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PubMed2006

[The hardware design of a portable gastrointestinal wireless endoscope image receiver].

The portable gastrointestinal wireless endoscope image receiver is developed and based on TMS320C6211 DSP. It can receive and demodulate the modulated signal which is transmitted from the camera-capsule, and then output the video signal. The synchronizing signals offered by SAA7114H are made best of and are used to design the time logic circuit. The fitful video signal can be collected under the control of the time logic circuit. The circuit can automatically get rid of useless blank data and only collect effective and good-quality video signals, and storage them in CF card. In addition, the image signal can be processed and compressed by DSP, and thus the data storage space and the data- analyzing time can be saved.

Capsule Endoscopes↗
PubMed1990

What happens to tablets and capsules in the stomach: endoscopic comparison of disintegration and dispersion characteristics of two microencapsulated potassium formulations.

Previously we investigated gastric emptying and distribution of a capsule formulation of microencapsulated KCl and found the drug was usually present in clumps of KCl crystals held in place by gastric mucus. We therefore investigated whether a tablet formulation of microencapsulated KCl would have improved dispersion. We characterized the intragastric disintegration of capsules and tablets of microencapsulated KCl in 12 subjects. The capsule formulation floated in the gastric pool; one end would adhere to the gastric mucosa and the motion of the tethered capsule would pull the end of the capsule off. The KCl crystals would then be deposited in a mass. In contrast, the tablet formulation sank to the anatomically most dependent portion of the stomach. The tablet rapidly became soft and fragile but, if allowed to remain in one place and minimally disturbed, required a median of 12 min to lose its shape. If allowed to reach the gastric antrum, the tablet was quickly ground by the antro-pyloric pump and widely dispersed. Once liberated in the stomach, the microencapsulated KCl crystals were bound into a more-or-less cohesive mass. The differences between KCl formulations, once the crystals were released, was minimal although the larger crystals from the tablet formulation appeared less adherent and cohesive; they dispersed more in a reticulated pattern when the stomach was distended. We conclude that formulation of a drug in a microencapsulated multiple-unit dosage form does not guarantee wide dispersion nor absence of high local concentration of drug.

Adult↗
PubMed2006

An inductive power link for a wireless endoscope.

An inductive link is presented that can handle freedom of motion. The envisaged application is to power a wireless camera capsule used for non-invasive visual inspection of the small bowel. Up to 150 mW of usable dc power can be delivered to the capsule for the entire duration of its travel along the gastric track. The outer dimensions of the power receiver compartment inside the capsule are Ø 10 mmx13 mm. The power efficiency of the link is measured to be 1% under worst-case geometrical conditions. The issue of patient's health and safety regarding exposure to the electromagnetic field is addressed. To this purpose, an experimental method is applied to predict specific absorption rates. Conversely, the effect of biological tissue on link performance and practical workability is evaluated as well. Electric shielding of the transmitter coil is applied to reduce biological tissue interaction. In this way, appliance on a living subject is made both safe and practically feasible.

Capsule Endoscopes↗
PubMed2006

Placement of the Bravo wireless pH monitoring capsule onto the gastric wall under endoscopic guidance.

BACKGROUND: The Bravo system was designed mainly to monitor esophageal pH, and there have been no reports on gastric pH monitoring using this system. OBJECTIVE: To place the Bravo capsule on the gastric wall and monitor gastric pH. DESIGN: Experimental clinical trial with the cooperation of volunteers. SETTING: Academic medical center. PATIENTS: Eleven volunteers (9 men, 2 women; mean age 38 years; 3 had symptoms of GERD). INTERVENTIONS: The Bravo system was introduced into the esophagus and stomach along a thin endoscope and capsules were attached, one each to the esophageal and gastric walls under direct vision through the endoscope. Esophageal and gastric pHs were simultaneously monitored. RESULTS: The 2 capsules were successfully placed in 10 of the 11 subjects, and both esophageal and gastric pHs were monitored for 48 hours in 9 subjects. Mild to moderate precordial pain was observed in 7 subjects, but no other complications or side effects were observed in this study. The gastric pH of 10 subjects increased after meals and returned to baseline pH 2 hours later. Decrease of esophageal pH was observed 1 hour after a meal in the symptomatic subjects and corresponded to the time when gastric pH decreased secondary to the increase of pH with meals. CONCLUSIONS: The Bravo capsule is easily placed on the gastric wall under endoscopic assistance and enables long ambulatory monitoring of gastric pH.

