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Shi RX, Guo ZP, Li X, Wang H, Wang B, Du MY, Wang JJ, Dong ZY. Small intestine metastasis from lung adenocarcinoma: A case report and review of literature. World J Gastrointest Surg 2025; 17:104049. [DOI: 10.4240/wjgs.v17.i5.104049] [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] [Received: 12/10/2024] [Revised: 03/03/2025] [Accepted: 04/09/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND The clinical metastasis rate of lung cancer is tremendously low in gastrointestinal tract. Individuals enduring small intestine metastasis of lung cancer are normally featured by less desirable prognosis and shorter survival than those with metastasis in other parts of the body. As a consequence, it holds crucial significance to conduct early diagnosis and development of systematic treatment for patients with gastrointestinal metastasis in lung cancer.
CASE SUMMARY In this case, a 59-year-old female patient, diagnosed with lung adenocarcinoma, experienced intestinal obstruction attributable to subsequent small intestinal metastasis. Imaging confirmed the metastasis to the small intestine after the adenocarcinoma diagnosis, ultimately giving rise to advanced-stage intestinal obstruction. Conservative treatment proved ineffective, progressing to intestinal perforation in the later stages. This resulted in peritonitis and infectious toxic shock and other serious clinical manifestations. Aggressive surgical resection mitigated the risk of disease progression and even fatality, which tremendously ameliorated the patient’s prognosis and prolonged her survival.
CONCLUSION Patients enduring lung cancer who exhibit acute abdominal symptoms should be mindful of the potential for small intestinal metastasis. Intestinal perforation typically occurs in advanced stages of the disease. Moreover, and aggressive surgical treatment can mitigate the risk of multifarious complications such as peritonitis, infectious toxic shock, and even fatality.
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Affiliation(s)
- Rui-Xian Shi
- Department of Neurology, Baotou Central Hospital, Baotou 014040, Inner Mongolia Autonomous Region, China
- Department of Neurology, Inner Mongolia Medical University, Hohhot 010080, Inner Mongolia Autonomous Region, China
| | - Zhen-Ping Guo
- Department of Cardiothoracic and Vascular Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Xin Li
- Department of Cardiothoracic and Vascular Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Hui Wang
- Department of Cardiothoracic and Vascular Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Bo Wang
- Department of Cardiothoracic and Vascular Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Ming-Yue Du
- Department of General Surgery, Baotou Central Hospital, Baotou 014040, Inner Mongolia Autonomous Region, China
| | - Ji-Jun Wang
- Department of General Surgery, Baotou Central Hospital, Baotou 014040, Inner Mongolia Autonomous Region, China
| | - Zhen-Yu Dong
- Department of Cardiothoracic and Vascular Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
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2
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Laiz P, Vitrià J, Gilabert P, Wenzek H, Malagelada C, Watson AJM, Seguí S. Anatomical landmarks localization for capsule endoscopy studies. Comput Med Imaging Graph 2023; 108:102243. [PMID: 37267757 DOI: 10.1016/j.compmedimag.2023.102243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 06/04/2023]
Abstract
Wireless Capsule Endoscopy is a medical procedure that uses a small, wireless camera to capture images of the inside of the digestive tract. The identification of the entrance and exit of the small bowel and of the large intestine is one of the first tasks that need to be accomplished to read a video. This paper addresses the design of a clinical decision support tool to detect these anatomical landmarks. We have developed a system based on deep learning that combines images, timestamps, and motion data to achieve state-of-the-art results. Our method does not only classify the images as being inside or outside the studied organs, but it is also able to identify the entrance and exit frames. The experiments performed with three different datasets (one public and two private) show that our system is able to approximate the landmarks while achieving high accuracy on the classification problem (inside/outside of the organ). When comparing the entrance and exit of the studied organs, the distance between predicted and real landmarks is reduced from 1.5 to 10 times with respect to previous state-of-the-art methods.
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Affiliation(s)
- Pablo Laiz
- Department of Mathematics and Computer Science, Universitat de Barcelona, Barcelona, Spain.
| | - Jordi Vitrià
- Department of Mathematics and Computer Science, Universitat de Barcelona, Barcelona, Spain
| | - Pere Gilabert
- Department of Mathematics and Computer Science, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Santi Seguí
- Department of Mathematics and Computer Science, Universitat de Barcelona, Barcelona, Spain
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3
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Gilabert P, Vitrià J, Laiz P, Malagelada C, Watson A, Wenzek H, Segui S. Artificial intelligence to improve polyp detection and screening time in colon capsule endoscopy. Front Med (Lausanne) 2022; 9:1000726. [PMCID: PMC9606587 DOI: 10.3389/fmed.2022.1000726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Colon Capsule Endoscopy (CCE) is a minimally invasive procedure which is increasingly being used as an alternative to conventional colonoscopy. Videos recorded by the capsule cameras are long and require one or more experts' time to review and identify polyps or other potential intestinal problems that can lead to major health issues. We developed and tested a multi-platform web application, AI-Tool, which embeds a Convolution Neural Network (CNN) to help CCE reviewers. With the help of artificial intelligence, AI-Tool is able to detect images with high probability of containing a polyp and prioritize them during the reviewing process. With the collaboration of 3 experts that reviewed 18 videos, we compared the classical linear review method using RAPID Reader Software v9.0 and the new software we present. Applying the new strategy, reviewing time was reduced by a factor of 6 and polyp detection sensitivity was increased from 81.08 to 87.80%.
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Affiliation(s)
- Pere Gilabert
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain,*Correspondence: Pere Gilabert
| | - Jordi Vitrià
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Pablo Laiz
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angus Watson
- Department of Colorectal Surgery, Raigmore Hospital, NHS Highland, Inverness, United Kingdom
| | - Hagen Wenzek
- CorporateHealth International ApS, Odense, Denmark
| | - Santi Segui
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
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4
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Spada C, McNamara D, Despott EJ, Adler S, Cash BD, Fernández-Urién I, Ivekovic H, Keuchel M, McAlindon M, Saurin JC, Panter S, Bellisario C, Minozzi S, Senore C, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Valori R, Bisschops R, Rutter MD. Performance measures for small-bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2019; 7:614-641. [PMID: 31210941 DOI: 10.1177/2050640619850365] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022] Open
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Samuel Adler
- Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Brooks D Cash
- Department of Gastroenterology, Hepatology, and Nutrition, UT Health Science Center at Houston/Memorial Hermann, Houston, TX, USA.,McGovern Medical School, Department of Internal Medicine, Houston, TX, USA
| | | | - Hrvoje Ivekovic
- Department of Gastroenterology and Hepatology, University Hospital Centre, Zagreb, Croatia
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Mark McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium
| | - Matthew D Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
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5
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Formulation and statistical evaluation of an automated algorithm for locating small bowel tumours in wireless capsule endoscopy. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Takase N, Fukui K, Tani T, Nishimura T, Tanaka T, Harada N, Ueno K, Takamatsu M, Nishizawa A, Okamura A, Kaneda K. Preoperative detection and localization of small bowel hemangioma: Two case reports. World J Gastroenterol 2017; 23:3752-3757. [PMID: 28611528 PMCID: PMC5449432 DOI: 10.3748/wjg.v23.i20.3752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/17/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
Among the various diagnostic modalities for small bowel hemangioma, video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) can be recommended as part of the work-up in patients with obscure gastrointestinal bleeding (OGIB). DBE is superior to VCE in the accuracy of diagnosis and therapeutic potential, while in most cases total enteroscopy cannot be achieved through only the antegrade or retrograde DBE procedures. As treatment for small bowel bleeding, especially spout bleeding, localization of the lesion for the decision of DBE insertion facilitates early treatment, such as endoscopic hemostatic clipping, allowing patients to avoid useless transfusion and the worsening of their disease into life-threatening status. Applying endoscopic India ink marking prior to laparoscopic surgical resection is a particularly useful technique for more minimally invasive treatment. We report two cases of small bowel hemangioma found in examinations for OGIB that were treated with combination of laparoscopic and endoscopic modalities.
