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PubMed2006

Advances in pediatric gastroenterology: introducing video camera capsule endoscopy.

The video camera capsule endoscope is a gastrointestinal endoscope approved by the U.S. Food and Drug Administration in 2001 for use in diagnosing gastrointestinal disorders in adults. In 2003, the agency approved the device for use in children ages 10 and older, and the endoscope is currently in use at Arkansas Children's Hospital. A capsule camera, lens, battery, transmitter and antenna together record images of the small intestine as the endoscope makes its way through the bowel. The instrument is used with minimal risk to the patient while offering a high degree of accuracy in diagnosing small intestine disorders.

Capsules↗

PubMed2005

Electromagnetic interference with implantable cardiac pacemakers by video capsule.

BACKGROUND: Electromagnetic fields, such as those generated by cellular phones and metal detectors, may interfere with normal pacemaker function. However, it remains unclear whether the wireless capsule endoscope interacts with implanted pacemakers. This prospective study evaluated potential interactions between the M2A video capsule (Given Imaging, Yoknam, Israel) and implanted pacemakers. METHODS: A total of 100 consecutive patients (70 men, 30 women) with an implanted pacemaker (95 on bipolar mode) were studied. The testing was performed with a functional testing device (Test Cap) for the Given Diagnostic System that reproduces the effect of the video capsule by transmitting at exactly the same frequency. During continuous electrocardiographic monitoring and recording, 100 tests were carried out without changing the pacemaker settings. Those with a positive result were retested 1 week later. RESULTS: The 100 pacemakers evaluated in the study population included the following: 70 dual chamber (11 DDD, 56 DDDR, 3 VDD) and 30 ventricular inhibited (12 VVI, 18 VVIR). In 4 of the 100 patients, pacemaker interference (noise-mode function forcing a synchronous mode) was registered during the Test Cap operation. Three patients had a dual-chamber pacemaker, and one had a single-chamber pacemaker. The interference was reproducible in all cases 1 week later. None of the implanted pacemakers tested was affected by oversensing. CONCLUSIONS: Electromagnetic interferences with pacemakers from the M2A video capsule can occur, but this is without clinical significance. No potentially dangerous pacemaker inhibition was observed.

Adult↗

PubMed2006

Does capsule endoscopy recognise gastric antral vascular ectasia more frequently than conventional endoscopy?

BACKGROUND: Gastric antral vascular ectasia (GAVE) is a rare cause of obscure gastrointestinal bleeding which can be difficult to recognise endoscopically. Capsule endoscopy is primarily designed to image the small bowel, but may identify gastric and colonic lesions. There have been few reported cases of GAVE diagnosed by capsule endoscopy in the literature. OBJECTIVE: Our aim was to assess the frequency of GAVE in patients with obscure gastrointestinal bleeding referred for capsule endoscopy. DESIGN: Case series. SETTING: This study was conducted in a tertiary referral hospital. PATIENTS. This study comprised 128 consecutive patients with obscure gastrointestinal bleeding. INTERVENTIONS: All patients underwent capsule endoscopy. RESULTS. Six patients were diagnosed with GAVE on the basis of the capsule endoscopy findings (4.7%, five female, median age 71.5 years). All patients had previously had numerous gastrointestinal investigations prior to capsule endoscopy. Five patients to date have been treated with argon plasma coagulation of their vascular lesions. This has resulted in stabilisation of their haemoglobin and cessation of blood transfusions in 4/5 cases with an average follow up period of 15 months. CONCLUSIONS: GAVE is commonly missed at gastroscopy and accounted for 4.7% of patients referred for capsule endoscopy with obscure gastrointestinal bleeding (in our series). This case series represents the largest number of GAVE recognised by capsule endoscopy. In the presence of any of the reported risk/associated factors for GAVE the gastroenterologist interpreting the capsule images should have a high index of suspicion.

Aged↗

PubMed2005

[Research on swallowable camera-capsules of gastrointestinal wireless endoscope].

The swallowable camera-capsule,described in the aper, 11 mm in diameter and 30 mm in length , contains a CMOS image sensor, an optical system, a battery, a light source, a transmitter, a antenna and so on. The CMOS image sensor and its driving circuit can be miniaturized with MEMS technology. Image signal can be transmitted by analog or digital way. Image signal can be wirelessly transmitted through serial data interface. Finally, the processing technics of the capsule's crust is introduced.