Adult↗
PubMed1998

Histologic evaluation of endoscopic versus suction biopsies of small intestinal mucosae in children with and without celiac disease.

BACKGROUND: Concern over the adequacy of histologic diagnosis of endoscopic duodenal biopsies in children prompted this comparative study on the histologic quality of endoscopic versus capsule biopsies. We found this problem addressed in only six previous reports. METHODS: Blind examinations of the histologic sections of 48 duodenal biopsies obtained by gastrointestinal endoscopy in children aged 2-18 years were compared to 52 biopsies obtained by the small bowel suction method (from children aged 1-16 years). RESULTS: Although 87.5% of endoscopic biopsies and 94.2% of capsule biopsies were adequate for histologic diagnosis, fragmentation or squashing was seen in 83.3% of endoscopic biopsies and only in 25% of capsule biopsies. CONCLUSIONS: Biopsies obtained by suction are of better quality than those obtained by endoscopy. If endoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a minimum of four biopsies should be obtained with forceps of a diameter greater than 2 mm. Adequate histologic criteria for diagnosis should include at least one full-thickness mucosal specimen more than 3 mm in length, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the specimens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient.

Adolescent↗
PubMed1989

Small bowel biopsy for disaccharidase levels: evidence that endoscopic forceps biopsy can replace the Crosby capsule.

Lactase, sucrase and maltase activities in endoscopic biopsies from the second part of the duodenum were compared to those in Crosby capsule biopsies from the proximal jejunum. In patients with villous atrophy disaccharidase activities were reduced compared with histologically normal mucosa in the duodenum and jejunum. Disaccharidase activities were significantly lower in the duodenum than in the proximal jejunum of patients with histologically normal mucosa and in those with partial villous atrophy but not significantly different for total villous atrophy patients. Primary and secondary disaccharidase deficiencies can be identified in biopsies from the duodenum. Duodenal biopsy is a valid alternative to jejunal biopsy for the diagnosis of disaccharidase deficiency.

Atrophy↗
PubMed2002

Endoscopy of the small bowel in inflammatory bowel disease.

With the heterogeneous clinical presentation of IBD, endoscopy plays an integral role in the initial diagnosis of Crohn's disease. Although radiographic tests are often supplemental in the evaluation of Crohn's disease, they previously had been the only modality available allowing for visualization of much of the small bowel. The advent of small bowel endoscopy allows for direct visualization, and often biopsy, of the small bowel, allowing for confirmation of diagnosing and extent of involvement. Currently, the only mode for obtaining biopsies from beyond the ligament of Treitz is via push enteroscopy or intraoperative enteroscopy. Knowing the extent of disease can also help explain recalcitrant symptoms or lack of response to certain therapies. With the advent of capsule endoscopy, endoscopic visualization of the entire small intestine is now possible with a relatively noninvasive test. Further advancements in capsule endoscopy may relegate push enteroscopy and intraoperative enteroscopy to those cases in which biopsies or therapy are required. In the future, total enteroscopy with new enteroscopes may become more widely available, allowing biopsies and therapy in all segments of the small intestine, without the need for operative intervention.

Crohn Disease↗
PubMed2002

Endoscopic CO2 laser management of laryngocele.

