyola University Medical Center Maywood Illinois USA
| | - Mukund Venu
- Division of Gastroenterology and NutritionLoyola University Medical Center Maywood Illinois USA
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2
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Abstract
Small bowel bleeding accounts for 5-10% of gastrointestinal bleeding. With the advent of capsule endoscopy, device-assisted enteroscopy, and multiphase CT scanning, a small bowel source can now be found in many instances of what has previously been described as obscure gastrointestinal bleeding. We present a practical review on the evaluation and management of small bowel bleeding for the practicing clinician.
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Shim KN, Jeon SR, Jang HJ, Kim J, Lim YJ, Kim KO, Song HJ, Lee HS, Park JJ, Kim JH, Chun J, Park SJ, Yang DH, Min YW, Keum B, Lee BI. Quality Indicators for Small Bowel Capsule Endoscopy. Clin Endosc 2017; 50:148-160. [PMID: 28391667 PMCID: PMC5398361 DOI: 10.5946/ce.2017.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, “Quality Indicators for Small Bowel Capsule Endoscopy” under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.
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Affiliation(s)
- Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine,Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
| | - Jinsu Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bora Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bo-In Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Bandorski D, Kurniawan N, Baltes P, Hoeltgen R, Hecker M, Stunder D, Keuchel M. Contraindications for video capsule endoscopy. World J Gastroenterol 2016; 22:9898-9908. [PMID: 28018097 PMCID: PMC5143757 DOI: 10.3748/wjg.v22.i45.9898] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/09/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.
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Moneghini D, Lipari A, Missale G, Minelli L, Cengia G, Bontempi L, Curnis A, Cestari R. Lack of interference between small bowel capsule endoscopy and implantable cardiac defibrillators: an 'in vivo' electrophysiological study. United European Gastroenterol J 2016; 4:216-20. [PMID: 27087949 PMCID: PMC4804376 DOI: 10.1177/2050640615608570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/01/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Capsule endoscopy is a widely performed procedure for small bowel investigation. Once swallowed by the patient, the capsule transmits images to an external recorder over a digital radiofrequency communication channel. Potential electromagnetic interferences with implantable cardiac devices have been postulated. Clinical studies on the safety of capsule endoscopy in patients with cardiac defibrillators are lacking. OBJECTIVE The aim of this study was to assess potential mutual electromagnetic interferences between capsule and defibrillators. METHODS This study used the Given M2A video capsule system. Ten different types of defibrillators were tested in a clinical setting. Before capsule ingestion, defibrillator electrical therapies were switched off. During capsule endoscopy patients were monitored with cardiac telemetry. At the end of capsule endoscopy the following defibrillator's parameters were analysed: change in device settings; inappropriate shocks; inappropriate anti-tachycardia therapy; inappropriate sensing or pacing; noise detection; device reset; programming changes; permanent electrical damages. Any technical problem related to capsule image transmission was recorded. RESULTS Neither defibrillator malfunction nor interference in sensing or pacing was recorded; conversely, no capsule malfunction potentially caused by defibrillators was registered. CONCLUSION Our results suggest that capsule endoscopy can be safely performed in patients with cardiac defibrillators.
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Affiliation(s)
- Dario Moneghini
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Alessandro Lipari
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Guido Missale
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luigi Minelli
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Gianpaolo Cengia
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luca Bontempi
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Antonio Curnis
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Renzo Cestari
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
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Stanich PP, Kleinman B, Betkerur K, Mehta Oza N, Porter K, Meyer MM. Video capsule endoscopy is successful and effective in outpatients with implantable cardiac devices. Dig Endosc 2014; 26:726-30. [PMID: 24673381 DOI: 10.1111/den.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/19/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Implantable cardiac devices are a relative contraindication to video capsule endoscopy (VCE) because of concerns regarding interference. As a result of a lack of alternatives, some centers have adopted protocols to allow for VCE in these patients. There are minimal published descriptions of the gastrointestinal outcomes of these procedures. We investigated the completion rate and diagnostic yield of VCE carried out in outpatients with implantable cardiac devices. METHODS We carried out a retrospective review of all VCE from April 2010 through March 2013 at our center. Patients that underwent VCE through a specialized protocol for outpatients with implantable cardiac devices were identified. The protocol used telemetry for cardiac monitoring during battery lifespan of the VCE. Demographic data, procedure indications, results and any procedural events were collected. RESULTS Twenty-one patients met the study criteria, with 16 (76%) pacemakers, four (19%) implantable cardioverter defibrilla tors and one (5%) implantable hemodynamic monitor. Two (10%) devices were adjusted prior to VCE. Twenty (95%) were completed to the colon, with a median gastric transit time of 18 min and a small bowel transit time of 216 min. The procedure was diagnostic in 13 (62%) patients. One (5%) capsule retention event occurred. No cardiac events or video capture disturbances occurred. CONCLUSIONS Video capsule endoscopy done on outpatients with implantable cardiac devices through a cardiac monitoring protocol resulted in a satisfactory completion rate and high diagnostic yield with no adverse cardiac events. A large prospective trial is needed to confirm these novel results.
