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Results for “Capsule Endoscopy”

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PubMed2004

Multicenter retrospective evaluation of capsule endoscopy in clinical routine.

BACKGROUND AND STUDY AIMS: The small bowel is anatomically difficult to examine; disease conditions are rarely located in it, but can be serious. Neither conventional radiography nor push enteroscopy has sufficient sensitivity and specificity to detect distinct lesions. Wireless capsule endoscopy can theoretically allow imaging of the entire small bowel, with only minimal discomfort for the patient. PATIENTS AND METHODS: Between November 2001 and May 2003, 191 patients received 195 capsules. Data were collected retrospectively from consecutive patients in three centers. The indications for capsule endoscopy were obscure or occult bleeding, suspected Crohn's disease, or other reasons in 151, 25, and 15 patients, respectively. The clinical outcome after 6 months was evaluated on the basis of interviews with patients or relatives. RESULTS: Visualization of the entire small bowel was adequate in 78.4 % of the examinations. The colon was not reached in 16.9 % of cases, and there were minor technical problems in 4.6 %. Relevant pathological findings were identified in 56.2 % of 151 patients with obscure bleeding or iron-deficiency anemia (64 % of whom received blood transfusions). The most common findings were angiodysplasia in 39.7 % of cases and ulcers of the small bowel in 7.3 %. In addition, individual cases of tumors and parasitic worms were detected. Seven of the 25 patients with suspected Crohn's disease (28 %) had the disease confirmed. Three of five patients with polyposis syndrome of the colon were found to have polyps in the small bowel. CONCLUSIONS: Wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure bleeding or iron-deficiency anemia. In patients with Crohn's disease, the method may be helpful in establishing or ruling out the diagnosis.

Adult↗

PubMed2005

Capsule endoscopy for the diagnosis and follow-up of blue rubber bleb nevus syndrome.

Blue rubber bleb nevus syndrome is a rare disorder characterised by cutaneous and gastrointestinal vascular malformations. A 31-year-old man came under our observation with obscure gastrointestinal bleeding. Hemangiomas on his back and the multiple bluish vascular lesions in the distal ileum revealed by capsule endoscopy led to the diagnosis of blue rubber bleb nevus syndrome. The patient was treated with octreotide to prevent rebleeding. During the 12 months of treatment he had no gastrointestinal bleeding episodes or anaemia. Then repeat capsule endoscopy showed that the small bowel vascular lesions were unchanged. Capsule endoscopy may be a useful tool for diagnosing and monitoring the effects of therapy in patients with blue rubber bleb nevus syndrome.

Adult↗

PubMed2000

A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions.

BACKGROUND & AIMS: Wireless capsule endoscopy is a new, painless method of imaging the entire small bowel. It has not been compared with push enteroscopy. We compared the sensitivity, specificity, and safety of capsule and push enteroscopy in detecting small-bowel lesions. METHODS: Nine to 13 radiopaque, colored beads (3-6 mm diameter) were sewn in random order inside 9 canine small bowels, half within the first meter, and confirmed on x-ray. After recovery, the number, order, and color of beads were assessed in 23 capsule enteroscopies and 9 push enteroscopies in a random order. The surgeons, push enteroscopists, capsule video interpreters, and pathologist were blinded to the others' findings. RESULTS: The capsules identified more beads than push enteroscopy (median, 6 [range, 2-9] vs. 3 [range, 2-6 beads]; P < 0.001). The sensitivity of the capsule was 64% compared with 37% for push enteroscopy. The specificity was 92% for capsule enteroscopy and 97% for push enteroscopy. The capsules identified significantly more beads beyond the reach of the push enteroscope (median, 4 [range, 2-7] vs. 0; P < 0.0001). Hair, ingested plastic, ulceration, submucosal swelling, and worms were clearly identified by the capsule. The capsules passed safely through the animals with no significant histologic findings. CONCLUSIONS: Wireless capsule endoscopy detected more abnormalities in the small bowel than push enteroscopy.

Animals↗

PubMed2006

Review article: capsule endoscopy - are all small intestinal lesions Crohn's disease?

