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Results for “Capsule Endoscopes”

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At least 271 records · Page 15Linked to original sources

PubMed2006

A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.

OBJECTIVE: Obscure gastrointestinal bleeding from jejunal and ileal lesions remains undiagnosed using traditional imaging techniques (radiologic, endoscopic). This prospective study compares the diagnostic detection rate of small-bowel lesions using wireless video capsule endoscopy (VCE) with the detection rate using double-balloon enteroscopy (DBE) in patients with obscure gastrointestinal bleeding (OGIB). Tolerance, adverse events, endoscopic interventions, and prognosis were described as secondary aims. METHODS: Thirty-five consecutive patients with obscure gastrointestinal bleeding were evaluated (22 males and 13 females; mean age 63.2 yr; range, 19-86 yr). The detection rates of the Given M2A wireless VCE and DBE were compared. RESULTS: Small-bowel abnormalities were detected using VCE in 28 (80%) of the 35 patients with OGIB, compared with 21 (60%) of the 35 patients using DBE (p = 0.01). Both examinations were well tolerated, but VCE was more acceptable to patients. No major adverse event occurred after either examination. Biopsies (n = 27), argon plasma coagulation (n = 19), tattoo injection (n = 8), and polypectomy (n = 2) were feasible with DBE when indicated in 27 of the 35 patients (77%). During a median (range) follow-up period of 5 (2-12) months, 26 (74%) patients remained clinically stable and did not require blood transfusions after DBE procedures. Eighteen (51%) of those who remained clinically stable had received APC therapy. CONCLUSIONS: High detection rates of the causes of OGIB are feasible with VCE and DBE. Although the detection rate of VCE was superior, our results indicate that the procedures are complementary; an initial diagnostic imaging employing VCE might be followed by therapeutic and interventional DBE.

Adult↗

PubMed2006

Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease?

BACKGROUND: Villous atrophy present on a duodenal biopsy remains the 'gold standard' diagnostic test for coeliac disease. However, endoscopic biopsy may cause morbidity and discomfort. Our aim was to evaluate wireless capsule endoscopy as an alternative test for the recognition of villous atrophy. METHOD: Twenty-one patients with a positive endomysial antibody referred for endoscopy and duodenal biopsy were also offered a wireless capsule endoscopy to evaluate their small bowel. Concurrently, other patients (n=23) referred for a wireless capsule endoscopy acted as controls. Wireless capsule endoscopy reports were assessed for the presence of villous atrophy by one blinded investigator. RESULTS: Twenty endomysial antibody positive patients subsequently had villous atrophy on duodenal biopsy. The controls all had normal duodenal biopsies (with a negative endomysial antibody) and no evidence of villous atrophy noted on their wireless capsule endoscopy. Of the 20 endomysial antibody positive patients with confirmed villous atrophy on biopsy, 17 had villous atrophy also detected by wireless capsule endoscopy. The sensitivity, specificity, positive and negative predictive values for wireless capsule endoscopy recognising villous atrophy were 85%, 100%, 100%, 88.9%, respectively. CONCLUSION: Wireless capsule endoscopy may be an option to recognise villous atrophy in patients with a positive endomysial antibody who are unwilling, or unable to have a gastroscopy. However, a negative test should be followed by a biopsy if coeliac disease is to be excluded.

Adult↗

PubMed2001

Endoscopic vitreoretinal surgery for complicated proliferative diabetic retinopathy.

PURPOSE: To evaluate the indication for endoscopic vitreoretinal surgery in proliferative diabetic retinopathy (PDR). METHODS: Chart review of consecutive cases of vitreoretinal surgery for PDR performed by one of the authors (Y.L.F.) over a 2-year period. RESULTS: Endoscopic vitreoretinal surgery was performed in 8 of 41 (19.5%) eyes. The surgical indications were small pupil (3), hyphema (3), pseudophakia with fibrotic posterior capsule (1), and pars plana neovascularization with anterior tractional retinal detachment (6). CONCLUSION: Endoscopic vitreoretinal surgery, by enhancing the visualization of the retroirideal space, is a useful technique in PDR with opaque ocular media and/or neovascularization of the pars plana and ciliary body.