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Affiliation(s)
- Peter P Stanich
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, USA
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Wang A, Banerjee S, Barth BA, Bhat YM, Chauhan S, Gottlieb KT, Konda V, Maple JT, Murad F, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Rodriguez SA. Wireless capsule endoscopy. Gastrointest Endosc 2013; 78:805-815. [PMID: 24119509 DOI: 10.1016/j.gie.2013.06.026] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 02/07/2023]
Abstract
Over the last decade, WCE has established itself as a valuable test for imaging the small intestine. It is a safe and relatively easy procedure to perform that can provide valuable information in the diagnosis of small-bowel conditions. Its applications still remain limited within the esophagus and colon. Future developments may include improving visualization within the esophagus and developing technologies that may allow manipulation of the capsule within the GI tract and biopsy capabilities.
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8
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Dye CE, Gaffney RR, Dykes TM, Moyer MT. Endoscopic and radiographic evaluation of the small bowel in 2012. Am J Med 2012; 125:1228.e1-1228.e12. [PMID: 23062406 DOI: 10.1016/j.amjmed.2012.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 06/26/2012] [Accepted: 06/26/2012] [Indexed: 02/08/2023]
Abstract
Traditionally, the diagnosis of small bowel disorders has been challenging secondary to the small intestine's length, tortuosity, and anatomic location. Recent technologic advancements in the field of enteroscopy and radiographic imaging have facilitated a more thorough endoscopic evaluation of patients with small bowel disease ranging from obscure gastrointestinal bleeding to inflammatory bowel disease and small bowel tumors. Such developments have made it possible to avoid invasive surgical procedures in certain clinical scenarios where they were previously the gold standard. In this review, we report an update on the diagnostic and management approach to patients with small bowel disease, emphasizing the advantages and limitations of the latest modalities now available to primary care physicians and gastroenterologists for evaluating patients with presumed disease of the small intestine.
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Affiliation(s)
- Charles E Dye
- Division of Gastroenterology/Hepatology, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Cuschieri JR, Osman MN, Wong RC, Chak A, Isenberg GA. Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review. World J Gastrointest Endosc 2012; 4:87-93. [PMID: 22442746 PMCID: PMC3309898 DOI: 10.4253/wjge.v4.i3.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/01/2012] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).
METHODS: Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008. authors searched for unexplained electrocardiogram (ECG) findings, changes in CP and ICD set parameters, any abnormality in transmitted capsule data, and adverse clinical events.
RESULTS: There were no adverse events or hemodynamically significant arrhythmias reported. CP and ICD set parameters were preserved. The majority of ECG abnormalities were also found in pre- or post- SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate. Two patients seemed to have episodes of undersensing by the CP. However, similar findings were documented in ECGs taken outside the time frame of the SBCE. One patient was observed to have a low signal encountered from the capsule resulting in lack of localization, but no images were lost.
CONCLUSION: Capsule-induced EMI remains a possibility but is unlikely to be clinically important. CP-induced interference of SBCE is also possible, but is infrequent and does not result in loss of images transmitted by the capsule.