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7
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Zhou S, Yang H, Siddique MA, Xu J, Zhou P. A novel method for automatically locating the pylorus in the wireless capsule endoscopy. ACTA ACUST UNITED AC 2017; 62:1-12. [DOI: 10.1515/bmt-2015-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 03/09/2016] [Indexed: 12/22/2022]
Abstract
AbstractWireless capsule endoscopy (WCE) is a non-invasive technique used to examine the interiors of digestive tracts. Generally, the digestive tract can be divided into four segments: the entrance; stomach; small intestine; and large intestine. The stomach and the small intestine have a higher risk of infections than the other segments. In order to locate the diseased organ, an appropriate classification of the WCE images is necessary. In this article, a novel method is proposed for automatically locating the pylorus in WCE. The location of the pylorus is determined on two levels: rough-level and refined-level. In the rough-level, a short-term color change at the boundary between stomach and intestine can help us to find approximately 70–150 positions. In the refined-level, an improved Weber local descriptor (WLD) feature extraction method is designed for gray-scale images. Compared to the original WLD calculation method, the method for calculating the differential excitation is improved to give a higher level of robustness. A K-nearest neighbor (KNN) classifier is incorporated to segment these images around the approximate position into different regions. The proposed algorithm locates three most probable positions of the pylorus that were marked by the clinician. The experimental results indicate that the proposed method is effective.
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8
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Charisis VS, Hadjileontiadis LJ. Potential of hybrid adaptive filtering in inflammatory lesion detection from capsule endoscopy images. World J Gastroenterol 2016; 22:8641-8657. [PMID: 27818583 PMCID: PMC5075542 DOI: 10.3748/wjg.v22.i39.8641] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/02/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
A new feature extraction technique for the detection of lesions created from mucosal inflammations in Crohn’s disease, based on wireless capsule endoscopy (WCE) images processing is presented here. More specifically, a novel filtering process, namely Hybrid Adaptive Filtering (HAF), was developed for efficient extraction of lesion-related structural/textural characteristics from WCE images, by employing Genetic Algorithms to the Curvelet-based representation of images. Additionally, Differential Lacunarity (DLac) analysis was applied for feature extraction from the HAF-filtered images. The resulted scheme, namely HAF-DLac, incorporates support vector machines for robust lesion recognition performance. For the training and testing of HAF-DLac, an 800-image database was used, acquired from 13 patients who undertook WCE examinations, where the abnormal cases were grouped into mild and severe, according to the severity of the depicted lesion, for a more extensive evaluation of the performance. Experimental results, along with comparison with other related efforts, have shown that the HAF-DLac approach evidently outperforms them in the field of WCE image analysis for automated lesion detection, providing higher classification results, up to 93.8% (accuracy), 95.2% (sensitivity), 92.4% (specificity) and 92.6% (precision). The promising performance of HAF-DLac paves the way for a complete computer-aided diagnosis system that could support physicians’ clinical practice.
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9
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Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy. Gastroenterol Res Pract 2015; 2015:623208. [PMID: 26229529 PMCID: PMC4503554 DOI: 10.1155/2015/623208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 12/14/2022] Open
Abstract
Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT), small bowel follow-through (SBFT), and capsule endoscopy (CE) in diagnosing small bowel tumors (SBTs). Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43%) and abdominal pain (13.9%). Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4), small polyps (3), inflammatory fibroid polyp (1), and adenocarcinoma (1). These tumors were located in the proximal jejunum (5), middle jejunum (1), distal jejunum (1), and proximal ileum (1). Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum.
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Bizzotto A, Riccioni ME, Landi R, Marmo C, Barbaro B, Costamagna G. Small-Bowel Tumors, Polyps, and Polyposis Syndromes. ENDOSCOPY IN SMALL BOWEL DISORDERS 2015:175-198. [DOI: 10.1007/978-3-319-14415-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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11
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Wang FS, Gao ZJ, Liu YF. Recent advances in diagnosis and treatment of primary duodenal tumors. Shijie Huaren Xiaohua Zazhi 2014; 22:5221-5227. [DOI: 10.11569/wcjd.v22.i34.5221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Compared to tumors from other parts of the gastrointestinal tract, primary tumors of the duodenum are uncommon. Both benign tumors and malignancies are possible, although the majority are malignancies. The treatment of choice is surgical resection, mostly pancreaticoduodenectomy. With the development of endoscopy microsurgery and medical imaging technology, especially the advent of gastroduodenal fiberscopy, capsule endoscopy, endoscopic ultrasonography (EUS), endoscopic retrograde cholangio-pancreatography (ERCP) and laparoscopy, more duodenal neoplasms have been detected in recent years. Some advances have been achieved in the diagnosis and treatment of duodenal tumors. Endoscopic and segmental resections play a more and more important role in the management of duodenal tumors. In this paper, we describe the clinical features, pathological patterns, diagnosis and treatment of primary duodenal tumors.
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12
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[Approach to the diagnosis and treatment of chronic anemia secondary to gastrointestinal diseases]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:573-82. [PMID: 25443541 DOI: 10.1016/j.gastrohep.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
Abstract
Iron deficiency anemia is the most common type of anemia and can cause asthenia, cognitive and functional impairment, and decompensation of underlying diseases. Iron deficiency anemia is not a disease but is the result of a potentially serious medical problem. Consequently, patients should always undergo investigation of the underlying cause. In men and postmenopausal women, the condition is caused by gastrointestinal loss and malabsorption of iron. In this group, recommended procedures are gastroscopy, colonoscopy and serological testing for celiac disease. If the results of these tests are negative, repeat examinations and iron therapy should be considered. In treatment-refractory or recurrent anemia, the small intestine should be investigated. In this case, the procedure of choice is capsule endoscopy. Iron deficiency anemia should always be treated until iron deposits have returned to normal levels. A wide variety of preparations are available, in both oral and parental formulations.