Capsule Endoscopes↗

PubMed2004

Safety of capsule endoscopy in patients with pacemakers.

BACKGROUND: Capsule endoscopy, a new technology, allows visualization of the entire small intestinal mucosa. The main indication for capsule endoscopy at present is the evaluation of GI bleeding of obscure origin. Studies to date suggest that capsule endoscopy is safe and is associated with few adverse events. One concern, which has not been studied, is the potential effect of the capsule on cardiac pacemakers and other electromedical devices. The primary aims of this study were to evaluate the safety of capsule endoscopy in patients with cardiac pacemakers who are being evaluated for GI bleeding of obscure origin and to determine whether pacemakers have any effect on the images captured by the capsule endoscope. METHODS: Patients with cardiac pacemakers referred for evaluation of GI bleeding of obscure origin were entered into the study. Before the procedure, an electrocardiogram was obtained, and pacemaker functions were checked. Capsule endoscopy was performed in a hospital setting to allow closer monitoring, instead of the outpatient clinic, which is our routine. Cardiac rhythm was assessed simultaneously during capsule endoscopy with a Holter monitor. Post-procedure pacemaker function was again checked for any disturbance. When the capsule endoscopy studies were reviewed, observations were made with particular reference to technical difficulty or interference with imaging. OBSERVATIONS: Five consecutive patients (4 men, 1 woman; mean age, 73 years, range 56-92 years) with cardiac pacemakers were studied. In all patients, the indication for capsule endoscopy was GI bleeding of obscure origin. A cardiologist and pacemaker nurse specialist reviewed the Holter monitor recordings and evaluated pacemaker function after the procedure for each patient. No arrhythmia or other adverse cardiac event was noted during capsule transmission. No pacemaker-induced interference on the capsule endoscopy images was observed. CONCLUSIONS: Capsule endoscopy appears to be safe in patients with cardiac pacemakers and does not appear to be associated with any significant adverse cardiac event. Pacemakers do not interfere with capsule imaging.

Aged↗

PubMed2004

Video capsule endoscopy.

PURPOSE OF REVIEW: The small bowel has been a difficult organ for gastroenterologists to evaluate. Small bowel radiographs and CT scanning have not had a high diagnostic rate, especially in patients presenting with small bowel bleeding. The video capsule "endoscope" has allowed for the direct visualization of the small bowel mucosa. This new technique provides direct viewing of the entire small bowel much like conventional endoscopy. RECENT FINDINGS: A series of studies have shown that video capsule endoscopy (VCE) is superior to barium radiography studies, CT scanning, and push enteroscopy for diagnosing disorders of the small bowel. Numerous case reports of angioectasias, Crohn disease, small bowel tumors, and other small bowel disorders have been reported. A recent study proposes that VCE helped to direct therapy and had a great impact in patient care. SUMMARY: Capsule endoscopy provides higher rates and more accurate diagnosis of small bowel diseases. The future of this technology could improve the ability to visualize the small bowel and improve the treatment of patients with small bowel disorders.

Journal Article↗

PubMed2006

Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study.

BACKGROUND AND STUDY AIMS: Population-based screening for colorectal cancer is widely recommended, with conventional colonoscopy considered to be the preferred diagnostic modality. However, compliance with screening colonoscopy is low and manpower capacity is limited. Capsule endoscopy might therefore represent a desirable alternative strategy. PATIENTS AND METHODS: The PillCam Colon capsule endoscope was prospectively tested in a multicenter setting. The indications for endoscopy in the enrolled patients included colorectal cancer screening (43 %), postpolypectomy surveillance (26 %), and lower gastrointestinal signs and symptoms (31 %). Study subjects underwent colon preparation and then ingested the capsule on the morning of the examination, with conventional colonoscopy being performed the same day. The PillCam Colon capsule findings were reviewed by three experts in capsule endoscopy who were blinded to the conventional colonoscopy findings. RESULTS: A total of 91 subjects were enrolled in three Israeli centers (55 men, 36 women; mean age 57), and the results were evaluable in 84 cases. The capsule was excreted within 10 hours in 74 % of the patients and reached the rectosigmoid colon in the other 16 %. Of the 84 evaluable patients, 20 (24 %) had significant findings, defined as at least one polyp of 6 mm or more in size or three or more polyps of any size: 14/20 (70 %) were identified with the capsule and 16/20 (80 %) were identified by conventional colonoscopy. Polyps of any size were found in 45 patients, 34/45 (76 %) found by the capsule and 36/45 (80 %) by conventional colonoscopy. In comparison with conventional colonoscopy, false-positive findings on PillCam Colon capsule examination were recorded in 15/45 cases (33 %). There were no adverse events related to the capsule endoscopy. CONCLUSIONS: PillCam Colon capsule endoscopy appears to be a promising new modality for colonic evaluation. Further improvements in the procedure will probably increase capsule examination completion and polyp detection rates. Additional studies are needed to evaluate the accuracy of PillCam Colon endoscopy in other patient populations with different prevalence levels of colonic disease.