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Affiliation(s)
- Justin R Cuschieri
- Justin R Cuschieri, Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5401 Old York Road, Klein building suite 363, Philadelphia, PA 19141, United States
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10
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Bandorski D, Jakobs R, Brück M, Hoeltgen R, Wieczorek M, Keuchel M. Capsule Endoscopy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators: (Re)evaluation of the Current State in Germany, Austria, and Switzerland 2010. Gastroenterol Res Pract 2011; 2012:717408. [PMID: 22253620 PMCID: PMC3255108 DOI: 10.1155/2012/717408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/11/2011] [Indexed: 01/01/2023] Open
Abstract
Background and Aims. The study was a repeated evaluation of the experience of capsule endoscopy (CE) in patients with cardiac pacemaker or implantable cardioverter defibrillator (ICD). Patients and Methods. A standardized questionnaire was sent by the manufactors Given Imaging and Olympus to all centers in Germany, Austria, and Switzerland providing capsule endoscopy service. The questionnaire covers the number of examined patients, monitoring during CE, check of the electric implants before and after CE, occurrence of arrhythmia, quality of CE video, complications, indication of CE, and type of institution. Results. Overall 580 questionnaires were sent to the users. 26/5% (Germany/Austria + Switzerland) of the questionnaires were sent back anonymously to the authors. 114 centers (82 hospitals, 11 surgeries, 21 without specification) replied. In 58 centers (51%), patients with cardiac pacemaker (n = 300) and ICDs (n = 80) underwent uneventful capsule endoscopy. The predominant indication (patients with CP 97%, patients with ICD 100%) was mid gastrointestinal bleeding. Conclusion. The results of our inquiry show that in spite of formal contraindication CE is increasingly applied in bleeding patients with cardiac pacemakers/ICDs and seems to be safe even in a large cohort.
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Affiliation(s)
- Dirk Bandorski
- Medizinische Klinik 2, Universitätsklinikum Gießen, Klinikstraße 32, 35392 Gießen, Germany
- Herz-/Kreislaufzentrum Rotenburg, Heinz-Meise-Straße 100, 36199 Rotenburg, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen, Germany
| | - Martin Brück
- Medizinische Klinik 1, Klinikum Wetzlar, Forsthausstraße 1, 35578 Wetzlar, Germany
| | - Reinhard Hoeltgen
- Medizinische Klinik III, Herzzentrum Duisburg, Gerrickstraße 21, 47137 Duisburg, Germany
| | - Marcus Wieczorek
- Medizinische Klinik III, Herzzentrum Duisburg, Gerrickstraße 21, 47137 Duisburg, Germany
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029 Hamburg, Germany
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11
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Hudák J. [Digestive system endoscopy in the elderly and in patients with severe comorbidities]. Orv Hetil 2011; 152:2078-85. [PMID: 22155515 DOI: 10.1556/oh.2011.29242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Besides the technical equipment, the endoscopic team's theoretical and practical skills, the success of endoscopic intervention is influenced by the patient's general condition. Advanced age, severe co-morbidities may increase the risk, especially in case of operative endoscopy. The decision is more complicated when alarm symptoms urge the examination. The endoscopic examination of digestive system, biliary track and pancreas in advanced age can safely be performed as alternatives of surgical intervention. It is important to know the exact stage of cardiovascular and pulmonary diseases, besides, in case of stroke the patient's cooperation is very important. In everyday practice the most common problems are the endoscopic examination of the patient in oral anticoagulant and/or thrombocyte aggregation inhibition therapy and the question of suspending, modifying or restarting the therapy. Examining the patients with implanted electronic device as well as antibiotic prophylaxis in expanding range of indications are special issues. The gastroenterologist makes the decision based on the knowledge of the endoscopic intervention, the patient's risk classification, the indications, the contradictions and the alternative diagnostic possibilities. This review attempts to give an overview with some practical aspects.
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Affiliation(s)
- János Hudák
- Városi Önkormányzat Kórháza Belgyógyászat-Gasztroenterológia Orosháza Könd u. 59. 5900.
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Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management. Heart Rhythm 2011; 8:1114-54. [DOI: 10.1016/j.hrthm.2010.12.023] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/26/2022]
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Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators, and left heart devices: a review of the current literature. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:376053. [PMID: 21603020 PMCID: PMC3095403 DOI: 10.1155/2011/376053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 02/27/2011] [Indexed: 12/16/2022]
Abstract
Background and Study Aims. Capsule endoscopy is an established tool for investigation of the small intestine. Because of limited clinical experience in patients with cardiac devices, the Food and Drug Administration and the manufacturer recommended not to use capsule endoscopy in these patients. The vast majority of investigations did not reveal any interference between capsule endoscopy and cardiac devices. Methods. Studies investigating interference between CE and cardiac devices were analysed. For the review we considered studies published in English or German and indexed in Medline, as well as highly relevant abstracts. Results. In vitro and in vivo studies mainly revealed no interference between capsule endoscopy and cardiac devices. Technical data of capsule endoscopy (Given Imaging) reveal that interference with cardiac pacemakers and implantable cardioverter defibrillator is impossible. Telemetry can interfere with CE video. Conclusion. The clinical use of capsule endoscopy (Given Imaging) is unproblematic in patients with cardiac pacemakers.