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Makipour K, Modiri AN, Ehrlich A, Friedenberg FK, Maranki J, Enestvedt BK, Heller S, Tokar J, Haluszka O. Double balloon enteroscopy: effective and minimally invasive method for removal of retained video capsules. Dig Endosc 2014; 26:646-9. [PMID: 24612157 DOI: 10.1111/den.12243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Prior case series document removal of retained video capsules predominantly via surgical intervention. Data on endoscopic removal of retained capsules are limited. Our aim was to describe an endoscopic method of retrieval using double balloon enteroscopy (DBE). METHODS A retrospective case series examination found 10 patients who underwent DBE for retrieval of a retained video capsule at two large tertiary referral academic centers from May 2007 to June 2013. RESULTS Mean age of patients was 64.9 ± 18.1 years (four females, six males). Five patients failed to pass the capsule as a result of an ileal or jejunal stricture (one patient with ulcerative colitis; four patients with Crohn's disease); two patients had a small bowel stricture as a result of non-steroidal anti-inflammatory drug enteropathy; one patient had intermittent partial small bowel obstruction without evidence of a stricture; one patient had an obstructing malignant jejunal mass and one patient had a small bowel stricture as a result of radiation enteritis. Endoscopic removal via DBE was successful in eight of 10 patients (80%). The remaining two patients underwent surgical removal of the retained capsule. The two failed cases of capsule retrieval were both patients with suspected ileal disease. CONCLUSIONS The most common cause of capsule retention was underlying Crohn's disease. DBE is an effective and minimally invasive method of capsule retrieval, including those patients with ileal disease, which has not been previously described. DBE can prevent unnecessary surgery while providing endoscopic therapy of inflammatory strictures by dilation.
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Affiliation(s)
- Kian Makipour
- Gastrointestinal Section, Department of Medicine, Temple University School of Medicine, Philadelphia, USA
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14
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Polin V, Coriat R, Perkins G, Dhooge M, Abitbol V, Leblanc S, Prat F, Chaussade S. Iron deficiency: from diagnosis to treatment. Dig Liver Dis 2013; 45:803-9. [PMID: 23582772 DOI: 10.1016/j.dld.2013.02.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/26/2013] [Accepted: 02/19/2013] [Indexed: 12/11/2022]
Abstract
Iron deficiency is the most frequent cause of anaemia worldwide. It impairs quality of life, increases asthenia and can lead to clinical worsening of patients. In addition, iron deficiency has a complex mechanism whose pathologic pathway is recently becoming better understood. The discovery of hepcidin has allowed a better clarification of iron metabolism regulation. Furthermore, the ratio of concentration of soluble transferrin receptor to the log of the ferritin level, has been developed as a tool to detect iron deficiency in most situations. The cause of iron deficiency should always be sought because the underlying condition can be serious. This review will summarize the current knowledge regarding diagnostic algorithms for iron deficiency anaemia. The majority of aetiologies occur in the digestive tract, in men and postmenopausal women, and justify morphological examination of the gut. First line investigations are upper gastrointestinal endoscopy and colonoscopy, and when negative, the small bowel should be explored; newer tools such as video capsule endoscopy have also been developed. The treatment of iron deficiency is aetiological if possible and iron supplementation whether in oral or in parenteral form. New parenteral formulations are available and seem to have promising results in terms of efficacy and safety.
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Affiliation(s)
- Vanessa Polin
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
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15
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Chen WG, Shan GD, Zhang H, Li L, Yue M, Xiang Z, Cheng Y, Wu CJ, Fang Y, Chen LH. Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study. World J Gastroenterol 2013; 19:3665-3671. [PMID: 23801870 PMCID: PMC3691029 DOI: 10.3748/wjg.v19.i23.3665] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/30/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors.
METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and operation results, were retrospectively collected.
RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively.
CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.
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Lee MJ, Chang JH, Maeng IH, Park JY, Im YS, Kim TH, Han SW, Lee DS. Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy. Clin Endosc 2012; 45:194-7. [PMID: 22977800 PMCID: PMC3429734 DOI: 10.5946/ce.2012.45.3.194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 01/31/2012] [Accepted: 02/03/2012] [Indexed: 12/15/2022] Open
Abstract
Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.
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Affiliation(s)
- Mi-Jeong Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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17
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Charisis VS, Hadjileontiadis LJ, Liatsos CN, Mavrogiannis CC, Sergiadis GD. Capsule endoscopy image analysis using texture information from various colour models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 107:61-74. [PMID: 22056811 DOI: 10.1016/j.cmpb.2011.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/25/2011] [Accepted: 10/12/2011] [Indexed: 05/31/2023]
Abstract
Wireless capsule endoscopy (WCE) is a novel imaging technique that is gradually gaining ground as it enables the non-invasive and efficacious visualization of the digestive track, and especially the entire small bowel including its middle part. However, the task of reviewing the vast amount of images produced by a WCE examination is a burden for the physicians. To tackle this major drawback, an innovative scheme for discriminating endoscopic images related to one of the most common intestinal diseases, ulceration, is presented here. This new approach focuses on colour-texture features in order to investigate how the structure information of healthy and abnormal tissue is distributed on RGB, HSV and CIE Lab colour spaces. The WCE images are pre-processed using bidimensional ensemble empirical mode decomposition so as to facilitate differential lacunarity analysis to extract the texture patterns of normal and ulcerous regions. Experimental results demonstrated promising classification performance (mean accuracy>95%), exhibiting a high potential towards automatic WCE image analysis.
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Affiliation(s)
- Vasileios S Charisis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, GR 54124 Thessaloniki, Greece
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Achour J, Serraj I, Amrani L, Amrani N. Small bowel tumors: what is the contribution of video capsule endoscopy? Clin Res Hepatol Gastroenterol 2012; 36:222-6. [PMID: 22579677 DOI: 10.1016/j.clinre.2011.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/28/2011] [Accepted: 10/14/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intestinal tumors represent less than 6% of digestive tumors and, because of the limitations of intestinal investigations, these tumors are difficult to diagnose. In this context, capsule endoscopy (CE) has proven effective especially in patients with obscure digestive bleeding. The aim of the present study was to calculate the frequency, and evaluate the diagnostic and therapeutic impact of CE in cases of small bowel tumors. PATIENTS AND METHODS A total of 95 patients (57 males and 38 females, mean age of 56 years) with negative endoscopy and colonoscopy results were directed to undergo CE examination. RESULTS Of the 95 patients, 13 (13.7%) were diagnosed with small bowel tumors. The main indications for CE were obscure (occult and overt) gastrointestinal bleeding. The mean duration of symptoms before diagnosis was 10 months. The final histological diagnosis was established through surgery. In our patients, this included gastrointestinal stromal tumor (nine cases), adenocarcinoma (two cases) and carcinoid tumor (two cases). CONCLUSION This study revealed that the prevalence of intestinal tumors appears to be higher than expected in patients through the use of CE.
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Affiliation(s)
- Jihane Achour
- EFD-Hepato-Gastroenterology Unit, Ibn-Sina Hospital, UMV Souissi, Rabat, Morocco.
