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At least 217 records · Page 12Linked to original sources
PubMed2003

Is esophageal capsule endoscopy feasible? Results of a pilot.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) has been shown to be accurate in the evaluation of small-bowel bleeding and possibly also other small-bowel disorders. It is commonly believed that other organs are not suitable for CE. We report here on our experience in studying the distal esophagus using CE under various conditions. PATIENTS AND METHODS: A prospective evaluation of CE was carried out in three groups: evaluation of the distal esophagus in routine patients (n = 58) mostly examined for suspected small-intestinal bleeding (group 1); in eight patients with signs of grade I - II reflux esophagitis on upper gastrointestinal endoscopy, who were examined in a supine position for esophageal passage (group 2); and in four volunteers who swallowed the capsule attached to a string (group 3). RESULTS: In 62 routine patients initially included in group 1, the median CE exposure time was 2 s (range 0 - 217 s; median of four pictures, range 0 - 434), excluding four patients with extremely delayed esophageal transit (esophageal times: 45 - 226 min); at least one image of the Z line was obtained in 24.1 % of cases, but adequate assessment of 50 % and 100 % of the circumference of the distal esophagus was possible in only 10.4 % and 0 % of these cases, respectively. In group 2, the values were better (adequate visibility rates of 50 % and 100 % in 12.5 % and 37.5 % of the eight patients, respectively), but the correct diagnosis of reflux lesions was obtained in only three of the eight. In group 3, the visibility of the Z line was good, but all four volunteers experienced the procedure with the attached string as being quite unpleasant. CONCLUSIONS: Distal esophageal assessment by CE with the aim of providing an easy screening method for reflux lesions is not at present feasible. Technical developments will be necessary to achieve this.

Adolescent↗
PubMedDate not supplied

Small bowel exploration with video capsule endoscopy.

In recent years, a revolutionary system has been developed, composed of a swallowable video capsule, able to visualize the entire small bowel. The device has been experimented on animals and man, based on miniaturization technology applied to its electronic components. The reported studies have indicated the superiority of video capsule endoscopy as compared to radiology. However, the great potentialities of this diagnostic system are still to be fully explored. In the near future, large, controlled clinical trials will solve some of the present problems.

Capsules↗
PubMed2005

Capsule endoscopy.

Explore the source record for details and available documents.

Capsule Endoscopy↗
PubMed2004

Obscure gastrointestinal bleeding: a complication of radiation enteritis diagnosed by wireless capsule endoscopy.

Obscure gastrointestinal bleeding is a common disorder and may account for as many as 5% of all gastrointestinal hemorrhages. It is often caused by lesions in the small intestine, which were very complicated to examine prior to the advent of wireless capsule endoscopy. Here we present the case of a 31-year-old woman with obscure gastrointestinal bleeding as a complication of radiation enteritis, which was diagnosed only after she underwent an examination with wireless capsule endoscopy. This technique has proven to be far superior to other radiographic and endoscopic methods in diagnosing obscure gastrointestinal bleeding and pathologies of the small intestine in general.

Adult↗
PubMed2006

Capsule endoscopy in celiac disease: diagnosis and management.

Celiac disease occurs in about 1% of the population. Although diarrhea is the classical presentation, the diagnosis of celiac disease is frequently not considered as part of the differential diagnosis of a variety of different symptoms. It is,therefore, imperative that physicians who perform capsule endoscopy, and those who review the images, are aware of the variety of mucosa appearances inpatients who have celiac disease. In addition, studies are needed to determine the role of capsule endoscopy in the diagnosis and management of celiac disease.

Celiac Disease↗
PubMed2005

Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators.

OBJECTIVES: Wireless video capsule endoscopy (CE) is a new technology that allows visualization of the entire small intestinal mucosa. It is indicated for the evaluation of obscure gastrointestinal bleeding (OGIB) and other disorders of the small intestine. Studies to date suggest that CE is safe and associated with few adverse events. A concern, which has not been studied, is the potential effect of CE on implanted cardiac devices such as implantable cardiac defibrillators (ICD) and other electromedical devices. We previously found CE to be safe in patients with cardiac pacemakers. The primary aim of this study was to evaluate the safety of CE in patients with ICDs who were being evaluated for OGIB. In addition, a secondary aim of the study was to determine whether ICDs had any effect on the images captured by CE. METHODS: Patients referred for the evaluation of OGIB and who also had an ICD were enrolled into the study after informed consent. Five consecutive patients (four females and one male; mean age: 72 yr; range: 60-81 yr) with ICDs were studied. All patients had transvenous endocardial ICDs located in the chest. Prior to CE, patients had a baseline electrocardiogram (ECG) and ICD interrogation. Thereafter, CE was performed in a hospital setting with telemetry monitoring performed simultaneously. A post-procedure ICD interrogation was carried out to evaluate changes in programmed parameters. A cardiologist and ICD nurse specialist together reviewed both the telemetry monitor and the post-procedure ICD interrogation on each patient. When CE studies were reviewed, observations pertaining to technical difficulties and interference with video imaging were documented. RESULTS: No arrhythmia or other adverse cardiac events were noted during capsule transmission. No interference by the ICD on the CE video images was seen. CONCLUSIONS: CE was performed safely in these five patients with ICDs, and was not associated with any adverse cardiac events. ICDs also do not appear to interfere with video capsule imaging.