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14
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Costa PD, Rodrigues PP, Reis AH, Costa-Pereira A. A review on remote monitoring technology applied to implantable electronic cardiovascular devices. Telemed J E Health 2010; 16:1042-50. [PMID: 21070132 DOI: 10.1089/tmj.2010.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Implantable electronic cardiovascular devices (IECD) include a broad spectrum of devices that have the ability to maintain rhythm, provide cardiac resynchronization therapy, and/or prevent sudden cardiac death. The incidence of bradyarrhythmias and other cardiac problems led to a broader use of IECD, which turned traditional follow-up into an extremely heavy burden for healthcare systems to support. Our aim was to assess the impact of remote monitoring on the follow-up of patients with IECD. We performed a review through PubMed using a specific query. The paper selection process included a three-step approach in which title, abstract, and cross-references were analyzed. Studies were then selected using previously defined inclusion criteria and analyzed according to the country of origin of the study, year, and journal of publication; type of study; and main issues covered. Twenty articles were included in this review. Eighty percent of the selected papers addressed clinical issues, from which 94% referred clinical events identification, clinical stability, time savings, or physician satisfaction as advantages, whereas 38% referred disadvantages that included both legal and technical issues. Forty-five percent of the papers referred patient issues, from which 89% presented advantages, focusing on patient acceptance/satisfaction, and patient time-savings. The main downsides were technical issues but patient privacy was also addressed. All the papers dealing with economic issues (20%) referred both advantages and disadvantages equally. Remote monitoring is presently a safe technology, widely accepted by patients and physicians, for its convenience, reassurance, and diagnostic potential. This review summarizes the principles of remote IECD monitoring presenting the current state-of-the-art. Patient safety and device interaction, applicability of current technology, and limitations of remote IECD monitoring are also addressed. The use of remote monitor should consider the selection of patients, the type of disease, and centers' availability to receive, interpret and respond to device alerts. Before remote IECD monitoring can be routinely used, technical, procedure, and ethical/legal issues should be addressed.
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Affiliation(s)
- Paulo Dias Costa
- Department of Biostatistics and Medical Informatics-Faculty of Medicine, University of Porto, Porto, Portugal.
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15
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Yamazaki O, Hanafusa N, Yamada A, Noiri E, Fujita T. Recurrent intestinal bleeding treated by double-balloon endoscopy in haemodialysis patients. NDT Plus 2009; 2:469-72. [PMID: 25949382 PMCID: PMC4421314 DOI: 10.1093/ndtplus/sfp111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 07/27/2009] [Indexed: 12/22/2022] Open
Abstract
Gastrointestinal (GI) bleeding is a common and troublesome complication of end-stage renal disease (ESRD). Patients often have various lesions in the small bowel and in either upper or lower GI tracts. Recently developed double-balloon endoscopy (DBE) enables observation of the entire small intestine through a combination of anterograde and retrograde approaches. Moreover, DBE is useful not only for diagnosis of small intestinal lesions; it provides a mode of treating the disease. This article presents patients with several small intestinal diseases from our facility. Their bleeding sources were identified using DBE. We also report two representative cases of angiodysplasia that had been diagnosed and treated successfully using DBE. One case particularly underscored the usefulness of the combination of capsule endoscopy (CE) and DBE as an electively diagnostic approach for patients with GI bleeding. Small intestinal bleeding is often observable repeatedly in a single patient, as described for case 1. In such circumstances, DBE can treat the lesions successfully without surgical procedures. In this report, ESRD patients, in whom comorbid conditions made it difficult to perform surgical procedures, receive great benefit from DBE.