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McAlindon ME, Parker CE, Hendy P, Mosea H, Panter S, Davison C, Fraser C, Despott EJ, Sidhu R, Sanders DS, Makins R. Provision of service and training for small bowel endoscopy in the UK. Frontline Gastroenterol 2012; 3:98-103. [PMID: 28839645 PMCID: PMC5517256 DOI: 10.1136/flgastro-2011-100044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/06/2011] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine the location and use of small bowel endoscopy services in the UK and to analyse training uptake to assess future demand and shape discussions about training and service delivery. DESIGN Surveys of British Society of Gastroenterology (BSG) members by web-based and personal contact were conducted to ascertain capsule endoscopy practice and numbers of procedures performed. This was compared with expected numbers of procedures calculated using BSG guidelines, hospital episode statistics and published data of capsule endoscopy in routine practice. Analysis of data from two national training courses provided information about training. RESULTS 45% of UK gastroenterology services offered in-house capsule endoscopy. 91.3% of survey responders referred patients for capsule endoscopy; 67.7% felt that local availability would increase referrals. Suspected small bowel bleeding and Crohn's disease were considered appropriate indications by the majority. Demand is increasing in spite of restricted use in 21.6% of centres. Only two regions performed more than the minimum estimate of need of 45 procedures per 250 000 population. Eight centres perform regular device-assisted enteroscopy; 14 services are in development. 74% of trainees were interested in training and of those training in image interpretation, 67% are doctors and 28% are nurses. CONCLUSIONS Capsule endoscopy is used by the majority of UK gastroenterologists but appears to be underused. Current demand for device-assisted enteroscopy seems likely to be matched if new services become established. Future demand is likely to increase, however, suggesting the need to formalise training and accreditation for both doctors and nurses.
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Affiliation(s)
- Mark E McAlindon
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Clare E Parker
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside, UK
| | - Philip Hendy
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | - Haider Mosea
- Department of Gastroenterology, Royal United Hospitals Bath, Bath, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside, UK
| | - Carolyn Davison
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside, UK
| | - Chris Fraser
- Department of Gastroenterology, St Mark's Hospital, Harrow, UK
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - David S Sanders
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Richard Makins
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
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20
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Cheung DY, Lee IS, Chang DK, Kim JO, Cheon JH, Jang BI, Kim YS, Park CH, Lee KJ, Shim KN, Ryu JK, Do JH, Moon JS, Ye BD, Kim KJ, Lim YJ, Choi MG, Chun HJ. Capsule endoscopy in small bowel tumors: a multicenter Korean study. J Gastroenterol Hepatol 2010; 25:1079-86. [PMID: 20594222 DOI: 10.1111/j.1440-1746.2010.06292.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Capsule endoscopy (CE) has proven to be highly effective at detecting small bowel lesions in a variety of clinical conditions, but studies concerning the practical impact of CE on small bowel tumors are still scarce, especially in the Asian population. The aim of this study was to evaluate the diagnostic and therapeutic impact of CE in the field of small bowel tumors. METHODS CE records consecutively pooled from the beginning of use of CE in Korea, October 2001 until April 2008, in 14 centers throughout Korea were reviewed. Clinical information and CE video images of small bowel tumors were analyzed. RESULTS A total of 1332 cases undergoing CE were reviewed with all clinical indications. Small bowel tumors were diagnosed with CE in 57 (4.3%) of 1332 patients. The tumors were malignant in 33 cases, and included three adenocarcinomas, eight lymphomas, 20 gastrointestinal stromal tumors, and two metastatic cancers. The most frequent indications for CE in malignant tumors were obscure gastrointestinal bleeding, followed by abdominal pain and weight loss. Thirty of 57 tumors were identified exclusively by CE (diagnostic impact = 30/57), and they were smaller in size (mean, range: 14.3 mm, 2-35 mm) compared to the other tumors detected in radiological studies (48.7 mm, 10-110 mm). Seven patients underwent surgical resection (therapeutic impact = 7/57). CONCLUSION CE effectively identifies small bowel tumors that are undetectable by conventional radiological studies (diagnostic impact = 52.6%) and can critically change the therapeutic course (therapeutic impact = 12.3%).
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Affiliation(s)
- Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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21
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Van Weyenberg SJB, Van Turenhout ST, Bouma G, Van Waesberghe JHTM, Van der Peet DL, Mulder CJJ, Jacobs MAJM. Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval. Gastrointest Endosc 2010; 71:535-41. [PMID: 20189512 DOI: 10.1016/j.gie.2009.10.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 10/22/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule retention in the small bowel is a known complication of small-bowel video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval. OBJECTIVE To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval. DESIGN Retrospective analysis of all video capsule studies was performed at our center, and evaluation of the outcome of DBE was the first method used to retrieve entrapped video capsules. SETTING Tertiary referral center. PATIENTS A total of 904 patients who underwent small-bowel video capsule endoscopy. INTERVENTIONS Capsule retrieval by DBE. MAIN OUTCOME MEASUREMENTS The number of patients in whom capsule retention occurred and the number of patients in whom an entrapped capsule could be retrieved by using DBE. RESULTS Capsule retention occurred in 8 patients (incidence 0.88%; 95% CI, 0.41%-1.80%) and caused acute small-bowel obstruction in 6 patients. All retained capsules were successfully removed during DBE. Five patients underwent elective surgery to treat the underlying cause of capsule retention. One patient required emergency surgery because of multiple small-bowel perforations. LIMITATIONS Retrospective design. CONCLUSIONS In our series, the incidence of capsule retention was low. DBE is a reliable method for removing retained capsules and might prevent unnecessary surgery. If surgery is required, preoperative capsule retrieval allows preoperative diagnosis, adequate staging in case of malignancy, and optimal surgical planning.
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Affiliation(s)
- Stijn J B Van Weyenberg
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
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22
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Brechmann T, Schmiegel W. [Capsule endoscopy]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2009; 104:562-563. [PMID: 19618142 DOI: 10.1007/s00063-009-1116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Thorsten Brechmann
- Abteilung für Gastroenterologie und Hepatologie, Medizinische Klinik, Berufsgenossenschaftliche Kliniken, Bergmannsheil, Klinikum der Ruhr-Universität Bochum, 44789 Bochum.
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23
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Mackiewicz M, Berens J, Fisher M. Wireless capsule endoscopy color video segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:1769-1781. [PMID: 19033093 DOI: 10.1109/tmi.2008.926061] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper describes the use of color image analysis to automatically discriminate between oesophagus, stomach, small intestine, and colon tissue in wireless capsule endoscopy (WCE). WCE uses "pill-cam" technology to recover color video imagery from the entire gastrointestinal tract. Accurately reviewing and reporting this data is a vital part of the examination, but it is tedious and time consuming. Automatic image analysis tools play an important role in supporting the clinician and speeding up this process. Our approach first divides the WCE image into subimages and rejects all subimages in which tissue is not clearly visible. We then create a feature vector combining color, texture, and motion information of the entire image and valid subimages. Color features are derived from hue saturation histograms, compressed using a hybrid transform, incorporating the discrete cosine transform and principal component analysis. A second feature combining color and texture information is derived using local binary patterns. The video is segmented into meaningful parts using support vector or multivariate Gaussian classifiers built within the framework of a hidden Markov model. We present experimental results that demonstrate the effectiveness of this method.