Capsule endoscopy is the gold-standard examination for the diagnosis of Crohn's disease (CD) of the small intestine. Its incremental yield over other imaging modalities is above 30%. It is important to keep in mind that over 10% of healthy subjects demonstrate mucosal breaks and erosions in their small intestinal mucosa. Thus, one should refrain from diagnosing CD based on the existence of a few erosions and ulcers of the small intestine. Such erosions and ulcers may in fact be the result of non-steroidal anti-inflammatory drug intake and other pathological conditions such as lymphoid hyperplasia, lymphoma and radiation enteritis. Non-steroidal anti-inflammatory drug intake should, therefore, be excluded as a cause prior to relating the presence of lesions to CD. Misdiagnosis of CD may be harmful to the patient because if unresponsive, intensification of therapy may occur and occasionally an unnecessary operation may be performed. At the same time, the patient may also be deprived of the appropriate therapy for the treatment of their condition.

Capsule Endoscopy↗

PubMed2004

Diagnosis of small bowel radiation enteritis by capsule endoscopy.

We report a case of radiation-induced enteritis of the small bowel diagnosed by capsule endoscopy. A 67-year-old woman, who had received radiotherapy for a carcinoma of cervix 10 years ago, presented with passage of tarry stool and anaemia. The gastroscopy results were normal and the small bowel enema showed no abnormalities, but colonoscopy revealed altered blood clots in the right-sided colon and in the terminal ileum. M2A capsule endoscopy was subsequently performed that showed an ulcer and stricture at the distal ileum. The capsule, however, became lodged at this stricture site caused by the stenosis. A small bowel resection was performed to remove both the diseased section and the capsule, and the patient made an uneventful recovery.

Aged↗

PubMedDate not supplied

Detecting a small bowel tumor via wireless capsule endoscopy: a clinical case study.

Tumors of the small intestine account for fewer than 5% of gastrointestinal neoplasms. Approximately 20% of small bowel neoplasms are gastrointestinal stromal cell tumors, a spectrum of mesenchymal tumors of the gastrointestinal tract that range from benign to highly malignant. Diagnosis of gastrointestinal stromal cell tumors is usually incidental, given their rarity and the limitations of traditional endoscopy and radiology studies in visualizing the small intestine. The advent of wireless capsule endoscopy has improved the definitive diagnosis of small bowel disorders. This article outlines the course of diagnosis and treatment for a patient who presented to our hospital with severe anemia and demonstrates the role of capsule endoscopy in identifying the causes of obscure gastrointestinal bleeding.

Abdominal Pain↗

PubMed2006

The effect of erythromycin on video capsule endoscopy intestinal-transit time.

BACKGROUND: Video capsule endoscopy (VCE) will fail to reach the cecum in 20% of patients within the 8-hour battery life. The use of prokinetics to improve VCE completion rates to the cecum remains unclear. The objective of this study was to determine whether erythromycin increases the completion rate of VCE to the cecum without adversely affecting image quality. METHODS: This was a prospective, randomized, single-blinded control trial at St. Vincent's Hospital, Melbourne, Australia. A total of 86 consecutive patients referred for VCE were considered for entry; 45 patients met the entry criteria. These 45 patients were prospectively randomized to no erythromycin (controls, n = 23) or 250 mg erythromycin (n = 22). Two gastroenterologists, who were unaware of which group the patients were randomized into, reported all VCEs. The number of VCEs that reached the cecum within the 8-hour study period, gastric emptying time (GET), and small-bowel transit time (SBTT) were calculated for each group. RESULTS: There was no significant difference in the number of VCEs that reached the cecum (32% failed to reach the cecum in the erythromycin group compared with 22% in the control group), GET, or SBTT between the two groups. Image quality was not adversely affected by the use of erythromycin. The dose and the preparation of erythromycin used in this study may have possibly had an effect on GET and SBTT. CONCLUSIONS: The use of erythromycin did not significantly increase the likelihood of the capsule reaching the cecum or affect the degree of visible peristalsis or the interpretation of capsule findings.

Administration, Oral↗

PubMed2004

Wireless capsule endoscopy in the evaluation of the esophagus.