Aged↗
PubMed2004

[A case of chronic gastrointestinal bleeding from a Meckel's diverticulum detected by wireless capsule endoscopy].

Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.

Adult↗
PubMed2004

Video capsule endoscopy: a voyage beyond the end of the scope.

Video capsule endoscopy (VCE), an important innovation in diagnostic endoscopy, was approved in 2001 and is now widely available. In this system, the patient swallows a miniature high-resolution camera that is propelled by peristalsis through the gastrointestinal tract. It is particularly useful in examining the small intestine, which is difficult to visualize by conventional endoscopic techniques.

Endoscopes, Gastrointestinal↗
PubMed2004

Jejunal leiomyosarcoma, a rare cause of obscure gastrointestinal bleeding diagnosed by wireless capsule endoscopy.

Obscure gastrointestinal bleeding is a relatively frequent disorder and may account for as many as 5% of all cases of gastrointestinal bleeding. The etiology of these hemorrhages may be attributed to lesions in the small intestine, which may not show up in radiologic studies, located in areas inaccessible to conventional endoscopy. The case of a 50-year-old patient admitted to the hospital on two occasions for gastrointestinal bleeding requiring blood transfusions is reported. On the first occasion, the bleeding was thought to be caused by a duodenal ulcer because no other lesions prone to bleeding were found. At the next admission for recurrent bleeding, the ulcer was found to have healed and thus was ruled out as the cause. Wireless capsule endoscopy detected an ulcerated tumor invading the submucosa of the jejunum. The pathologic diagnosis was low-grade leiomyosarcoma. Wireless capsule endoscopy has proved to be far superior to other radiologic and endoscopic techniques for the diagnosis of obscure gastrointestinal bleeding and pathologies of the small intestine in general.

Blood Transfusion↗
PubMed2005

Visualization of jejunal bleeding by capsule endoscopy in a case of eosinophilic enteritis.

Eosinophilic enteritis is a rare disease characterized by tissue eosinophilia, which can affect different layers of bowel wall. Normally, the disease presents as colicky abdominal pain, and rarely as an acute intestinal obstruction or perforation. In this paper, we report a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis. Seventeen days after operation, intermittent abdominal pain occurred again, and subsided upon 30 mg per day treatment with prednisolone. Fourteen days after this pain attack, the patient exhibited hematochezia, in spite of continuous prednisolone treatment. Capsule endoscopy showed fresh blood spurting from the mid-to-distal jejunum, in the absence of any mass or ulcer. This hematochezia rapidly disappeared following a high-dose steroid injection, suggesting it was a manifestation of jejunal eosinophilic enteritis.

Endoscopy, Gastrointestinal↗
PubMed2002

Wireless capsule endoscopy in a patient with obscure occult bleeding.

A case of obscure/occult bleeding in a 39-year old man with a 7-year history of chronic fatigue and iron-deficiency anemia is presented here. Esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and a magnetic resonance imaging small-bowel follow-through did not reveal any abnormalities. Multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the area of the lower jejunum and ileum were diagnosed only with capsule endoscopy. One ulcer located near the ileocecal valve was then biopsied during a repeat ileocolonoscopy, and the histology showed signs of Crohn's enteritis. The further treatment approach was changed, with medical treatment being initiated and intraoperative enteroscopy being averted. Wireless capsule endoscopy clarified the cause of the obscure/occult bleeding in this patient and contributed to the diagnosis and endoscopic imaging of an isolated Crohn's enteritis, which is the cause of bleeding in approximately 10 - 20 % of cases of occult bleeding.

Adult↗
PubMed2005

Capsule endoscopy for gastrointestinal bleeding with an obscure etiology.