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Affiliation(s)
- Michal Mackiewicz
- School of Computing Sciences, University ofEast Anglia, NR47TJ Norwich, UK.
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24
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Giday S, Pickett-Blakely O, Mullin GE. Colon cancer diagnosed by capsule endoscopy. Clin Gastroenterol Hepatol 2008; 6:A34. [PMID: 18586560 DOI: 10.1016/j.cgh.2008.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 03/05/2008] [Accepted: 03/12/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Samuel Giday
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Li F, Gurudu SR, De Petris G, Sharma VK, Shiff AD, Heigh RI, Fleischer DE, Post J, Erickson P, Leighton JA. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc 2008; 68:174-80. [PMID: 18513723 DOI: 10.1016/j.gie.2008.02.037] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 02/18/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Retention of the video capsule is the most significant complication associated with capsule endoscopy (CE). There are limited data on incidence, risk factors, and outcomes of capsule retention. OBJECTIVE We aimed to determine the incidence of capsule retention and to investigate the causes and clinical outcomes of capsule retention. SETTING Single tertiary referral medical center. PATIENTS All patients who underwent CE for suspected small bowel disease from June 2002 to March 2006. METHODS Retrospective case series. RESULTS Capsule retention occurred in 1.4% of our patients (14/1000). Eleven patients failed to pass the capsule because of nonsteroidal anti-inflammatory drug (NSAID) enteropathy (diaphragm disease). One patient had capsule retention from an obstructing carcinoid tumor. Metastatic ovarian cancer with invasion of the ileum was the cause of retention in another patient. One patient who did not have surgical removal of the capsule because of loss of follow-up had retention caused by a small-bowel tumor suspicious for carcinoid tumor on CT enterography. All patients remained "asymptomatic" from the retained capsules. Thirteen patients underwent elective partial small-bowel resection and capsule removal. No deaths were associated with these surgeries. Eleven patients recovered promptly, whereas 2 patients had mild postoperative ileus. LIMITATION Retrospective study. CONCLUSION Retention of the capsule endoscope appears to be infrequent. The most common cause is diaphragm disease resulting from NSAIDs in this study population. In most cases, capsule retention is asymptomatic, and it usually leads to surgical removal, which appears safe and also identifies and treats the underlying small-bowel condition.
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Affiliation(s)
- Feng Li
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA
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26
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Ward SM, Mobsby CJ, Wilkinson S. Capsule endoscopy: a surgical perspective. ANZ J Surg 2008; 78:28-33. [PMID: 18199202 DOI: 10.1111/j.1445-2197.2007.04352.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is gaining acceptance as an accurate method of imaging the small bowel. However, it is still being assessed for its use in successfully changing management and improving outcomes. We report the initial experience of CE in Tasmania. METHODS Findings were collected retrospectively for the first 55 consecutive CE carried out in Tasmania from May 2003 to June 2005. One surgeon had carried out and reported on these tests. Findings included indication, previous tests, abnormalities detected, subsequent change in management and outcomes. RESULTS The median age was 68 years (range 33-87). Fifty-two CE were carried out for obscure gastrointestinal bleeding (23 for overt and 29 for occult bleeding) and 3 for abdominal pain without bleeding. Fifty-six per cent of tests had an abnormal result. Seven laparotomies were carried out to treat the abnormal findings of three suspected small bowel angiodysplasias, two suspected small bowel tumours, one patient with slow small bowel transit and abdominal pain and one patient with suspected Crohn's disease. Two patients died of cardiac arrest within 1 week of surgery, three patients showed improvement of their symptoms of gastrointestinal bleeding, one patient had resection and definitive diagnosis of Crohn's disease and another had excision of a bleeding Meckel's diverticulum. CONCLUSION CE is an effective investigation for diagnosis of small bowel diseases amenable to medical or surgical management. However, the most appropriate use of this test to achieve an improvement in outcome is yet to be determined.
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Affiliation(s)
- Salena M Ward
- Department of General Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
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27
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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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28
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Lai LH, Wong GLH, Lau JYW, Sung JJY, Leung WK. Initial experience of real-time capsule endoscopy in monitoring progress of the videocapsule through the upper GI tract. Gastrointest Endosc 2007; 66:1211-4. [PMID: 17945224 DOI: 10.1016/j.gie.2007.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 04/14/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Wireless capsule endoscopy (WCE) is one of the most important investigations for small bowel examination. Although newer-generation WCE is equipped with a real-time viewer, the role of this advancement in daily practice remains unknown. OBJECTIVE Our purpose was to determine the role of the real-time viewer for monitoring of the videoendoscope passage through the upper GI tract. DESIGN Case-control comparison. SETTING Single tertiary referral center. PATIENTS Forty-five consecutive patients who underwent capsule endoscopy in a 12-month period were studied. Twenty-seven patients received conventional WCE, whereas 18 patients were examined by real-time WCE. Passage into the small bowel was monitored with the real-time viewer in the second group of patients. Gastric transit time and the rate of complete small bowel examination were compared. INTERVENTIONS On-demand polyethylene glycol and erythromycin were prescribed according to the progress as viewed by the real-time monitor. MAIN OUTCOME MEASUREMENTS Small bowel examination completion rate and gastric transit time. RESULTS Small bowel examination was completed in 19 (70.4%) and 17 (94.4%) patients undergoing conventional and real-time WCE, respectively (P = .048). With the real-time monitoring and on-demand preparations, gastric passage time was significantly reduced (100 vs 59 minutes, P = .02). LIMITATIONS Nonrandomized study. CONCLUSIONS The use of the real-time viewer may help to secure the passage of the capsule endoscope into the small bowel and hence result in a higher rate of complete small bowel examination.