Wireless capsule endoscopy is an exciting and innovative technology that allows direct visualization of areas of the small bowel that were previously inaccessible to the "umbilicated" endoscope except during intraoperative enteroscopy. The wireless capsule endoscope permits noninvasive small bowel endoscopy in the ambulatory setting and has been proven to be a significant advance in the evaluation of patients with challenging small intestinal disease.

Contraindications↗

PubMed2003

Diagnosing small bowel Crohn's disease with wireless capsule endoscopy.

BACKGROUND: The small bowel is the most commonly affected site of Crohn's disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy. AIMS: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of the M2A Given Capsule. PATIENTS: Seventeen patients (eight males, mean age 40 (15) years) with suspected CD fulfilled study entry criteria: nine had iron deficiency anaemia (mean haemoglobin 10.5 (SD 1.8) g%), eight had abdominal pain, seven had diarrhoea, and three had weight loss. Small bowel x ray and upper and lower gastrointestinal endoscopic findings were normal. Mean duration of symptoms before diagnosis was 6.3 (SD 2.2) years. METHODS: Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter, and an antenna. Recording time was approximately eight hours. The capsule was excreted naturally in the patient's bowel movement, and the data it contained were retrieved and interpreted the next day. RESULTS: Of the 17 study participants, 12 (70.6%, six males, mean age 34.5 (12) years) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. CONCLUSIONS: Wireless capsule endoscopy diagnosed CD of the small bowel (diagnostic yield of 71%). It was demonstrated as being an effective modality for diagnosing patients with suspected CD undetected by conventional diagnostic methodologies.

Adult↗

PubMed2005

Capsule endoscopy examination--preliminary review by a nurse.

Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were pre-read by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved dollar 324 per CE examination. The use of nurse practitioner to pre-read CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.

Clinical Competence↗

PubMed2004

Capsule endoscopy, technical impact, benefits and limitations.

BACKGROUND: The small bowel is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations. However, for a wide variety of specific lesions, the diagnostic value of other tests for imaging the small bowel is low. For the first time wireless capsule endoscopy has made non-invasive imaging of the entire small bowel possible. A number of peer-reviewed studies has been published that compare the method with push-enteroscopy in patients with obscure gastrointestinal bleeding and have shown superior diagnostic results. CONCLUSION: Capsule endoscopy has opened up new horizons for the diagnosis of small-bowel disease. All published studies show a higher diagnostic yield of capsule endoscopy compared with push-enteroscopy and standard radiographic investigations.

Abdominal Pain↗

PubMed2006

Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator.

Video capsule endoscopy (VCE) is a useful diagnostic tool in patients with unknown blood loss, particularly when there is a high suspicion of small bowel disease, but because of its use of radio frequency, it is relatively contraindicated in patients with a cardiac device. We report the case of a patient with an implantable cardiac defibrillator (ICD) who underwent VCE because of anaemia and previous surgery for colorectal cancer. Device interrogations were performed before and after the procedure. No interference between VCE and ICD was found. VCE is feasible and relatively safe in patients with ICDs.

Aged↗

PubMed2005

Structured terminology for capsule endoscopy: results of retrospective testing and validation in 766 small-bowel investigations.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) is an effective means of investigating the small bowel in patients with gastrointestinal diseases. Computerized reports are frequently used in endoscopy, and the Minimal Standard Terminology (MST) has been promoted by endoscopy societies as the official vocabulary for endoscopy. The aims of this study were to design a lexicon for CE reports based on the principles of the MST and to validate lists of terms for describing findings and reasons for performing a CE by cross-matching them with the results of CE procedures collected during ongoing clinical studies. MATERIALS AND METHODS: A consensus-based Capsule Endoscopy Structured Terminology (CEST) was developed by experts involved in CE studies. Lists of terms suitable for CE were designed for the various sections of an endoscopic report. They were then correlated with the corresponding MST lists for duodenal and intestinal endoscopy. The results of 766 CE procedures, collected in an electronic case record form (eCRF), were analyzed to provide lists of reasons for performing the procedures and of the findings. The eCRF provided only a limited number of items for each data field, along with free-text facilities. Only descriptions pertaining to the small bowel were analyzed. Lists of terms were then reviewed by two experts to group obvious synonyms. The accuracy of the CEST was defined beforehand as the capability to describe 90 % of entries. RESULTS: A total of 766 CE procedures were analyzed. The eCRF included 824 entries as reasons for the examination in 655 CEs (1.3 per procedure). These represented 122 different expressions. After grouping of synonyms, 28 expressions remained. Among them, 10 were matched with terms from the list of reasons for performing CE offered in the CEST. These were the most frequently used, accounting for 768 entries in this field (93.2 %). All eCRFs contained at least one description of findings. A total of 109 CE procedures were classified as normal (14.3 %). A total of 2624 entries for abnormal findings were recorded for 657 procedures (4.0 per procedure). In all, 213 different expressions were used to describe abnormal findings. After grouping of synonyms, 52 expressions remained. Among these, 27 were matched with terms from the list of findings in the CEST, covering 2403 entries (91.6 %). CONCLUSIONS: In this study, CEST terms were capable of describing more than 90 % of the reasons for performance and of the findings in an unselected set of CE procedures. CEST is therefore suitable for use as the standard lexicon for CE reports. Adopted as a standard, it could significantly improve the quality of the data collected and reported in CE studies.

