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PubMedDate not supplied

Eosinophilic gastroenteritis: percutaneous biopsy under ultrasound guidance.

Eosinophilic gastroenteritis (EG) is an unusual disorder that is characterized by diffuse or scattered eosinophilic infiltration of the digestive tract. The diagnosis is based on histology obtained by capsule, endoscopic, laparoscopic, or laparotomy biopsy. The eosinophilic infiltration produces thickening of the small bowel wall that can be observed by using sonography. The appearance produces the pseudokidney sign that can be used to guide biopsy. We report the first case of EG diagnosed by percutaneous biopsy under ultrasound guidance.

Aged↗
PubMed2007

Wireless capsule endoscopy: from diagnostic devices to multipurpose robotic systems.

In the recent past, the introduction of miniaturised image sensors with low power consumption, based on complementary metal oxide semiconductor (CMOS) technology, has allowed the realisation of an ingestible wireless capsule for the visualisation of the small intestine mucosa. The device has received approval from Food and Drug Administration and has gained momentum since it has been more successful than traditional techniques in the diagnosis of small intestine disorders. In 2004 an esophagus specific capsule was launched, while a solution for colon is still under development. However, present solutions suffer from several limitations: they move passively by exploiting peristalsis, are not able to stop intentionally for a prolonged diagnosis, they receive power from an internal battery with short length, and their usage is restricted to one organ, either small bowel or esophagus. However the steady progresses in many branches of engineering, including microelectromechanical systems (MEMS), are envisaged to affect the performances of capsular endoscopy. The near future foreshadows capsules able to pass actively through the whole gastrointestinal tract, to retrieve views from all organs and to perform drug delivery and tissue sampling. In the long term, the advent of robotics could lead to autonomous medical platforms, equipped with the most advanced solutions in terms of MEMS for therapy and diagnosis of the digestive tract. In this review, we discuss the state of the art of wireless capsule endoscopy (WCE): after a description on the current status, we present the most promising solutions.

Capsule Endoscopes↗
PubMed2005

Extraction of entrapped capsules from the small bowel by means of push-and-pull enteroscopy with the double-balloon technique.

The new technique of push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) makes it possible to remove swallowed foreign bodies causing intestinal obstruction deep in the small bowel without the need for surgical laparotomy. This report describes two cases of enteroscopic removal of entrapped capsules. In one patient with acute recurrent intestinal bleeding and recurrent abdominal pain, Crohn's disease had been suspected on capsule endoscopy. The second patient, with known Crohn's disease, was suffering from abdominal pain and underwent capsule endoscopy for investigation of the small bowel. Prior enteroclysis had not revealed stenoses in either patient. An oral approach was chosen and the capsules were identified approximately 140 cm and 310 cm from the pylorus, respectively, in front of stenoses. The capsule endoscopes were removed successfully in both patients by means of push-and-pull enteroscopy using a new enteroscope device.

Device Removal↗
PubMed2005

A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases.

INTRODUCTION: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. AIM: Compare the accuracy (specificity, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. METHODS: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. RESULTS: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92%; specificity, 95%). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97%, 99%, 97%, and 99%, respectively, and for esophagitis 89%, 99%, 97%, and 94%, respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. CONCLUSIONS: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.

Endoscopy, Gastrointestinal↗
PubMed2003

Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.