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Affiliation(s)
- Larry H Lai
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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29
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Antao B, Bishop J, Shawis R, Thomson M. Clinical application and diagnostic yield of wireless capsule endoscopy in children. J Laparoendosc Adv Surg Tech A 2007; 17:364-70. [PMID: 17570790 DOI: 10.1089/lap.2006.0114] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The small bowel is anatomically difficult to examine and was investigated by invasive, indirect modalities, such as push enteroscopy and small bowel follow-through. The aim of this study was to assess the efficacy and clinical impact of wireless capsule endoscopy (WCE) in children. MATERIALS AND METHODS Over the last 3 years (2002-2005), 37 patients with suspected small-bowel disease were investigated with WCE at a median age of 11 years (range, 16 months-16 years). The indications for WCE was suspected Crohn's disease (CD) (18), obscure or occult gastrointestinal bleeding (7), polyposis syndromes (5), protein losing enteropathy (4), recurrent abdominal pain (2), and malabsorption syndrome (1). All patients had preceding upper gastrointestinal endoscopy (OGD), ileocolonoscopy, and 26 cases had a small bowel follow-through (SBFT). These results were compared with the findings on WCE. RESULTS Thirty-three (33) cases successfully completed the WCE through the small bowel. Four (4) patients were unable to swallow the capsule, 3 of which had to be placed in the duodenum endoscopically. In 3 patients, the capsule remained in the stomach and no small bowel images were obtained. The overall diagnostic yield was 85% (28/33 patients). The diagnostic findings included CD (13), source of gastrointestinal bleeding (7), polyposis syndromes (3), erosive enteropathy and patchy lymphangiectasia (4), and intussusception (1). WCE was found to be more sensitive for small bowel pathology than SBFT (20 vs. 6 [30% sensitivity, compared to WCE]) and endoscopic investigations (28 vs. 12 [43% sensitivity compared to WCE]). As a result of WCE findings, there was a positive alteration in the management in 28 of 33 (85%) cases. CONCLUSIONS WCE is a novel, noninvasive, and useful tool for the investigation of the small intestine in children. It is superior and more sensitive than other conventional endoscopic and radiologic investigations in the assessment of the small bowel. It can help in guiding surgical decisions and should be routinely integrated as a part of the diagnostic work-up of small bowel pathology.
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Affiliation(s)
- Brice Antao
- Pediatric Surgical Unit and Sheffield Children's Hospital, Sheffield, United Kingdom.
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30
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Baichi MM, Arifuddin RM, Mantry PS. Small-bowel masses found and missed on capsule endoscopy for obscure bleeding. Scand J Gastroenterol 2007; 42:1127-32. [PMID: 17710681 DOI: 10.1080/00365520701266898] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Data on the nature of small-bowel tumors found or missed by capsule endoscopy (CE) are limited. The aim of this study was to review the CE findings in patients with small-bowel tumors presenting as obscure gastrointestinal (GI) bleeding. MATERIAL AND METHODS We retrospectively reviewed the medical records of the first 300 patients who underwent CE for obscure bleeding (non-diagnostic EGD and colonoscopy) at our institution. RESULTS Ten (3%) confirmed small-bowel masses were found in 9 patients. CE findings included distinct mass (n=4), focal irregular (ulcerated or nodular) mucosa (n=2), focal blood without clear lesion (n=1), proximal angiodysplasia with obscuring distal melena (n=1), incomplete distal examination with normal proximal images (n=1), and normal findings (n=1). Most (80%) of the lesions were potentially malignant: adenocarcinoma (n=4), neuroendocrine carcinoma (n=1), leiomyosarcoma (n=1), and GI stroma cell tumors (GISTs) (n=2). Benign lesions included inflammatory fibroid polyp (n=1) and lipoma (n=1). Three duodenal masses were missed on a previous EGD; one was missed by CE as well. CE findings led directly to tumor diagnosis in 7 of the 10 cases. Capsule retention occurred in 2 of the 10 cases, with one patient requiring urgent surgery for acute obstruction. CONCLUSIONS Small-bowel tumors are a rare but serious source of obscure GI bleeding. Our large single-center experience shows that most lesions are of malignant potential. Tumors can have an atypical appearance including focal ulceration, nodularity, or active bleeding without a clear lesion. Mass lesions in the duodenum are particularly elusive and can be missed by both EGD and CE.
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Affiliation(s)
- Matthew M Baichi
- Division of Digestive and Liver Disease, University of Rochester, Rochester, New York, USA.
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31
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Enns R. Transit times in capsule endoscopy: are all patients the same? Dig Liver Dis 2007; 39:581-3. [PMID: 17459793 DOI: 10.1016/j.dld.2007.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 03/27/2007] [Indexed: 12/11/2022]
Affiliation(s)
- R Enns
- St Paul's Hospital UBC Vancouver, Vancouver, BC, Canada.
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32
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Chen HL, Lin SC, Chang WH, Yang TL, Chen YJ. Identification of ectopic pancreas in the ileum by capsule endoscopy. J Formos Med Assoc 2007; 106:240-3. [PMID: 17389169 DOI: 10.1016/s0929-6646(09)60246-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Ectopic pancreas, an uncommon submucosal tumor in the gastrointestinal (GI) tract, is histologically similar to normal pancreatic tissue. We present a case of ectopic pancreas in the ileum. A 35-year-old man had intermittent dark bloody stool for 2 months accompanied by epigastric pain and postprandial abdominal fullness. Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Capsule endoscopy revealed a small red polyp in the ileum. Abdominal computed tomography scan and small bowel barium follow-through study were not of any help. GI bleeding and abdominal discomfort were resolved after the lesion was surgically removed. Pathologic examination demonstrated pancreatic acinar cells and a secretory duct in the ileal submucosa, consistent with ectopic pancreas. Ectopic pancreas in the small intestine may be a rare cause of obscure GI bleeding. Capsule endoscopy seems to be a good, noninvasive tool for identification in the small bowel, particularly when other imaging modalities fail to detect any abnormalities.
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Affiliation(s)
- Huan-Lin Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Baichi MM, Arifuddin RM, Mantry PS. Capsule endoscopy for obscure GI bleeding: therapeutic yield of follow-up procedures. Dig Dis Sci 2007; 52:1370-5. [PMID: 17357840 DOI: 10.1007/s10620-006-9542-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 07/25/2006] [Indexed: 12/22/2022]
Abstract
Positive findings on capsule endoscopy (CE) often prompt a follow-up procedure with therapeutic intent. Our purpose was to review the therapeutic yield of subsequent procedural interventions based on positive CE findings. The medical records of all patients who underwent CE between June 2002 and February 2005 for obscure bleeding were retrospectively reviewed. Fifty-two patients had follow-up procedures based on positive capsule findings. In this group, angiodysplasia was the most common CE finding (n=30), with therapeutic intervention performed in 16 cases (53%). Fresh blood without clear lesion was the second most common finding (n=9), with therapeutic intervention performed in 6 cases (67%). Overall, a therapeutic intervention was performed in 33 of the 52 follow-up procedures (63%). Positive capsule findings directed further procedural investigation in 52 cases, with a high therapeutic yield of 63% in those cases. The long-term efficacy of such interventions warrants further investigation.
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Affiliation(s)
- Matthew M Baichi
- Division of Digestive and Liver Diseases, Strong Memorial Hospital, University of Rochester Medical center, Rochester, NY 14642, USA.