BACKGROUND AND PURPOSE: Capsule endoscopy (CE) is a new diagnostic modality that is being utilized with increasing frequency for examination of lesions suspected to be of small bowel origin. The most common indication for CE is obscure gastrointestinal bleeding. This study investigated the safety and diagnostic value of CE in patients with obscure gastrointestinal bleeding. METHODS: From February 1 to October 30, 2003, 35 patients with obscure gastrointestinal bleeding among 43 consecutive patients with suspected small bowel pathology were enrolled. The mean age of the patients was 50.5 years (range, 24-81 years). A negative panendoscopy and colonoscopic study were required for study eligibility. An M2A video capsule endoscope was swallowed by each patient after an overnight fast if plain abdominal radiograph done 1 day prior to the procedure was negative for obstruction. Bowel preparation using a mixed solution containing magnesium carbonate, citric acid anhydrous and potassium bicarbonate, and bisacodyl was performed only in selected patients. RESULTS: Abnormal findings were noted in 31 of 35 patients (89%), 20 (57.2%) of whom had gastrointestinal pathology explaining their symptoms. Only 12 (34%) of the 20 patients had lesions solely in the small bowel. Angiodysplasia was the most common source of bleeding (37%), followed by Crohn's disease (14%). Other findings included Osler-Weber-Rendu's disease, gastrointestinal stromal tumor, vascular ectasia and small bowel diverticulum. Three capsules became lodged and did not provide images during subsequent transit through the colon, but serial abdominal plain radiographs done every 3 days after capsule ingestion showed passage of the capsules had occurred by 1 week. No discomfort or side effects were noted up to 2 months after ingestion. CONCLUSION: CE is a safe, painless and effective method for diagnosing obscure gastrointestinal bleeding. A final diagnosis was reached in more than one half of the patients and positively affected treatment. The capsule produced clear and recognizable images of lesions even without bowel preparation. If done early, CE can aid in directing proper management in patients with suspected small bowel pathology.

Adult↗
PubMed2006

Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video).

BACKGROUND: Video capsule endoscopy (VCE) may be useful for surveillance of small-bowel polyps in patients with familial adenomatous polyposis (FAP). OBJECTIVE: To compare VCE to standard endoscopy for diagnosing small-bowel polyps in a defined segment of small bowel (proximal to a tattoo) and the entire examined small bowel. DESIGN: Prospective. SETTING: Single tertiary referral center. PATIENTS: Participants with FAP (n = 32). The majority were selected for their high number of proximal small-bowel polyps and prior endoscopic tattoo placement in the proximal small bowel. INTERVENTIONS: VCE (interpreted by 2 readers), push enteroscopy (PE), and lower endoscopy (LE) to count and measure small-bowel polyps. RESULTS: In the defined segment, VCE detected a median of 10.0 (interquartile range [IQR], 5.0-19.0) and 9.0 (IQR, 6.0-16.0) polyps for each reader compared with a median of 41.0 (IQR, 19.0-64.0) polyps on PE (P = .002). Agreement between the 2 methods was fair (kappa = 0.34, 0.36). Agreement between VCE and PE was poor to fair (kappa = 0.10, 0.22) for estimating the size of the largest polyp and poor (kappa = -0.20, -0.27) for detecting large polyps (> or =1 cm). In the entire examined small bowel, VCE diagnosed a median of 38.0 (IQR, 10.5-71.5) and 54.0 (IQR, 13.0-100.0) polyps for each reader compared with a median of 123.0 (IQR, 38.5-183.0) for combination endoscopy (PE and LE) (P < .001). Agreement between the 2 methods was fair to moderate (kappa = 0.21, 0.56). LIMITATIONS: Participants selected for high polyp burden, and results may not be applicable to all patients with FAP. CONCLUSIONS: VCE underestimates the number of small-bowel polyps in persons with FAP and does not reliably detect large polyps.

Adenomatous Polyposis Coli↗
PubMed2004

[Diagnostic utility of capsule endoscopy in occult gastrointestinal bleeding].

BACKGROUND AND OBJECTIVE: The video-capsule endoscopy (CE) of the small intestine is a novel innovative procedure for outpatient use that can detect even small lesions of the mucosa of the small intestine. Aim of this retrospective clinical study was to evaluate the diagnostic value of CE in a clinical routine setting. PATIENTS AND METHODS: Between July 2001 and October 2002 we investigated 42 patients with suspected gastrointestinal bleeding by CE. In all patients, the previous upper and lower endoscopy work-up was normal. In some cases additional procedures such as bloodpool scintigraphy, angiography, small-bowel enteroclysis or push-enteroscopy were performed. RESULTS: CE detected relevant pathological findings in 23 out of 42 Patients (55 %). The majority of findings in the CE consisted of angiodysplasia (n = 16), ulcer and haemorrhagical erosions (n = 10), one Ulcus Dieulafoy and additional polyps of the small intestine (n = 2). In 4 cases an inflammatory small-bowel disease was detected. These findings could be confirmed by Re-endoscopy. The information provided was helpful to direct further diagnostic and treatment options. In 14 cases (33 %) CE-findings steered additional diagnostic and therapeutic steps. We conclude that CE is safe and has a high diagnostic yield. CONCLUSION: M2A video CE is likely to become an integral part of the algorithm of diagnostic of occult gastrointestinal bleeding after exclusion of other causes of anemia and negative upper and lower endoscopy work-up.

