Biomedical subjects

I Fassler

Publications and source records attributed to I Fassler.

4 recordsLinked to original sources

PubMed2006

Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy.

BACKGROUND AND STUDY AIM: Video capsule endoscopy and push-and-pull enteroscopy (PPE), both allow a complete examination of the small bowel in patients with suspected intestinal disorders. Due to the invasiveness of PPE, indications should probably be selective. The aim of the present prospective study was to evaluate the outcome of an approach whereby capsule endoscopy was used to select patients in whom PPE was indicated. PATIENTS AND METHODS: 164 patients were included (90 men; age 54+/-18 years) with various indications for small-bowel investigation, such as obscure bleeding (n=88), suspected Crohn's (n=14) or celiac (n=12) disease, or known or strongly suspected localized diseases such as neoplasms (n = 18) for biopsy. Four patients with a suspected intestinal stenosis underwent PPE without prior capsule endoscopy. In the remaining 160 patients, who had a capsule endoscopy, PPE was selected if there were lesions requiring biopsy or angiodysplasias to be treated by argon plasma coagulation (APC). Regarding the insertion route, an anal PPE was indicated if the capsule transit time from ingestion to arrival at the lesion was >or= 75 % of the total time from ingestion to arrival at the cecum. After gut cleansing, PPE was performed with general anesthesia, and the small bowel was examined until the lesion was reached or the scope could not be advanced further. If the suspected lesion had not been reached, a second procedure was performed through the alternative route, under the same conditions. RESULTS: The diagnostic yield of capsule endoscopy was 75 %. According to the indications, 47 PPE procedures were performed in 42 patients, including 33 through the oral route, 4 through the anal route and 5 combined ones. Indications were: suspicion of intestinal tumor (n=13), celiac disease with chronic bleeding (n=4), suspicion of Crohn's disease (n=3), treatment of significant arteriovenous malformations (AVMs) (n=10), diffuse enteropathies (n=3), nonsteroidal anti-inflammatory drug (NSAID)-related conditions (n=2), and obscure digestive bleeding (n=3). Lesions detected by capsule endoscopy were reached by PPE in all but two cases. The positive predictive value (PPV) of capsule endoscopy to make a correct indication for PPE was 94.7 % and the negative predictive value (NPV) was 98.3 %. The PPV and NPV of a time index of > 0.75 to start via the anal route were 94.7 % and 96.7 %. No complications were observed and all patients were discharged the day after the procedure. Follow-up at 9 months showed that capsule endoscopy followed by PPE had positively influenced the management of 90.5 % of the patients. CONCLUSIONS: The use of capsule endoscopy as a filter for PPE results in effective management of patients with various intestinal diseases. Capsule endoscopy can also direct the choice of route of PPE; a time index of > 0.75 appears to reliably indicate an anal route so that a double procedure is required in only about 12 % of cases.

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PubMed2004

Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months.

BACKGROUND AND STUDY AIMS: In patients with obscure digestive bleeding, the bleeding source is frequently located in the small bowel. Capsule endoscopy (CE) is an effective method of investigating the whole small bowel in such patients. In the present study, a diagnostic approach was tested in patients with obscure digestive bleeding in which CE was included as the initial examination of the small bowel when the esophagogastroduodenoscopy (EGD) and colonoscopy findings were normal. PATIENTS AND METHODS: Patients admitted between October 2000 and February 2002 for obscure digestive bleeding underwent CE as the initial intestinal investigation, and the further management was decided on the basis of the results. After 12 months, follow-up data were obtained from all patients and referring physicians. The positive predictive value was calculated as the percentage of patients in whom CE detected a relevant lesion, and the negative predictive value as the percentage of patients with normal CE in whom no intestinal lesion was detected during the follow-up period. RESULTS: Forty-four patients (21 men, 23 women, aged 63 +/- 17 y) were included in the study. Twenty-two had overt bleeding and 22 had occult bleeding. CE detected an intestinal lesion in 18 patients (41.9 %)-- nine with angiomas, five with ulcers, one with a tumor, two with portal hypertension, and one with ischemic ileitis. The findings were normal in 17 patients (39.5 %). CE detected upper gastrointestinal lesions missed at EGD in four patients and blood in the stomach in two patients or in the proximal colon in three, leading to new endoscopies. Intestinal lesions detected at CE were treated as follows: push enteroscopy with treatment in eight patients, surgery in four, and medical treatment in six. In eight patients who underwent push enteroscopy, the procedure did not reveal lesions missed by CE. After 1 year, 15 of the 18 patients treated for intestinal lesions had no further bleeding and no anemia; one died after surgery (for resection of an ischemic intestinal loop), one relapsed, and one was diagnosed with a different intestinal condition. In all patients with extraintestinal lesions or blood detected at CE, further endoscopies led to diagnosis and therapy, with a favorable outcome. In patients with normal CE, no intestinal lesion was detected, but an extraintestinal source of bleeding was diagnosed and treated in nine patients (in the upper gastrointestinal tract in five cases and in the colon in four). Three patients had anemia of hematological origin and four had inadequate iron intake. The positive predictive value of CE was 94.4 % in patients with intestinal lesions, and the negative predictive value was 100 % in patients with normal CE findings. CONCLUSIONS: In patients with obscure digestive bleeding, CE positively predicted the intestinal diagnosis or normal status in 95.5 % of cases. A diagnostic approach to obscure digestive bleeding that includes CE after the initial endoscopic work-up thus appears to be a valid strategy for small-bowel examinations.