Adult↗

PubMed1996

Routine jejunal endoscopic biopsy in children.

UNLABELLED: The aim of the study was to evaluate and compare two methods of jejunal biopsy-endoscopic (EB) and suction (SB). Jejunal EB was performed using an Olympus GIF P20 endoscope in 119, and SB with a modified Crosby capsule in 254 patients. A light microscope with micrometer was used for the analysis and measurement of biopsy specimens. Calculated per patient, the total average number of all adequate specimens was: jejunal or duodenal mucosa -2.97 in EB and 0.93 in SB; jejunal mucosa only -2.82 in EB and 0.89 in SB group. Duodenal mucosa was unintentionally biopsied in 17.1% of EB and in 3.7% of SB. Jejunal mucosal specimens were selected for measurement at random -82 from the EB and 24 from the SB group. The difference in height between EB and SB specimens was not significant (EB: 0.72 +/- 0.13 mm; vs SB: 0.77 +/- 0.14 mm). The difference in length was significant (EB: 2.57 +/- 1.24 mm; vs SB: 3.22 +/- 1.38 mm; P = 0.03). The advantages of the EB over the SB technique included elimination of fluoroscopy, no failures in obtaining biopsies and a 97% success rate in obtaining specimens adequate for histological analysis. It also enabled the biopsy site to be chosen and several specimens to be taken, providing additional tissue for various analyses. CONCLUSION: Jejunal endoscopic biopsy is suggested as a good alternative to the suction biopsy, wherever paediatric upper gastrointestinal endoscopy is available.

Adolescent↗

PubMed2005

Previously unknown stricture due to radiation therapy diagnosed by capsule endoscopy.

Radiation enteritis is a complex clinical entity secondary to the affectation of intestinal epithelial cells as a result of radiation in the management of pelvic malignancies that may occasionally cause intestinal strictures. We present the case of a 60 year-old woman who had been diagnosed ten years before with endometrial adenocarcinoma, and who underwent hysterectomy with double adnexectomy and subsequent radiation therapy. The patient consulted for abdominal pain and ferropenic anemia of several years standing, and had negative results following radiographic and endoscopic conventional techniques, reason why she was subjected to a capsule endoscopy study that revealed the presence of an ulcerated ileal stricture, which caused the asymptomatic retention of the capsule within the ileum. A laparotomy was subsequently performed--the strictured segment was resected and the capsule retrieved. The histologic examination of the resected segment confirmed the capsule endoscopy-raised suspicion of radiation enteritis. This case shows the role capsule endoscopy may play in the diagnosis of this condition.

Abdominal Pain↗

PubMed2006

What we have learned from 5 cases of permanent capsule retention.

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.

Aged↗

PubMed2005

Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.

OBJECTIVES: At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel. METHODS: We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients. RESULTS: A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients. CONCLUSIONS: Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.

Adenomatous Polyposis Coli↗

PubMed2003

[Imaging in gastroenterology--what is new?].

In the last years there are a lot of developments in endoscopical, radiological and sonographical imaging techniques for example virtual colonoscopy, capsule endoscopy and contrast-enhanced sonography. The MR- or CT-colonography has a high sensitivity of about 90% in the detection of polyps > 1 cm. But what there is to be said against virtual colonoscopy as a routine examination is the need for bowel cleansing with an oral lavage and the high costs due to a long examination and evaluation time. The capsule endoscopy is a very interesting new imaging technique for the diagnostic evaluation of small bowel diseases. The capsule endoscopy is superior to push-enteroscopy, the gold-standard until now. But it is not clear, whether there is change in therapeutical procedures due to the results of the capsule endoscopy and whether the high costs for the examination are justified. The contrast-enhanced sonography improves especially the detection and characterization of solid liver lesions and some CT- and MR-examination will be unnecessary in the future.

Colonography, Computed Tomographic↗

PubMed2004

Second capsule endoscopy for patients with severe iron deficiency anemia.