PURPOSE: To retrospectively compare capsule endoscopic (CE) findings with findings at barium studies or computed tomography (CT) in patients without evidence of small-bowel stricture at barium examination. MATERIALS AND METHODS: Fifty-two patients underwent CE, and the majority (43 of 52) did so for obscure gastrointestinal bleeding. Forty-two (81%) of 52 patients underwent 36 small-bowel follow-through examinations; four, enteroclysis; and 19, contrast material-enhanced CT of the abdomen and pelvis within 6 months of CE (either before or after CE). Imaging results were retrospectively reviewed and compared with CE, standard endoscopic, and surgical results. Findings of any examinations between CE and imaging that were discrepant were retrospectively reviewed by a radiologist not blinded to CE results. Proportion of positive findings at CE was compared with proportion of positive findings at barium studies and CT in the same patients. Statistical significance was calculated with McNemar chi2 statistic. RESULTS: Barium examination findings were positive in one (3%) of 40 patients; CE findings were positive in 22 (55%) (P <.001). CT demonstrated small-bowel findings in four (21%) of 19 patients, but CE demonstrated findings in 12 (63%) of 19 patients (P =.02). The most common CE finding, angioectasia (n = 11), was not detected at any imaging study. More ulcers (n = 8) were detected with CE than with barium study (one of eight) and CT (three of six). At CE, three of five surgically confirmed masses (carcinoid, intussusception, lymphangioma) were identified, but two jejunal tumors were not detected in a patient with poor bowel preparation. At barium study, no masses (zero of five) were detected; at CT, one of four masses was detected. CONCLUSION: In patients without a small-bowel stricture at barium study, more small-bowel disease was found at CE when findings were retrospectively compared with barium examination and CT findings.

Adult↗
PubMed2006

Video capsule endoscopy: clinical relevance of capsule endoscopy findings.

Video capsule endoscopy (VCE) is a novel diagnostic tool for noninvasively visualizing the lumen of the entire small intestine. It is especially useful in identifying the source of obscure small intestinal bleeding. However, VCE is not always optimal for localizing small bowel lesions. Several studies show VCE to be markedly superior to standard diagnostic techniques although the true clinical relevance of many of the capsule endoscopic findings remain unknown. We present two case reports of VCE findings that resulted in surgical intervention but were found to be benign lesions on definitive pathological examination. The actual clinical relevance of many of the lesions found on VCE thus remains to be demonstrated.

Aged↗
PubMed1996

Endoscopic excision of large capsulated lipomas.

The technique of endoscopic excision of large capsulated lipomas is presented and the versatility of this method is discussed based on our clinical experience. We have applied this new technique in 6 cases. In all cases the lipoma was completely removed in one piece through a single incision, up to 1.5 cm in length. The endoscope made it possible to view the lipoma through a narrow space with a wide range of vision on a TV monitor. We stress that this method is not only appropriate as treatment for benign lipomas but also effective from a cosmetic point of view. The applications of the endoscope should widen in plastic surgery when the advantages of it are recognized and new operative approaches for using it are developed.

Adult↗
PubMed1985

Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens.

Biopsy specimens of the small bowel were obtained from 40 patients suspected of having malabsorption. Four different techniques were used at a single session--namely, endoscopic biopsy of the descending duodenum using paediatric and standard size forceps and suction capsule biopsy of the descending duodenum and the proximal jejunum. Specimens were compared for size, adequacy, and ability to confirm or exclude mucosal abnormality. Fourteen patients had villous atrophy. In all patients four biopsy specimens were obtained with paediatric endoscopic forceps and four with standard endoscopic forceps. No capsule biopsy specimen was retrieved from the duodenum in three patients and from the jejunum in five patients. Specimens were considered to be adequate in 36 patients when paediatric forceps were used, in 39 when standard forceps were used, in 28 on duodenal capsule biopsy, and in 32 on jejunal capsule biopsy. This study indicates that the most reliable method for diagnosing or excluding villous atrophy is endoscopic forceps biopsy of the descending duodenum, provided that at least four specimens are obtained with standard size forceps.

Adult↗
PubMedDate not supplied

Comparison of endoscopic forceps biopsies and capsule biopsies in determining disaccharidase activity in the duodenum.

Endoscopic biopsy is an accepted technique for obtaining samples of small bowel mucosa for histological examination. In this study a comparison between endoscopic forceps biopsies and capsule biopsies in estimating disaccharidase enzyme activity in the small bowel was evaluated. Disaccharidase levels on 168 consecutive small bowel biopsies obtained by either endoscopic biopsy or capsule biopsy were reviewed retrospectively. There was no significant difference in enzyme activity in samples collected by either method. Another 18 patients had simultaneous endoscopic and capsule biopsies from the second part of the duodenum. Again, there was no difference in enzyme activity between samples collected by either technique at the same level in the duodenum. The disaccharidase activity in forceps biopsies taken from the second part of the duodenum is equivalent to those obtained by capsule biopsy.