OBJECTIVE: To report on the management of laryngoceles by CO2 laser-assisted endoscopic excision. STUDY DESIGN: A 15-year retrospective study of 12 adult patients (7 men and 5 women) who presented with a laryngocele. Nine patients had an internal laryngocele, one patient had an external laryngocele, and two patients had combined internal-external components. Two laryngoceles were right-sided, six were left-sided, and four were bilateral. METHODS: An endoscopic examination of the laryngocele was carried out for both diagnostic and therapeutic purposes. Once identified the air- or mucus-filled cyst (extending from the laryngeal ventricle into the paraglottic space and beyond the thyrohyoid membrane in some cases), the laryngocele was excised in toto, with its surrounding capsule, via endoscopic approach using the CO2 laser. RESULTS: The main presenting symptom was dysphonia in seven patients, visible or palpable mass in the neck in three, and upper airway obstruction in the remaining two. All laryngoceles were treated with endoscopic laser excision of the internal and external components when required. The average postoperative stay in hospital was 1.8 days. Only two of the patients treated had a tracheotomy; both cases presented elsewhere with an emergency airway obstruction, which necessitated tracheotomy. In these two cases, decannulation was subsequently performed. There were no significant complications. The follow-up ranged from 6 months to 5 years. CONCLUSION: CO2 laser-assisted endoscopic excision of a laryngocele is a quick, precise, and safe alternative to an external approach excision (lateral thyroidotomy, laryngofissure) with fewer complications than its external counterparts, resulting in speedier rehabilitation of both the patient and his or her voice.

Adult↗
PubMed2005

Capsule endoscopy in gastrointestinal lymphomas.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) is a new procedure for small-bowel imaging. The potential contribution of this method to the diagnosis and staging of gastrointestinal lymphomas has not yet been evaluated. The aim of this prospective study was to assess the frequency and morphology of different forms of intestinal pathology in patients with gastrointestinal lymphomas. PATIENTS AND METHODS: Commercially available capsule video endoscopes were administered to 27 patients (16 men and 11 women, aged 27-77) with known gastrointestinal lymphomas. CE was also carried out in 30 control individuals. RESULTS: All seven patients with primary intestinal lymphomas who were examined were found to have pathological findings on CE--four with ulcerations, four with nodes, three with villous atrophy, and one with plaques/white villi. One patient with severe diarrhea was examined three times before and after chemotherapy, and improvement of the lesions was evident, as well as resolution of diarrhea. Twenty patients with gastric lymphoma were examined (16 with low-grade and four with high-grade B cell lymphomas). The capsule did not leave the stomach in three patients, suggesting impaired motility. The small-bowel transit times were 261+/-41 min for intestinal lymphoma, 245+/-62 min for gastric lymphoma, and 224+/-82 min for controls (P>0.05). Five of the 20 patients with gastric lymphoma had pathological findings in the intestine--three with plaques/white villi, two with nodes, and two with villous atrophy. In two patients, subsequent biopsies revealed secondary follicular lymphoma and high-grade lymphoma, respectively. CONCLUSIONS: CE is a valuable diagnostic tool for defining the extent of bowel involvement and assessing the efficacy of treatment in patients with gastrointestinal lymphoma.

Adult↗
PubMed2006

Technology Insight: current status of video capsule endoscopy.

Video capsule endoscopy (VCE) is the most recent major practical and conceptual development in the field of endoscopy. The video capsule endoscope-a small, pill-sized, passive imaging device-has been demonstrated to be the pre-eminent imaging device for disorders of the small intestine. The initial use for VCE was to detect the origin of obscure gastrointestinal bleeding. Several other indications have now been justified, or are in the process of evaluation. More than 200,000 of these disposable devices have been used worldwide, with an extraordinarily good safety record: indeed, the device has been approved for use in children as young as 10 years of age. In addition, a double-ended capsule has now been approved for the evaluation of mucosal disease in the esophagus. The now-widespread deployment of the device into gastrointestinal practice in the US and many other countries suggests that VCE has achieved mainstream utility. The development of similar competitor devices, and devices whose movement can be controlled, is in progress.

Endoscopy, Gastrointestinal↗
PubMed2002

A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease.