Adult↗
PubMedDate not supplied

Is a 2-liter PEG preparation useful before capsule endoscopy?

AIMS: Small bowel contents can sometimes hamper the quality of capsule images. Our aim was to investigate the effect of PEG administered prior to capsule endoscopy (CE) upon quality of images, gastrointestinal transit time, and detection rate of small bowel bleeding lesions in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: Forty-two consecutive patients were included. CE was performed following a 12-hour fasting period. The 16 first patients (Group A) received no preparation and the following 27 patients (Group B) received 2 L of PEG the night before. The quality of images was assessed at both in duodenojejunum and ileum level, using a scale including the presence of air bubbles, biliary secretion, and residue (1-4). RESULTS: Quality of images were not different in Group A compared with Group B in the duodenojejunum and in the ileum. Gastric transit time tended to be shorter in Group A compared with Group B (25.5 vs. 45.7 minutes) (P = 0.15), whereas small bowel transit was not different between both groups (271 vs. 288 minutes). Total small bowel CE examination was complete in Group A and in 24 of 26 in Group B (not significant). Potential bleeding lesions were seen in 8 patients in Group A and 12 in Group B (not significant). CONCLUSION: Our retrospective study suggests that 2 L PEG preparation seems able to improve neither the quality of CE images nor its diagnostic performance. Moreover, in our study, PEG tended to increase gastric emptying time and may constitute a limitation for small bowel complete examination.

Adult↗
PubMed2005

Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease.

BACKGROUND AND AIMS: Small bowel MR enteroclysis and wireless capsule endoscopy (WCE) are new diagnostic tools for the investigation of the small bowel. The aim of this study was to compare the diagnostic yield of WCE with MR enteroclysis in the detection of small bowel pathologies. METHODS: A total of 36 patients were included in the study. Indications for imaging of the small bowel were proven or suspected small bowel Crohn's disease (CD; n=18), obscure gastrointestinal (GI) bleeding (n=14) and tumour surveillance (n=4). RESULTS: In patients with Crohn's disease WCE detected significantly more inflammatory lesions in the first two segments of the small bowel compared with MR enteroclysis (12 patients vs. 1 patient, p=0.016). In 5 out of 14 (36%) patients with GI bleeding, angiodysplasia was detected as a possible bleeding source. Three of these patients had active bleeding sites detected by WCE. One patient had scattered inflammation of the mucosa. MR enteroclysis did not reveal any intestinal abnormalities in this patient group. MR enteroclysis provided extraintestinal pathologies in 10 out of 36 (28%) patients. CONCLUSION: In patients with Crohn's disease WCE revealed significantly more inflammatory lesions in the proximal and middle part of the small bowel in comparison to MR enteroclysis, whereas in patients with obscure GI bleeding WCE was superior to MR enteroclysis.

Adolescent↗
PubMed2005

Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis.

BACKGROUND AND STUDY AIMS: Video capsule endoscopy and double-balloon enteroscopy (DBE) are novel methods of enteroscopy. The aim of this investigation was to compare the value of CE and DBE in the diagnosis of small-intestinal pathology. PATIENTS AND METHODS: Thirteen patients with gastrointestinal bleeding of obscure origin and nine patients with known gastrointestinal polyposis were examined using antegrade or retrograde DBE, and the most distal or proximal site in the explored small intestine was marked by submucosal injection of sterilized ink. The patients were then evaluated by CE. Video images obtained by CE were reviewed by an observer who was blinded to the DBE findings. RESULTS: DBE identified positive findings in 12 patients (54.5 %). CE identified positive findings in the area explored by DBE in eight patients (36.4 %), and in the unexplored area in 11 patients (50.0 %). The overall diagnostic yield in the area explored by DBE did not differ between the two procedures. The enteroscopic findings in the area explored by DBE were concordant in 12 of 13 patients with gastrointestinal bleeding of obscure origin. In patients with polyposis, the diagnoses were discordant in three patients, in whom CE failed to detect any polyp. In two of three polyposis patients with concordant positive findings, DBE detected a larger number of polyps than CE did. CONCLUSIONS: DBE appears to be superior to CE in the diagnosis of small-intestinal polyps, whereas the value for diagnosing gastrointestinal bleeding of obscure origin is similar in the two procedures.

Adult↗