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Sidhu R, Sanders DS, Kapur K, Hurlstone DP, McAlindon ME. Capsule endoscopy changes patient management in routine clinical practice. Dig Dis Sci 2007; 52:1382-6. [PMID: 17357836 DOI: 10.1007/s10620-006-9610-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 09/12/2006] [Indexed: 12/17/2022]
Abstract
Our objective was to evaluate the diagnostic yield and effect of capsule endoscopy on patient management in routine clinical practice. Three hundred examinations were performed (176 females; mean age, 51 years), with a median follow-up of 17 months. Indications included overt bleeding (n=55), anemia (n=104), suspected Crohn's disease (n=68), celiac disease (n=35), suspected functional symptoms (n=23), polyposis (n=5), and miscellaneous (n=10). The overall diagnostic yield was 39%, but it was notably higher in overt bleeders, 66%, compared to 46% in the anemia group (P<0.025), 32% in the suspected Crohn's group (P<0.001), and 17% in the functional group (P<0.001). As a result of capsule endoscopy, management was altered in 26% of patients. This study shows that capsule endoscopy has both a high diagnostic yield and an impact on subsequent patient management. These data further support the role of capsule endoscopy in routine clinical practice.
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Affiliation(s)
- Reena Sidhu
- Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom.
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Estévez E, González-Conde B, Vázquez-Iglesias JL, Alonso PA, Vázquez-Millán MDLA, Pardeiro R. Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding. Surg Endosc 2007; 21:1776-80. [PMID: 17356941 DOI: 10.1007/s00464-007-9242-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Revised: 10/07/2006] [Accepted: 10/25/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Capsule endoscopy has involved a significant advance in techniques for imaging of the small bowel. Its most frequent indication is for studying patients with obscure gastrointestinal bleeding (OGIB). Small bowel tumors are infrequent, representing only 1% to 3% of all malignant gastrointestinal tumors. This study aimed to assess retrospectively the occurrence and characteristics of tumoral pathology diagnosed by means of capsule endoscopy in patients with OGIB. METHODS A retrospective review analyzed the first 320 patients submitted to capsule endoscopy because of OGIB (166 with obscure overt bleeding and 154 with obscure occult bleeding) at a single center. The patients with a tumor diagnosis were analyzed in terms of incidence, characteristics, and treatment of OGIB pathology. RESULTS Tumor incidence was of 7.18% (23/320), with 65.2% of the cases supported with histologic confirmation (15/23). Obscure overt bleeding was the most frequent form of presentation, with the jejunum as the most frequent location (65.2%). For 16 patients, an intervention was conducted with a healing intent. Capsule endoscopy allowed the diagnosis of two cecal adenocarcinomas missed by colonoscopy. CONCLUSIONS Small bowel tumors are not an infrequent cause of OGIB. Capsule endoscopy, even if it does not allow determination of the benign or malignant nature or the histologic type of the tumor, is a useful tool for the diagnosis and early management of these tumors.
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Affiliation(s)
- E Estévez
- Gastroenterology Department, Complexo Hospitalario Juan Canalejo, As Xubias de Arriba 84, 15006, A Coruña, Spain.
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Blankenhorn M, Jankiewicz C, Zimmermann V, Tomczak RR. Unklare peranale Blutabgänge bei einem 21-jährigen Mann. Radiologe 2007; 47:262-5. [PMID: 16708200 DOI: 10.1007/s00117-006-1376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Blankenhorn
- Zentrum für Radiologie, Klinikum am Plattenwald der SLK-Kliniken Heilbronn GmbH, Am Plattenwald 1, 74177 Bad Friedrichshall
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Picazo-Yeste J, González-Carro P, Moreno-Sanz C, Seoane-González J. [Intestinal perforation secondary to impaction of a retained endoscopic capsule]. Cir Esp 2006; 79:316-8. [PMID: 16753124 DOI: 10.1016/s0009-739x(06)70880-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present the first documented case of intestinal perforation due to impaction of an endoscopic capsule. The capsule was used to investigate anemia in an 80-year-old woman and was retained in the intestinal lumen for 2 months without producing symptoms. The patient presented to the emergency service with sudden, intense, diffuse abdominal pain. Hollow viscus perforation was suspected and surgery was performed. The diagnosis was distal ileum perforation secondary to an impacted endoscopic capsule in an area of severe postsurgical adhesions under a subcostal cholecystectomy incision performed 10 years previously. After reviewing the literature, we believe it important to report this exceptional complication of capsule endoscopy and suggest the possible management of capsules retained in the digestive tract.
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Affiliation(s)
- Joaquín Picazo-Yeste
- Servicio de Cirugía General, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España.
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Baichi MM, Arifuddin RM, Mantry PS. What we have learned from 5 cases of permanent capsule retention. Gastrointest Endosc 2006; 64:283-7. [PMID: 16860090 DOI: 10.1016/j.gie.2006.02.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 02/20/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Capsule endoscopy allows the direct visualization of the entire small bowel. There is limited data on the clinical significance of permanent capsule retention. OBJECTIVE Our purpose was to document the frequency, findings, risk factors, management, and outcomes of permanent capsule retention. DESIGN Retrospective, case series. SETTING Single tertiary referral center, outpatient. RESULTS Permanent capsule retention occurred in 2% of our cases (5/245). The following pathologies caused insufficient capsule passage: adenocarcinoma in a patient with hereditary nonpolyposis colorectal cancer (1), idiopathic stenosis (1), stricturing Crohn's disease (2), and adhesions (1). Capsule retention lead to a symptomatic small-bowel obstruction in only 1 of these cases (0.4%). As a consequence, 2 cases had successful endoscopic retrieval; 3 cases required surgical intervention. Four of 5 patients had a clear clinical benefit resulting from the capsule findings or the secondary procedure. CONCLUSIONS Permanent capsule retention is rare. Even though this event may lead to the necessity of an endoscopic or surgical intervention, a clear benefit for the patient in respect to the underlying disease resulted in 4 of 5 patients.
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Affiliation(s)
- Matthew M Baichi
- Digestive and Liver Diseases Unit, University of Rochester Medical Center, Rochester, New York 14642, USA
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Estévez E, González-Conde B, Vázquez-Iglesias JL, de Los Angeles Vázquez-Millán M, Pértega S, Alonso PA, Clofent J, Santos E, Ulla JL, Sánchez E. Diagnostic yield and clinical outcomes after capsule endoscopy in 100 consecutive patients with obscure gastrointestinal bleeding. Eur J Gastroenterol Hepatol 2006; 18:881-8. [PMID: 16825907 DOI: 10.1097/00042737-200608000-00014] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The endoscopic capsule is a useful tool for visualizing the small bowel in patients with obscure gastrointestinal bleeding. In this study the authors evaluated the diagnostic aid provided by the endoscopic capsule, the factors predicting a significant finding and their impact on the patients' clinical evolution. METHODS A total of 100 patients (52 men and 48 women, average age 64.4 years) underwent capsule endoscopy. Of this group, 52 patients presented with obscure-overt bleeding and 48 with obscure-occult bleeding. After an average follow-up time of 11.4 months, the clinical outcome was evaluated in 95 patients. RESULTS The endoscopic capsule identified significant findings in 68% of patients. The most common diagnosis (33.8%) was angiodysplasias. The most important factor predicting significant findings was the previous need for transfusion in the overt bleeding group. As the result of the findings, a specific intervention was made in 75.8% of patients. At the end of follow-up, the clinical outcome was considered positive in 71.6% of patients. Capsule retention occurred in one patient, who required surgery. CONCLUSION In patients with obscure gastrointestinal bleeding, capsule endoscopy provides a high degree of diagnostic aid. The best candidates for this procedure are patients with obscure-overt bleeding who have required blood transfusions. Capsule endoscopy has a positive influence on an important proportion of patients, whether oriented towards new diagnostic techniques or towards a definitive treatment.