BACKGROUND: Patients with iron deficiency anemia are subjected to multiple endoscopic and radiologic examinations of the GI tract. If negative, some of the examinations are repeated, occasionally with positive findings. The diagnostic yield of a second capsule endoscopy in such patients is unknown. The aim of the current study was to assess the diagnostic yield of a second capsule endoscopy in patients with significant iron deficiency anemia and a previous negative evaluation. METHODS: Twenty patients with iron deficiency anemia (Hb < 10 g/dL) were enrolled. All had at least one normal evaluation of the GI tract, including capsule endoscopy. A second capsule endoscopy examination was offered to all patients. RESULTS: The time between the first and the second capsule endoscopy ranged from 2 months to 1 year. Depending on the nature of an abnormality and its relevance to blood loss, the findings were classified as positive, suspicious, clinically irrelevant, or negative. In 7 patients, the second capsule endoscopy disclosed findings that were classified as either positive or suspicious findings, including arteriovenous malformations (2), flat polypoid lesion (1), edematous inflamed mucosa (1), erosions (1), and hemorrhagic gastritis (1). Lesions were located in the small intestine (5), the stomach (1), and the cecum (1). Based on the findings of the second capsule endoscopy, therapy was changed in two patients (10%). CONCLUSIONS: A second capsule endoscopy should be considered for patients with severe iron deficiency anemia and negative initial evaluation.

Adult↗

PubMed2005

Endoscopic distal soft tissue procedure in hallux valgus surgery.

The distal soft tissue procedure is the basis of surgical hallux valgus correction. It involves release of the transverse metatarsal ligament, adductor hallucis, and lateral joint capsule, which permits the proximal phalanx to be realigned on the metatarsal head. The attenuated medial capsule is plicated after the medial bony prominence has been excised. We describe a new endoscopic approach for the distal soft tissue procedure with better cosmetic results.

Arthroscopy↗

PubMed2005

[Capsule endoscopy].

Video capsule endoscopy provides a noninvasive diagnostic approach to the entire small intestine. The main indications are suspected chronic or recurrent obscure intestinal bleeding, which can-not be clarified by esophago-gastro-duodenoscopy and colonoscopy. Further indications are polyposis syndromes, suspected Crohn's disease and malignomas of the small bowels. Esophago-gastroduodenoscopy and colonoscopy are essential preceding diagnostic procedures before capsule endoscopy.

Diagnosis, Differential↗

PubMed2006

Development and use of a quality scale for assessing studies that analyze the diagnostic capacity of capsule endoscopy.

BACKGROUND AND STUDY AIMS: The aim of this study was to develop a scale for assessing the quality of published studies on capsule endoscopy, and to apply it to research papers retrieved by a systematic review. METHODS: The scale was based on the evidence-based quality assessment tools used in diagnostic accuracy studies, and was adapted by the inclusion of additional aspects considered to be relevant for the assessment of capsule endoscopy. The scale that was developed used a score range of 0 - 100 and was divided into two sections: validity, with six criteria and a weight of 80 %; and applicability, with two criteria and a weight of 20 %. Two investigators applied the scale independently to the studies retrieved in a systematic review. RESULTS: Twenty studies were included. These studies registered scores ranging from 13 % to 78 % (median score 60 %). In the applicability subsection, only 5/20 studies included were awarded the maximum score. The concordance between the assessors was 0.98. CONCLUSIONS: The scale showed itself to be a valid and reproducible tool that could be used to assess the quality of capsule endoscopy studies. Our study revealed that the methodology of the studies published on this endoscopic technique showed room for improvement, however.

Capsule Endoscopy↗

PubMed2006

Thalidomide as treatment for digestive tract angiodysplasias.

An 80-year-old man with von Willebrand's disease was admitted with severe melaena. Despite suppletion with von Willebrand concentrate he continued to be dependent on blood transfusions. Endoscopic examination did not show a bleeding focus. Video capsule endoscopy showed active bleeding from angiodysplasias in the proximal section of the small intestine. Ultimately, treatment with thalidomide was initiated at a dose of 100 mg/day. Soon after starting treatment his stools became normal and his haemoglobin level stabilised. No bleeding problems occurred for 11 months, after which the thalidomide treatment was stopped because of the potential side effects. Two months later he again developed melaena and treatment with thalidomide was restarted with a successful outcome. Trying to lower the dose to 50 mg resulted in rebleeding after three months with stabilisation after increasing the dose to 100 mg again. Monotherapy with thalidomide improves the clinical picture but may not be sufficient in the long term. Additional therapy, such as argon plasma coagulation or the use of the novel drug lenalidomide, might be necessary.