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PubMed2003

Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy.

BACKGROUND AND STUDY AIMS: This study was designed to prospectively compare the diagnostic yield of the M2A endoscopic capsule with that of video push-enteroscopy in exploring the small intestine in patients with obscure digestive bleeding. PATIENTS AND METHODS: Patients with either occult or overt obscure digestive bleeding and a negative endoscopic work-up underwent a double intestinal investigation, with video push-enteroscopy and a wireless capsule, performed blindly by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions, i. e. those having the potential for bleeding. RESULTS: 60 patients (27 men, 33 women; age 58 +/- 18 years; hemoglobin 9.4 +/- 2.5 g/dl) were included, 32 with occult and 28 with overt bleeding. Results were analyzed for 58 patients, who completed both examinations. Lesions were detected in 43 patients: with both techniques in 19, only by capsule in 21, and, conversely, only by push-enteroscopy in 3 ( P = 0.04). Final diagnoses were as follows: a P2 lesion with high bleeding potential in 28 patients (19 angiomata, 6 ulcerations, 2 tumors, 1 case of intestinal varices); a P1 lesion with intermediate bleeding potential in 15 patients (2 patients with mucosal erosions, 13 patients with mucosal red spots); and there were normal findings from 15 procedures. No procedure induced any complication. CONCLUSION: The use of the wireless endoscopy capsule detects significantly more clinically relevant intestinal lesions than video push-enteroscopy in patients with obscure digestive bleeding, raising the diagnostic yield to 67.2 %. Its influence on the clinical outcome for patients needs further investigation.

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PubMed2000

Social workers and subbstance-abusing clients: caseload composition and competency self-ratings.

Past research and reports from the field have described social workers as having a host of negative responses to alcohol- and drug-abusing clients. Some found that substance abuse training increased social workers' sense of security and legitimacy in the therapeutic role with such clients. We report on 23 master's level social workers (MSWs) who completed an intensive 9-month substance abuse training program (trainees) and 22 MSW comparison subjects (comparisons). Both trainees and comparisons completed caseload forms identifying their clients by diagnosis and self-rated their competence to assess and treat each client. We predicted that workers trained in substance abuse, when compared with workers who lacked such intensive training, would (a) assess and treat more substance-abusing clients, (b) work with more complex substance-abusing clients (i.e., dually diagnosed clients), and (c) perceive themselves to be more competent to assess and treat substance-abusing clients. No significant differences were found between trainees and comparisons on relevant background variables. Using the t-test statistic to compare groups, we found that social workers trained in substance abuse had more substance abuse cases, with and without additional diagnoses, and rated themselves higher on two of six competency measures: in intervening with clients when all diagnoses were combined and in intervening when substance abuse only diagnoses were combined. This study takes the work a step further in demonstrating how social workers translate substance abuse training into practice. However, findings must be interpreted cautiously since training participants were not assigned randomly and selection bias may have been operating. The study is relevant for other health, mental health, and human service professionals for whom negative attitudes and behavior toward substance-abusing clients may be influenced by education and training.

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