BACKGROUND & AIMS: This study was undertaken to prospectively compare the clinical outcomes of small bowel radiographs with the wireless capsule endoscopy. METHODS: Twenty-two patients were selected consecutively because of suspected small bowel disease. Two patients were excluded owing to ileal stenosis. Thus, the results of barium follow-through and the Given M2A wireless video capsule (Given Imaging Ltd., Yoqneam, Israel) endoscopy were compared in 20 patients (13 men; mean age, 52.5 yr; range, 29-78 yr). RESULTS: Barium follow-through was normal in 17 patients and showed ileal nodularity in 3 patients. Capsule endoscopy was normal in 3 patients and showed positive findings in the remaining 17 patients. The barium study was considered diagnostic in 4 (20%) patients. The capsule endoscopy was considered diagnostic in 9 (45%) patients, suspicious in 8 (40%) patients, and failed in 3 (15%) patients. For obscure gastrointestinal (GI) bleeding, the diagnostic potential of barium follow-through was much worse as compared with the capsule endoscopy (5% vs. 31%, P < 0.05). Capsule endoscopy was well tolerated and better accepted by patients when compared with the most recently performed endoscopic procedure. CONCLUSIONS: The video capsule endoscope was found to be superior to small bowel radiograph for evaluation of small bowel diseases. However, this novel wireless endoscope system needs further assessment because of limitations such as difficulties in interpretation of potentially nonspecific findings.

Adenomatous Polyposis Coli↗
PubMed1994

Evaluation of polydimethylsiloxane as an alternative in the endoscopic treatment of vesicoureteral reflux.

Endoscopic correction of vesicoureteral reflux is an attractive alternative to open repair. In terms of effectiveness and long-term successful results polytetrafluoroethylene (Polytef) is the most reliable injectable product. However, legitimate concerns regarding particle migration still exist for polytetrafluoroethylene. Polydimethylsiloxane (Macroplastique) was evaluated as an alternative to polytetrafluoroethylene. Seven mongrel female dogs underwent endoscopic suburothelial injections of 0.35 to 0.50 cc polydimethylsiloxane paste by the O'Donnell technique to a unilateral nonrefluxing ureteral orifice. To facilitate migratory surveillance the paste was mixed with 57carbon monoxide radiolabeled 80 microns. microspheres and injected in 5 of the 7 animals. Animals were sacrificed at 1, 3 and 6-month intervals. All major organs were retrieved and processed. After intensive histological evaluation the remaining tissue underwent dissolution and centrifugation in sodium hypochlorite. The resulting insoluble pellet was further analyzed. In dogs injected with radiolabeled paste tissue samples and insoluble pellets of each organ system were analyzed for gamma counts. Smears of the insoluble pellets of all animals were examined on light and phase contrast microscopy. At autopsy no gross abnormalities were noted. Tissue reaction at injection sites revealed a well encapsulated foreign body reaction with predominantly giant cells, fibroblasts and collagen deposition. Limited local migration of polydimethylsiloxane particles into the periureteral lymphatics of 1 animal sacrificed at 1 month was noted and a single particle visually indistinguishable from polydimethylsiloxane also was found within the splenic capsule. The endoscopic procedure in this animal was complicated in that 2 separate injections were required and histological evaluation confirmed that the injections were performed uniquely deep into the bladder muscularis. Radioactive counts and dissolution of all major organ systems demonstrated no migration in the remaining 6 animals. Endoscopic subureteral injection of polydimethylsiloxane is technically feasible, and it may prove to be biocompatible and without risk of distant migration if injected correctly.

Animals↗
PubMed2006

Capsule endoscopy versus push enteroscopy for evaluation of obscure gastrointestinal bleeding with 1-year outcomes.

Because of the low diagnostic yield of standard radiologic tests for identifying sources of obscure gastrointestinal bleeding in the small intestine, we compared wireless video capsule endoscopy with push enteroscopy and small-bowel follow-through. Patients referred to Mayo Clinic, Scottsdale, Arizona, between August and December 2001 for evaluation of obscure gastrointestinal bleeding were potential candidates. Eligible patients had previously inconclusive endoscopy, colonoscopy, small-bowel follow-through, and other radiologic studies. Participants underwent capsule endoscopy and enteroscopy (within 24 hr). The primary end point was localization of any bleeding source, with 1-year telephone follow-up. Capsule endoscopy yielded positive findings in 10 of 20 patients (11 men; mean age, 69 years), 6 of whom had negative enteroscopy and small-bowel follow-through. No patient with negative findings on capsule endoscopy had positive findings on enteroscopy and small-bowel follow-through. At follow-up, 19 patients reported fewer transfusions, gastrointestinal procedures, and hospitalizations. Capsule endoscopy identified more lesions and improved outcomes.

Adult↗