Endoscopy, Gastrointestinal↗

PubMed2003

Capsule endoscopy in patients with suspected Crohn's disease and negative endoscopy.

BACKGROUND AND STUDY AIMS: The aim of the present study was to assess the value of capsule endoscopy in the diagnostic work-up of patients in whom there is a clinical suspicion of small bowel Crohn's disease that cannot be confirmed using traditional techniques. PATIENTS AND METHODS: A total of 21 patients (14 men, seven women; mean age 43 +/- 8 years) with a clinical and biochemical suspicion of Crohn's disease were included in the study. Conventional imaging work-up, including upper and lower endoscopy, as well as a small-bowel follow-through, was carried out in all of the patients. RESULTS: Pathological findings were not observed in 12 of the 21 patients (57 %). In the other nine patients (43 %), lesions supporting the diagnosis of Crohn's disease were seen. The most frequent findings were located in the distal ileum and included aphthae, lineal and serpiginous ulcers, and fissures. Four patients had lesions in the jejunum. One patient showed erosions in the distal duodenum, jejunum, and ileum. No adverse effects of the technique were observed in any of the patients. CONCLUSIONS: Capsule endoscopy is a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques.

Adult↗

PubMed2005

[Capsule endoscopy in patients with cardiac pacemakers: current situation in Germany].

BACKGROUND AND AIMS: The study evaluated the actually experience of capsule endoscopy (CE) in patients with electrical implants (cardiac pacemaker/defibrillator) in Germany. PATIENTS AND METHODS: A standardized questionnaire was sent to all centers in Germany doing capsule endoscopy. The questionnaire covers the number of examined patients, monitoring during CE, check of the electric implants before and after CE, occurrence of arrhythmia, quality of CE-video, complications, location and indication of CE. RESULTS: The questionnaire was sent to 154 hospitals and 51 surgeries. 43% of the questionnaires were sent back to our hospital. In 28 centers 45 Patients with a cardiac pacemaker (CP) and 8 patients with a defibrillator (ICD) were examined with CE. There were no relevant complications. In only two cases supraventricular extrasystoles were seen. 93% of patients with a cardiac pacemaker and 67% of the patients with a defibrillator were examined in a hospital. The predominant indication (patients with CP 86%, patients with ICD 67%) was a gastrointestinal bleeding. CONCLUSION: There are limited experiences of CE in patients with electric implants in Germany. Domain of CE is the diagnostic of gastrointestinal bleeding. Through the results of the inquiry you can conclude that CE in patients with cardiac pacemakers seems to be acceptable in the clinics.