Adolescent↗

PubMed2005

Complete small-bowel transit in patients undergoing capsule endoscopy: determining factors and improvement with metoclopramide.

BACKGROUND: Passage of the capsule endoscope to the colon occurs in only approximately three quarters of patients. This study assessed factors that might influence the completeness of small-bowel transit, including orally administered metoclopramide. METHODS: Clinical and procedural parameters were recorded prospectively for 150 patients undergoing capsule endoscopy. Metoclopramide was not administered to the first 83 patients (Group 1) but was given orally (10 mg) to the subsequent 67 (Group 2). RESULTS: Small-bowel transit was complete in 63 patients in Group 1 (76%). Gastric transit time was significantly longer when the capsule did not reach the colon than when it did (114.9 +/- 32.6 minutes vs. 26.6 +/- 2.9 minutes; p=0.007). Small-bowel transit time also was longer. The likelihood of complete small-bowel passage was not predicted by any clinical or procedural factor. In Group 2 (metoclopramide), the capsule reached the colon in 65 (97%) patients (OR 10.3: 95% CI[2.32, 93.55], p <0.001). This improvement was associated with a significant reduction in gastric transit time (47.9 +/- 9.0 minutes vs. 30.8 +/- 7.5 minutes; p=0.025). CONCLUSIONS: Metoclopramide increases the likelihood of a complete small-bowel examination in patients undergoing capsule endoscopy.

Aged↗

PubMed2005

[How endoscopy has changed in recent 60 years].

Sixty years ago only semi flexible instruments were used for the endoscopic examination of the gastrointestinal tract. They were developed by the German physician Rudolf Schindler together with George Wolf, the producer of medical instruments in 1932. They construct optical gastroscope with a system of lenses in the flexible distal end and with the rigid metallic proximal part. Those instruments were used in gastroscopy till the sixties when the era of fibroendoscopy with the use of glass fibre optic has started. In 1957 Basil Hirschowitz with his co-workers introduced a flexible gastroscope--a fibroscope. The next years brought improvement in the size of image, its brilliancy, possibility to control the distal end and a bioptic channels was added. Working length was elevated and since 1970 the instrument has been used as ezofago-gastro-duodenoscope. At the end of millennium a new technology was developed--videoendoscopy. Experience with the prototype of videoendoscope was published in 1984 (Sivak a Fleischer, Classen a Phillip). In the nineties of the previous century Paul Swain constructed the first prototype of wireless endoscopic capsule. A single chip camera with low electricity consumption was presented in 2000. Endoscopy has developed in recent years considerably and its progress will definitely continue.

Endoscopes, Gastrointestinal↗

PubMed2004

Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease.

BACKGROUND AND AIMS: Wireless capsule enteroscopy (WCE) offers the potential to directly visualize the entire small bowel and identify superficial lesions not detected by traditional endoscopy and radiography. The aim of this study is to assess the clinical utility of WCE in the evaluation of patients with known or suspected inflammatory bowel disease (IBD). METHODS: Fifty patients with ongoing symptoms underwent Given M2A endoscopic capsule examinations. Indications included: (1) evaluation for small-bowel involvement in patients with IBD with isolated colitis (n = 22), (2) determination of the extent of small-bowel disease in patients with Crohn's disease (CD; n = 20), and (3) workup of suspected IBD (n = 8). Outcome measures were classified as diagnostic when multiple ulcerations were present, suspicious when </=3 ulcerations were seen, and nonspecific or normal. RESULTS: WCE findings were diagnostic for CD in 20 patients and suspicious for small-bowel CD in 10 patients. Seventeen of 20 patients with diagnostic WCE findings improved with increased IBD-directed medical therapy, as did 7 of 10 patients with suspicious study results. WCE was normal or showed nonspecific findings in the remaining 20 patients. Notably, identification of small-bowel lesions in 5 patients with a previous history of isolated colitis resulted in a change in diagnosis to CD after confirmatory ileoscopy with biopsy. CONCLUSIONS: Results of this preliminary study suggest that WCE is a novel and potentially clinically useful method of directly visualizing and diagnosing small-bowel lesions in patients with IBD that can be missed by traditional endoscopic and radiological procedures.