Aged, 80 and over↗

PubMedDate not supplied

Gastroesophageal reflux in chronic alcoholics. Endoesophageal pH determinations using Heidelberg telemetring capsule.

Gastroesophageal reflux (GER) was studied in 86 chronic ethanol consumers, by determination of endoesophageal pH using a Heidelberg telemetring capsule. All the subjects were subjected to radiologic and endoscopic explorations in some cases completed by esophageal mucosa biopsy. In 49 subjects (56.4%) GER was present in various degrees according to the calculated score; medium and high intensity reflux in 37 cases (44%). GER was symptomatic in 62% of the cases and 30 patients (35.7%) presented esophagitis with columnar epithelium metaplasia in 3 cases. The intensity of reflux and the presence of esophagitis were found to be correlated with the degree of alcoholic "impregnation". Radiologic exploration detected GER in only 22 patients (44.9%).

Alcoholism↗

PubMed1989

Omeprazole and cimetidine in the treatment of ulcers of the body of the stomach: a double blind comparative trial. Danish Omeprazole Study Group.

OBJECTIVE: To see whether omeprazole was superior to cimetidine in healing ulcers of the body of the stomach. DESIGN: Double blind randomised parallel group study of omeprazole versus cimetidine for six weeks with assessment of healing at end of every second week. SETTING: Outpatient referrals in 11 centres in Denmark. PATIENTS: One hundred sixty one patients who satisfied the following criteria: age 18-79; one or more ulcers of body of stomach (that is, at or above the angulus) seen endoscopically within four days before study treatment; no H2 receptor antagonists taken within previous two weeks; no history of gastric surgery and no complications needing surgery; no concurrent treatment or disease that might confound assessment; oral contraception or an intrauterine device being used by women of childbearing age. INTERVENTIONS: Omeprazole 30 mg daily (one capsule in the morning) or cimetidine 1 g daily (one 200 mg tablet thrice daily, two tablets at bedtime) for six weeks. Inactive capsules and tablets provided so that all patients took same number of capsules and tablets daily. Compliance monitored by pill counts. END POINT: Endoscopic evidence of accelerated healing of type I gastric ulcers after four weeks of omeprazole. MEASUREMENTS AND MAIN RESULTS: Pain recorded on diary cards and patients assessed after two, four, and six weeks of treatment for clinical state and by endoscopy and biopsy and repeat laboratory tests. Twenty eight patients withdrawn during trial for violations of protocol. At two weeks healing rates were identical in the two treatment groups (omeprazole 41% (30/73 patients); cimetidine 41% (30/73]. At four weeks cumulative healing rates were 77% (53/69 patients) in the omeprazole treatment group and 58% (41/71) in the cimetidine treatment group (95% confidence interval of difference between groups 4% to 34%). By six weeks the cumulative healing rates in the two treatment groups differed by only 6% (60/68 patients (88%) given omeprazole; 53/65 (82%) given cimetidine). Log rank analysis with ulcer size used as covariable showed a significant difference in healing times in favour of omeprazole. There was no difference in the occurrence of pain relief between the two treatment groups. No serious clinical or biochemical side effects of treatment were noted. CONCLUSIONS: Omeprazole 30 mg daily accelerates healing of ulcers in the body of the stomach as compared with cimetidine 1 g daily. This effect is more pronounced in ulcers greater than 12 mm diameter.

Aged↗

PubMed2003

[The effects of bifidobacterium on the intestinal mucosa of the patients with ulcerative colitis].