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Affiliation(s)
- Emilio Estévez
- Department of Gastroenterology, Complexo Hospitalario Juan Canalejo, A Coruña, Spain. estevez@canalejo
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Elliott EJ, Cameron D, Davidson G. Capsule endoscopy: a new technology for investigating obscure gastrointestinal bleeding. J Paediatr Child Health 2006; 42:244-7. [PMID: 16712552 DOI: 10.1111/j.1440-1754.2006.00848.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In Australia, Medicare rebate was approved in May 2005 for use of capsule endoscopy in children aged 10 years and over. Approval was granted for an interim period to allow investigation of obscure ongoing or recurrent gastrointestinal bleeding, for which no cause could be found after investigation, including conventional radiology and endoscopy. Strict eligibility criteria for Medicare rebate for the procedure have been developed. These criteria relate to patient selection, type of device, timing of the procedure, qualifications of providers and requirements for prospectively monitoring the use, uefulness, safety and cost-effectiveness of the procedure in children.
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Qvigstad G, Hatlen-Rebhan P, Brenna E, Waldum HL. Capsule endoscopy in clinical routine in patients with suspected disease of the small intestine: a 2-year prospective study. Scand J Gastroenterol 2006; 41:614-8. [PMID: 16638706 DOI: 10.1080/00365520500335159] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Capsule endoscopy is a promising method for examining the small intestine. The study was performed to evaluate the use of capsule endoscopy in clinical routine in patients with suspected disease of the small intestine. MATERIAL AND METHODS Consecutive patients with clinically suspected disease of the small intestine referred for capsule endoscopy between 1 January 2003 and 31 December 2004 were included in the study. All patients had previously completed a conventional diagnostic work-up with upper and lower endoscopy as well as abdominal CT scan or small-bowel enteroclysis. RESULTS A total of 167 patients were referred during the time period and 195 procedures were performed. Seventeen (8.7%) of the procedures were unsuccessful, with no visualization of the small bowel. In the remaining procedures the caecum was reached in 83%. The reason for referral was gastrointestinal bleeding (30%), iron-deficiency anaemia (25%), abdominal pain (15%), diarrhoea (13%) and Crohn's disease (12%). Pathology was found in 27% of the patients, with the highest diagnostic yield in patients referred for Crohn's disease (60%) and the lowest yield (4%) in patients referred for abdominal pain. There were no complications, with the exception of one patient referred for Crohn's disease who had transient abdominal pain during the procedure. CONCLUSIONS Capsule endoscopy is a safe and well-tolerated procedure. In unselected patients with clinically suspected disease of the small intestine, the procedure gives additional information to conventional diagnostic procedures in 27% of patients. Incomplete examination of the small intestine was frequent in our group of patients.
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Affiliation(s)
- Gunnar Qvigstad
- Department of Medicine, Section of Gastroenterology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
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Abstract
Obscure bleeding is a consolidated indication to CE, which when used as a first-line exploration is the most efficient strategy as regards diagnosis in these patients. Patient selection and timing of the procedure are of paramount importance in the high diagnostic yield of CE. When integrated into a global patient care plan, CE is helpful in achieving effective decision-making concerning subsequent investigations and treatments. Although most studies appear to indicate a positive influence of CE diagnosis on clinical outcome of OGIB patients, large prospective trials are warranted to assess what is the most effective therapeutic strategy in patients with vascular lesions.
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Affiliation(s)
- Marco Pennazio
- 2nd Division of Gastroenterology, Department of Gastroenterology and Clinical Nutrition, S. Giovanni A.S. Hospital, Via Cavour 31-10123 Torino, Italy.
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Tatar EL, Shen EH, Palance AL, Sun JH, Pitchumoni CS. Clinical utility of wireless capsule endoscopy: experience with 200 cases. J Clin Gastroenterol 2006; 40:140-4. [PMID: 16394875 DOI: 10.1097/01.mcg.0000196185.11802.b2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS To evaluate the indications and diagnoses made with 200 small bowel capsule endoscopies in an academic medical center. BACKGROUND Wireless capsule endoscopy (PillCam SB) has recently become available as a new tool in the evaluation of patients with small bowel diseases. Its impact on patient care and usefulness in clinical practice has steadily been gaining ground, yet there are few studies that evaluate large numbers of patients. METHODS A retrospective review of wireless capsule endoscopies was performed between September 2003 and January 2005. Reviewed are the indications for the studies, number of complete and incomplete examinations, evaluation of gastric and small bowel transit times, findings made on examination, and the percent of diagnoses made and diagnoses suspected for each study indication. RESULTS A total of 200 cases were reviewed. Indications included anemia (66% of cases), gastrointestinal hemorrhage (31% cases), abdominal pain (21% cases), diarrhea (11% cases), and other indications such as evaluation of abnormal radiographic findings or surveillance of inflammatory bowel disease (9% cases). The average patient age was 61.5 years (SD +/- 19.1 years). Males comprised 49% of patients. The wireless capsule endoscopy study completely evaluated the entire small bowel in 87% of cases. The most common cause for an incomplete examination was premature battery failure in 8% of cases. Only 9.5% of studies were normal without findings. Small bowel ulcerations were present in 38% of studies. Vascular ectasias were present in 23% of studies. Overall, a diagnosis was made in 23% of all studies, whereas a diagnosis was suspected based on the findings in an additional 31% of studies. The indication with the highest percentage of diagnoses made or suspected was gastrointestinal hemorrhage, with a diagnostic yield of 65%, followed by anemia 61%, diarrhea 36%, and pain 17%. CONCLUSIONS Wireless capsule endoscopy is a valuable diagnostic tool in the evaluation of occult small bowel lesions, and was most effective in patients with gastrointestinal hemorrhage and anemia.
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Affiliation(s)
- Eric L Tatar
- Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
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Stancanelli B, Vita A, Vinci M, Magnano A, Purrello F. Bleeding of small bowel in Henoch-Schönlein syndrome: the successful diagnostic role of video capsule endoscopy. Am J Med 2006; 119:82-4. [PMID: 16431200 DOI: 10.1016/j.amjmed.2005.05.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 05/24/2005] [Accepted: 05/24/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Benedetta Stancanelli
- Clinic of Internal Medicine, University of Catania, Ospedale Cannizzaro, Catania, Italy.
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45
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Korman U, Kurugoglu S, Ogut G. Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging. ACTA ACUST UNITED AC 2005; 30:564-75. [PMID: 16132433 DOI: 10.1007/s00261-005-0331-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- U Korman
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, Kocamustafapasa, Istanbul 34300, Turkey.
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46
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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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47
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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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