Adolescent↗

PubMed2003

Locally advanced small-bowel adenocarcinoma missed primarily by capsule endoscopy but diagnosed by push enteroscopy.

Wireless-capsule-endoscopy is a new painless method that is able both to visualize the entire small bowel and to detect even small lesions. We report here the case of a patient in whom a locally advanced small-bowel adenocarcinoma was initially missed on capsule endoscopy, but was diagnosed by subsequent push enteroscopy. Capsule endoscopy was carried out in a 47-year-old patient with a history of obscure gastrointestinal bleeding, iron-deficiency anemia, and a lack of symptoms suggestive of stenosis. The capsule imaging revealed angiodysplasias in the jejunum, but no other abnormalities. Push enteroscopy was carried out to allow argon plasma coagulation treatment of the angiodysplasias that had been detected; it revealed a polypoid tumor 20 mm in diameter at 150 cm from the incisors, with the capsule endoscope still located proximal to the tumor and with its optical dome turned towards the push enteroscope. Clinical staging and subsequent surgical resection showed a locally advanced adenocarcinoma (pT4, pN0 (0/7), pMx, G3).[nl]Small-bowel tumors within the reach of push enteroscopy may be missed by capsule endoscopy. Although wireless capsule endoscopy is a major advance in the investigation of the small bowel, well-designed clinical studies still need to define the precise algorithm for diagnostic work-up of suspected small-bowel diseases.

Adenocarcinoma↗

PubMed2006

Treatment of small-bowel diaphragm disease by using double-balloon enteroscopy.

BACKGROUND: Double-balloon enteroscopy is a new technique that allows endoscopic therapy throughout the entire length of the small bowel. Diaphragm disease, characterized by thin septa that narrow the small-bowel lumen, is traditionally treated surgically by segmental resection. OBJECTIVE: To report successful endoscopic treatment of diaphragm disease by double-balloon enteroscopy. PATIENTS: Three patients. DESIGN: Case report. INTERVENTIONS: Double-balloon enteroscopy and stricture balloon dilation. RESULTS: We report, for the first time, 3 cases in which diaphragm strictures were successfully treated during double-balloon enteroscopy. In 2 cases, a retained capsule endoscope was removed by the retrograde approach after stricture dilation. LIMITATIONS: Small number of patients and brief length of patient follow up. CONCLUSION: Double-balloon enteroscopy may be used to treat patients with diaphragm disease, thus avoiding potentially complicated surgery.

Aged↗

PubMedDate not supplied

Late hematoma after aesthetic breast augmentation with saline-filled, textured silicone prosthesis.

Late, progressive enlargement of the breast after augmentation mammaplasty is an extremely rare complication. We present two cases of late capsular hematoma after augmentation mammaplasty with saline-filled, textured silicone implants. The MRI and C-T scan both clearly showed fluid accumulated within the capsule in one case. In this patient, we examined the interior of the fibrous capsule endoscopically, finding no persistent bleeding source. However, the inner lining had granulated tissue with new capillary ingrowth. After replacement with smooth-surface prostheses, neither patient had recurrence of the complication. No identifiable etiology could be demonstrated, however, the breakdown of an eroded capsular artery is suspected, caused by friction between the rough surface of the textured prosthesis and the fibrous capsule.

Adult↗

PubMed2006

Novel developments in non-erosive and erosive gastroesophageal reflux disease.