Adult↗
PubMed2005

Capsule endoscopy: current indications and future prospects.

Capsule endoscopy represents a significant advance in the investigation of small bowel diseases and the beginning of wireless endoscopic imaging. Capsule endoscopy involves swallowing a video capsule endoscope, which is painless and relatively safe. Its use has been established for suspected small bowel bleeding, and the role of capsule endoscopy in the investigation of inflammatory bowel disease, iatrogenic disease, polyposis syndromes and coeliac disease is evolving. It is likely that in many instances it will become the next test after standard endoscopic evaluation. Early data suggest that capsule endoscopy improves outcome in patients with suspected small bowel bleeding, but more data are required on outcomes for the other indications.

Endoscopes↗
PubMed2003

Endoscopically assisted video capsule endoscopy of the small bowel in patients with functional gastric outlet obstruction.

Since the introduction in 2001 of M2A video capsule imaging of the small bowel in humans, this technique has been used increasingly in patients with disorders of the small bowel. In particular the assessment of small obscure gastrointestinal bleeding sources and the detection of shallow inflammatory lesions in the small bowel, have been greatly facilitated by this novel imaging procedure. We report two cases of patients with obscure gastrointestinal bleeding, in whom normal passage of the capsule through the antroduodenal junction was inhibited. This was because of delayed gastric emptying in both patients, which was presumably caused by functional impairment of pyloric motility. To facilitate capsule transport into the small bowel, after swallowing the capsule each patient underwent unsedated upper gastrointestinal endoscopy during which the capsule was grasped with a polypectomy snare, directly transported through the pylorus, and finally released upon arrival in the second portion of the duodenum. Capsule recordings revealed the source of bleeding in both patients and their medical or surgical treatment was subsequently escalated. Capsule imaging of the small bowel facilitated by esophagogastroduodenoscopy (EGD) is safe, and can be applied when patients have functional disorders of pyloric motility.

Endoscopy, Gastrointestinal↗
PubMedDate not supplied

[Incidental diagnosis of caecum adenocarcinoma due to retention of endoscopic videocapsule: a clinical case].

Capsule endoscopy is a new technique for the study of small intestine particularly in cases of obscure gastro-intestinal bleeding or chronic iron-deficiency anemia. In our study we present a case of 62 years-old man with a chronic iron-deficiency anaemia developed at least six months before and refractory to iron therapy. The patient was submitted to upper gastro-intestinal endoscopy and to partial colonscopy due to abdominal adhesions for previous abdominal surgery. A capsule endoscopy was indicated to achieve a definitive diagnosis. Wich discosed an intestinal obstruction. So far a surgical resolution was indicated. The surgery revealed a stricturing neoplasia of the cecum in which the capsule endoscopy was retained.

Adenocarcinoma↗
PubMed2006

Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort.

BACKGROUND: Few patients have significant symptoms during wireless esophageal pH monitoring, and the capsule typically sloughs spontaneously. Severe discomfort during monitoring can occur that requires endoscopic dislodgement of the capsule. OBJECTIVE: To determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention. DESIGN: Chart review. SETTING: University-based outpatient endoscopy facility. PATIENTS: A total of 452 consecutive patients undergoing wireless pH monitoring over a 3.5-year period. INTERVENTIONS: Endoscopic dislodgement of the capsule by using nudging with the endoscope tip and cold snare techniques. RESULTS: Eight subjects (1.8%) required endoscopic capsule dislodgement because of severe chest pain or odynophagia (n = 7) or severe foreign-body sensation (n = 1). Chest pain was the initial indication for pH monitoring in 5 (62.5%) of the subjects. Initial nudging with the endoscope tip successfully dislodged 2 capsules; continued nudging produced mucosal stripping in 3 subjects, which required hemostasis in 1. A cold snare was used successfully, without complication, to separate the capsule from stripped mucosa and as a primary removal method in the remainder of subjects. Capsule removal uniformly resulted in marked improvement of discomfort. CONCLUSIONS: Endoscopic removal of the capsule was required in <2% of subjects who underwent wireless pH monitoring. Separation of the capsule from the mucosa with a cold snare may be the preferred method of accomplishing uncomplicated removal.

Adult↗