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PubMed2006

Recent advances in endoscopic capsule imaging: see what we have been missing.

Depiction of the small intestine has always been a challenge because of its length and tortuosity. The development of capsule endoscopy has been a significant advance that has allowed for more complete small intestine evaluations. The capsule is disposable, captures 2 images per second, and has a battery life of approximately 8 hours. Images are transmitted to a data recorder via digital radio frequency communication, and downloaded to the workstation computer, where it can be read by a gastroenterologist. One of the complications of use is capsule retention; however, a patency capsule has been developed that indicates whether obstruction is present before capsule endoscopy is performed. Capsule endoscopy has renewed interest in the diagnosis and evaluation of small intestinal diseases, been partly responsible for increased research in this area, and led to the development of newer radiologic and endoscopic techniques to evaluate the small intestine.

Capsules↗
PubMed2004

Evidence of small-bowel involvement in hereditary hemorrhagic telangiectasia: a capsule-endoscopic study.

BACKGROUND AND STUDY AIMS: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant vascular disorder leading to telangiectases and arteriovenous malformations of the skin, mucosa, and viscera. Telangiectases in the upper gastrointestinal tract are known, but data regarding possible small-bowel involvement are scarce due to the technical difficulty of exploring the entire gastrointestinal tract. The aim of the present study was to use capsule endoscopy (CE) to determine the prevalence of small-bowel telangiectases in HHT patients. PATIENTS AND METHODS: From December 2001 to September 2002, 20 consecutive adult HHT patients at an interdepartmental HHT center were prospectively evaluated. All patients underwent esophagogastroduodenoscopy (EGD) followed by CE within 24 h. The telangiectases were scored according to commonly accepted criteria by two endoscopists and two observers of the video-capsule images, who were blinded to each other's findings. RESULTS: EGD revealed gastric telangiectases in 15 of the 20 patients (75 %), while CE demonstrated small-bowel involvement in 10 of 18 patients (56 %; images were not recorded for two patients due to battery failure). No preferential site for telangiectasia was found between the jejunum and the terminal ileum. All patients who were positive on CE were also found to have gastric involvement at EGD. Patients with small-bowel telangiectases were significantly older than those without (62.5 years vs. 45 years; P < 0.02). CONCLUSIONS: This study established a 56 % prevalence of small-bowel telangiectases in patients with HHT. This new endoscopic technique will probably change the etiological diagnosis of occult bleeding in HHT patients (which is too often attributed only to epistaxis) and may also be able to alter treatment strategies in HHT patients with gastrointestinal bleeding.

Adult↗
PubMed2006

Double-balloon endoscopy: from concept to reality.

The history of the double-balloon endoscope from conception to development and practical application has been described. The theory itself is quite simple, and there were opinions doubting its practicality at the early stage of development.Double-balloon endoscopes, however, are commercially available now. They have been used widely, and their usefulness has been recognized. When development of the double-balloon endoscope was progressing, development of capsule endoscopes also was progressing. The authors often heard opinions that, since capsule endoscopes were expected to become commercially available in the near future, it was out-of-date to devise a method to insert an enteroscope into the small intestine. The authors, however, believed that if the use of capsule endoscopes spread, the necessity of an enteroscope that can reach the entire area in the small intestine would not disappear, but become even bigger. If any abnormal finding is detected by a capsule endoscope, the necessity of enteroscopy for a detailed examination increases. This is being proven at present.

Catheterization↗
PubMedDate not supplied

[Evaluation of small intestine mucosal biopsies obtained simultaneously by suction capsule and endoscopic forceps in children with suspected enteropathy].

The aim of the study was to compare biopsy specimens obtained by suction with those obtained by endoscopy morphometrically and histologically in order to evaluate their adequacy for histological interpretation. For this, 23 children with suspected enteropathy underwent upper gastrointestinal endoscopy. For histological evaluation, biopsies were assessed for orientation, depth, length, presence of Brunner's glands and/or lymphoid follicles and presence of artifact. The mucosa total height and villi height were evaluated for morphometric assessment. The results of all the analysed parameters were not statistically significant, except for the presence of Brunner's glands that were most evident in endoscopic biopsies. Although, the suction capsule biopsies and the endoscopic ones were appropriate for histological interpretation in 91.3% respectively, the difference was not statistically significant. Based on the morphometric analysis, the mucosa total height and the villi height values in both biopsy techniques were not statistically significant different. The small intestine mucosal biopsies obtained by endoscopy compared with those obtained by suction capsule were adequate for histological interpretation.

Adolescent↗