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Affiliation(s)
| | | | - Atsuo Yamada
- Department of Gastroenterology , The University of Tokyo Hospital , Japan
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16
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Elias G, Toubia N. Safety of capsule endoscopy in the setting of implanted cardiac defibrillators: a brief report. Am J Gastroenterol 2009; 104:1856-7. [PMID: 19436283 DOI: 10.1038/ajg.2009.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
A capsule endoscope is a swallowable wireless miniature camera for getting images of the gastrointestinal (GI) mucosa. The initial capsule endoscope model was developed by Given Imaging and approved in Western countries in 2001. Before the introduction of capsule endoscopy (CE) and double-balloon endoscopy (DBE), there was no effective modality for the evaluation and management of patients with obscure GI bleeding. Obscure GI bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial or primary endoscopy (colonoscopy or upper endoscopy) result. The first capsule endoscope model, which is now regarded as a first-line tool for the detection of abnormalities of the small bowel, was the PillCam SB. It was approved in Japan in April 2007. The main indication for use of the PillCam SB is obscure GI bleeding. Almost the only complication of CE is capsule retention, which is the capsule remaining in the digestive tract for a minimum of 2 weeks. A retained capsule can be retrieved by DBE. There are some limitations of CE in that it cannot be used to obtain a biopsy specimen or for endoscopic treatment. However, the combination of a PillCam SB and DBE seems to be the best strategy for management of obscure GI bleeding. Recently, several new types of capsule endoscope have been developed, such as Olympus CE for the small bowel, PillCam ESO for investigation of esophageal diseases, and PillCam COLON for detection of colonic neoplasias. In the near future, CE is expected to have a positive impact on many aspects of GI disease evaluation and management.
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Affiliation(s)
- Tetsuya Nakamura
- Department of Gastrointestinal Endoscopy, Department of Medical Informatics, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
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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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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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Pelargonio G, Dello Russo A, Pace M, Casella M, Lecca G, Riccioni ME, Bellocci F. Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator. Europace 2006; 8:1062-1063. [PMID: 17098781 DOI: 10.1093/europace/eul116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Video capsule endoscopy (VCE) is a useful diagnostic tool in patients with unknown blood loss, particularly when there is a high suspicion of small bowel disease, but because of its use of radio frequency, it is relatively contraindicated in patients with a cardiac device. We report the case of a patient with an implantable cardiac defibrillator (ICD) who underwent VCE because of anaemia and previous surgery for colorectal cancer. Device interrogations were performed before and after the procedure. No interference between VCE and ICD was found. VCE is feasible and relatively safe in patients with ICDs.
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Affiliation(s)
- Gemma Pelargonio
- Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli, 8, 00168 Rome, Italy
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Bhuket T, Takami M, Fisher L. The use of wireless capsule endoscopy in clinical diagnostic gastroenterology. Expert Rev Med Devices 2006; 2:259-66. [PMID: 16288589 DOI: 10.1586/17434440.2.3.259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This profile describes a new wireless video endoscopy device designed to image previously inaccessible areas of the gastrointestinal tract with unprecedented precision and clarity. This PillCam technology involves a disposable, ingestible camera that transmits more than 50,000 digital images of the small bowel to personal computer software. The wireless capsule endoscopy technology supplements and is rapidly replacing standard small bowel imaging techniques, and its use has revolutionized conventional ideas about the small bowel's role in many conditions such as Crohn's disease and occult blood loss. In addition to the small bowel device, an esophageal adaptation was released in January 2005. This capsule technology anticipates exponential growth in both diagnostic and possible therapeutic dimensions in the future.
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Affiliation(s)
- Taft Bhuket
- University of Michigan, 1500 E. Medical Center Drive, 3912 Taubman, Ann Arbor, MI 48109-0362, USA.
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Abstract
In patients requiring WCE most contraindications are relative and the procedure can be performed safely in almost all clinical settings. The only true remaining contraindications to capsule endoscopy are obstruction/pseudo-obstruction and pregnancy. Informed consent of the risks and benefits, including NNE, should be discussed with all patients undergoing WCE examination.
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Affiliation(s)
- Ian Storch
- University of Miami, Miller School of Medicine/Mt. Sinai Medical Center, Division of Gastroenterology, 4300 Alton Road, Miami Beach, FL 33140, USA
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Mishkin DS, Chuttani R, Croffie J, Disario J, Liu J, Shah R, Somogyi L, Tierney W, Song LMWK, Petersen BT. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointest Endosc 2006; 63:539-45. [PMID: 16564850 DOI: 10.1016/j.gie.2006.01.014] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel S Mishkin
- American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Ste. 202, Oak Brook, IL 60523, USA
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Abstract
Video capsule endoscopy is a major innovation that provides high-resolution imaging of the entire small intestine in its entirety. In the 4 years since its introduction, capsule endoscopy has demonstrated its viability as a first-line investigation in patients with obscure gastrointestinal bleeding after a negative esophagogastroduodenoscopy and colonoscopy, and it has a positive impact on the outcome. Video capsule endoscopy is also useful in the evaluation of inflammatory and neoplastic disorders of the small bowel. Its role in children and in the evaluation of esophageal disorders is currently being explored and defined.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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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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