OBJECTIVE: To investigate the effects of bifidobacterium (Bf) on the intestinal mucosa of the patients with ulcerative colitis (UC). METHODS: Thirty patients in clinical and endoscopic remission by sulphasalazine and glucocorticoid were randomized to receive either Bifid Triple Viable capsule (BIFICO), 420 mg/d, or an identical placebo (starch) for 8 weeks. Fecal samples were collected for stool culture before and after treatment. Patients were assessed clinically endoscopically and histologically after 2 months or in the case of a relapse. p65 and IkappaB expression was determined by Western blot analysis DNA-binding activity of NF-kappaB in colonic nuclear extracts was detected by electrophoretic mobility shift assay. The mRNA expression of cytokines were identified by a semi-quantitative assay, reverse transcription-polymerase chain reaction. RESULTS: Three patients in the BIFICO group had relapses within the 2-month follow-up period, compared with 14 in the placebo group (P < 0.01). Fecal concentration of lactobacilli, bifidobacteria, increased significantly from baseline levels only in the BIFICO-treated group (P < 0.01). The expression of NF-kappaB p65 and DNA binding activity of NF-kappaB were significantly attenuated in the treat group than that in control (P < 0.05). The mRNA expression of anti-inflammatory cytokines elevated obviously comparable of control group. CONCLUSIONS: The Bf maybe impede the activation of NF-kappaB, decrease the expression of TNF-alpha and IL-1beta and elevate the expression of IL-10. These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic UC. It will become a prophylactic drug delaying the relapse of UC.

Adolescent↗

PubMed2006

Sensitivity and inter-observer variability for capsule endoscopy image analysis in a cohort of novice readers.

AIM: To determine the performance of novice readers (4th year medical students) for detecting capsule endoscopy findings. METHODS: Ten capsule endoscopy cases of small bowel lesions were administered to the readers. Gold standard findings were pre-defined by gastroenterologists. Ten gold standard "targets" were identified among the 10 cases. Readers were given a 30-min overview of Rapid Reader software and instructed to mark any potential areas of abnormalities. A software program was developed using SAS to analyze the thumbnailed findings. RESULTS: The overall sensitivity for detecting the gold standard findings was 80%. As a group, at least 5 out of 10 readers detected each gold standard finding per recording. All the gold standard targets were identified when the readers' results were combined. Incidental finding/false positive rate ranged between 8.2-59.8 per reader. CONCLUSION: A panel of medical students with minimal endoscopic experience can achieve high sensitivity in detecting lesions on capsule endoscopy. A group of novice readers can pre-screen recordings to thumbnail potential areas of small bowel lesions for further review. These thumbnails must be reviewed to determine the clinical relevance. Further studies are ongoing to assess other cohorts.

Diagnostic Imaging↗

PubMed2006

Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn's disease: a prospective study.

BACKGROUND AND AIMS: Following ileocolonic resection for Crohn's disease (CD), early endoscopic recurrence predicts recurrence of symptoms. The aim of the study was to compare ileocolonoscopy and wireless capsule endoscopy (WCE) for the detection of postoperative recurrence in CD. METHODS: WCE and ileocolonoscopy were performed within six months following surgery in 32 prospectively enrolled patients. Two independent observers interpreted the results of WCE. Recurrence in the neoterminal ileum was defined by a Rutgeerts score>or=1. When observers at WCE did not concur, WCE results were considered as either true negative or true positive and sensitivity and specificity were calculated according to both assumptions. RESULTS: Recurrence occurred in 21 patients (68%) and was detected by ileocolonoscopy in 19 patients. Sensitivity was 90% and specificity 100%. Sensitivity of WCE was 62% and 76% and specificity was 100% and 90%, respectively, depending on assumptions. There was a correlation between the severity of the lesions measured by both methods (p<0.05). Lesions located outside the scope of conventional endoscopy were detected by WCE in two thirds of patients with excellent interobserver agreement (kappa>0.9) for all lesions with the exception of ulceration (kappa=0.7). CONCLUSIONS: The sensitivity of WCE in detecting recurrence in the neoterminal ileum was inferior to that of ileocolonoscopy. In contrast, WCE detected lesions outside the scope of ileocolonoscopy in more than two thirds of patients. Additional follow up studies are needed to assess the clinical relevance of such lesions. At the present time, it seems that WCE cannot systematically replace ileocolonoscopy in the regular management of patients after surgery.

Adult↗