PURPOSE OF REVIEW: Despite being clinically important and highly prevalent, several aspects of gastroesophageal reflux disease are incompletely understood. Research activity remains high, however, and we shall review some highlights from last year's publications. RECENT FINDINGS: Community based epidemiological studies have elucidated the risk factors for gastroesophageal reflux disease and demonstrated a significant risk for developing complications over time. New histological parameters such as distended intercellular spaces in the epithelium will detect minor signs of reflux damage. The esophageal endoscopic capsule has been studied as a way of screening for esophageal disease. Wireless pH-metry and impedance-pH-metry have increased our insight into the pathophysiology and improved the diagnostic work-up in atypical and therapy resistant cases. At the molecular level, the role of cytokines has been elucidated and there is increased support for the nitrosative stress theory for epithelial damage at the cardia. Endoscopic therapies have shown disappointing long-term results or safety concerns, leading to withdrawal of several methods. SUMMARY: The last year has brought significant development in diagnostic modalities, and increased our insight in the molecular events involved in the pathogenesis of gastroesophageal reflux disease. Ultimately, this may and must lead to new therapeutic modalities which will supplement proton pump inhibitors in medical therapy for gastroesophageal reflux disease.

Endoscopy, Gastrointestinal↗

PubMed1980

The effectiveness of carbenoxolone in the treatment of gastro-duodenal ulcer patients.

A double-blind clinical study was carried out in 70 patients with the preparations Biogastrone and Biogastrone-Duodenal (Duogastrone) or Placebo. The group comprised 42 men and 28 women aged between 19 and 64 years. Twenty four patients had gastric ulcer and 46 patients duodenal ulcer. The intensity of pain, dyspepsia, the rate of healing of the ulcer niche using endoscopic assessment were used to assess efficacy. The effect on the secretory function, blood electrolyte changes and the process of the ulcer regeneration were also studied. The tolerance and the appearance of side-effects were carefully observed. Biogastrone and Biogastrone-Duodenal were administered in daily doses of 300 mg for the first week, followed by 150 mg over the following weeks. Patients given placebo treatment received identical dummy tablets or capsules. Endoscopic assessment showed a healing rate of over 70% in both gastric and duodenal ulcer, healing occurred usually between 3-5 weeks. About 36% placebo healing was observed in both types of ulcer. The preparations were well tolerated and side-effects seldom observed. These results show that Biogastrone and Biogastrone-Duodenal are efficient preparations in the treatment of gastric and duodenal ulcer.

Adult↗

PubMed2007

Wireless video capsule in pediatric patients with functional abdominal pain.

OBJECTIVES: Upper endoscopy (esophagogastroduodenoscopy [EGD]) has a limited role, if any, in the evaluation of functional abdominal pain (FAP). Nevertheless, children with intractable FAP are occasionally referred to EGD to rule out intestinal pathology. We evaluated the role of wireless video capsule endoscopy (VCE) in children referred for EGD with a diagnosis of FAP. PATIENTS AND METHODS: Ten children older than 10 years of age were prospectively enrolled. Children were first studied with the PillCam SB (VCE; Given Imaging, Yokneam, Israel) followed by standard EGD within 2 weeks. After the completion of the study, a questionnaire of tolerance and content regarding the 2 procedures was completed by the patients. RESULTS: Physical examinations and laboratory tests were within normal limits in all of the patients. Patients swallowed the endoscopic capsules without difficulty. There were no complications. VCE identified gastritis in 4 patients (confirmed by biopsies), whereas EGD detected erosive gastritis in only 1 of the 4 children. EGD detected no duodenal abnormalities. VCE detected Crohn disease in the small intestine and cecum in 1 patient. VCE was ranked by 8 patients as convenient and as a preferable procedure compared with EGD. CONCLUSION: The results of this small cohort suggest that in children with FAP, VCE is more sensitive than EGD for detection of macroscopic gastric and small bowel pathologies.

Abdominal Pain↗

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↗

PubMed2005

Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy.

AIM: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. METHODS: Consecutive patients who underwent capsule endoscopy during the 16-mo study period were either given 250 mg oral erythromycin, 1 h prior to swallowing the capsule endoscope or nothing. The gastric and small bowel transit time, and the small bowel image quality were compared. RESULTS: Twenty-four patients received oral erythromycin whereas 14 patients were not given any prokinetic agent. Patients who received erythromycin had a significantly lower gastric transit time than control (16 min vs 70 min, P = 0.005), whereas the small bowel transit time was comparable between the two groups (227 min vs 183 min, P = 0.18). Incomplete small bowel examination was found in three patients of the control group and in one patient of the erythromycin group. There was no significant difference in the overall quality of small bowel images between the two groups. A marked reduction in gastric transit time was noted in two patients who had repeat capsule endoscopy after oral erythromycin. CONCLUSION: Use of oral erythromycin significantly reduces the gastric transit time of capsule endoscopy.

Body Mass Index↗