Aged↗

PubMed2005

Capsule endoscopy in gastrointestinal lymphomas.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) is a new procedure for small-bowel imaging. The potential contribution of this method to the diagnosis and staging of gastrointestinal lymphomas has not yet been evaluated. The aim of this prospective study was to assess the frequency and morphology of different forms of intestinal pathology in patients with gastrointestinal lymphomas. PATIENTS AND METHODS: Commercially available capsule video endoscopes were administered to 27 patients (16 men and 11 women, aged 27-77) with known gastrointestinal lymphomas. CE was also carried out in 30 control individuals. RESULTS: All seven patients with primary intestinal lymphomas who were examined were found to have pathological findings on CE--four with ulcerations, four with nodes, three with villous atrophy, and one with plaques/white villi. One patient with severe diarrhea was examined three times before and after chemotherapy, and improvement of the lesions was evident, as well as resolution of diarrhea. Twenty patients with gastric lymphoma were examined (16 with low-grade and four with high-grade B cell lymphomas). The capsule did not leave the stomach in three patients, suggesting impaired motility. The small-bowel transit times were 261+/-41 min for intestinal lymphoma, 245+/-62 min for gastric lymphoma, and 224+/-82 min for controls (P>0.05). Five of the 20 patients with gastric lymphoma had pathological findings in the intestine--three with plaques/white villi, two with nodes, and two with villous atrophy. In two patients, subsequent biopsies revealed secondary follicular lymphoma and high-grade lymphoma, respectively. CONCLUSIONS: CE is a valuable diagnostic tool for defining the extent of bowel involvement and assessing the efficacy of treatment in patients with gastrointestinal lymphoma.

Adult↗

PubMed2005

Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.

PURPOSE: Capsule endoscopy (CE) has been shown to have a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB). It is not known if repeating CE improves diagnostic yield or changes patient management when the initial CE is negative or nondiagnostic. The aims of this study are (1) to understand the reasons for repeat CE, (2) to determine the diagnostic yield of repeat CE, and (3) to establish if findings on repeat CE resulted in a change in patient management. METHODS: Between August 2001 and October 2003, we performed 391 capsule studies. Of these, 24 were repeat studies in patients with OGIB. We retrospectively reviewed the charts of these 24 patients. RESULTS: The reasons for repeat CE were: recurrent gastrointestinal bleeding (13), limited visualization on first exam due to poor prep or blood (10), complication (1) (capsule impaction at cricopharyngeus). Eighteen of 24 (75%) repeat capsule studies revealed additional findings (7 arteriovenous malformations, 2 gastropathy, 2 erosions, 2 masses, 1 ulcer, 2 red spots, 1 linear streak, 1 erythema). These findings led to changes in patient management in 15 of the 24 (62.5%) cases. CONCLUSIONS: Indications for repeat CE most commonly include recurrent gastrointestinal bleeding and limited visualization on initial study. Repeat CE results in a high yield of new findings that lead to changes in patient management. Repeat CE should be considered in patients with persistent OGIB when the initial study is negative or inconclusive.

Aged↗

PubMed2004

Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases.

BACKGROUND & AIMS: Capsule endoscopy (CE) is a promising diagnostic tool for the study of patients with obscure gastrointestinal bleeding. However, the diagnostic yield of this technique has not been adequately studied. We evaluated sensitivity and specificity of CE and the outcome after CE in patients with obscure gastrointestinal bleeding. METHODS: One hundred consecutive patients (all with recent negative upper and lower endoscopy; 26 with ongoing overt bleeding [group A], 31 with previous overt bleeding [group B], and 43 with guaiac-positive stools and iron-deficiency anemia [group C]) underwent CE. RESULTS: The yield of positive findings on CE was 92.3% in group A, 12.9% in group B, and 44.2% in group C (P < 0.0001, A vs. B, A vs. C). Angiodysplasia (29%) and Crohn's disease (6%) were the most common diagnoses. Sensitivity, specificity, and positive and negative predictive values of CE were 88.9%, 95%, 97%, and 82.6%, respectively. CE results led to treatments resolving the bleeding in 86.9% of patients undergoing the procedure while actively bleeding. Capsule retention because of unsuspected stenosis occurred in 5 patients and required surgery, which resolved the clinical problem, in 4 patients. CONCLUSIONS: CE is an effective diagnostic tool for patients with obscure GI bleeding. The best candidates for the procedure are those with ongoing obscure-overt bleeding or with obscure-occult bleeding. If done early in the course of the workup, CE could shorten considerably the time to diagnosis, lead to definitive treatment in a relevant proportion of patients, and spare a number of alternative investigations with low diagnostic yield.

Adult↗