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[Diagnosis of a high-grade B-cell lymphoma of the small bowel by means of wireless capsule endoscopy].

Wireless capsule endoscopy is a new diagnostic procedure to detect diseases of the small bowel, in particular in patients with obscure gastrointestinal bleeding. We report on a 76-year-old patient who presented at our hospital with signs of gastrointestinal bleeding and hypochromic anaemia. Bidirectional endoscopy, push enteroscopy, angiography as well as small bowel barium enema rendered no pathologic findings. Wireless capsule endoscopy demonstrated a polypous space in the cantral area of the small bowel. Subsequent intraoperative endoscopy revealed a subtotal stenosing tumour of the upper jejunum which was resected. Based on the histology a high-grade B-Cell lymphoma was diagnosed. The postoperative staging examinations did not indicate any further extranodal involvement.

Aged↗

The role of simeticone in small-bowel preparation for capsule endoscopy.

BACKGROUND AND STUDY AIMS: Capsule endoscopy is a new diagnostic method allowing painless visualization of the entire small bowel. However, there is as yet no standardized protocol for bowel preparation before the examination. The aim of this study was to assess the effectiveness of simeticone in reducing bowel gas bubbles in patients undergoing capsule endoscopy. PATIENTS AND METHODS: A randomized, prospective, and controlled study was conducted, including 56 patients, from March to October 2004. The patients were randomly allocated to groups receiving either simeticone or no simeticone, on the basis of a computer-generated random number table. Patients in the simeticone group (n = 28) received 300 mg simeticone for bowel preparation 20 min before capsule endoscopy, while patients in the non-simeticone group (n = 28) received no medication for bowel preparation. Two experienced endoscopists assessed and graded the visibility of the mucosa and intraluminal gas bubbles in a single-blinded fashion. RESULTS: The visibility of the mucosa in the proximal small bowel in patients who received preparation with simeticone was considered to be better, with fewer intraluminal bubbles, than in those without bowel preparation ( P < 0.025). Interobserver agreement was excellent ( R > or = 0.8, P < 0.05). No adverse effects of simeticone were observed. CONCLUSIONS: Simeticone administration before capsule endoscopy improves the visualization of the mucosa in the proximal small intestine.

Adolescent↗

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy.

BACKGROUND: The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge. AIM: To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding. METHODS: Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding. RESULTS: A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach. CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.

Adolescent↗

Meta-analysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases.

BACKGROUND: Prospective trials support the role of capsule enteroscopy as an improvement in diagnosing mucosal lesions in the small bowel. AIM: To determine the diagnostic yield and safety of capsule enteroscopy vs. alternative diagnostic modalities (such as push enteroscopy, small bowel follow-through or enteroclysis) in patients with small bowel diseases. METHODS: A search for prospective studies comparing capsule enteroscopy vs. other diagnostic tests in adults was performed between 1966 and 2005. Selected articles were included in a meta-analysis. Three analyses were run separately, all included studies and studies having occult gastrointestinal bleeding or Crohn's disease as main outcome. RESULTS: Seventeen studies (526 patients) met inclusion criteria. The rate difference (i.e. the absolute pooled difference in the rate of positive findings) between capsule enteroscopy and alternative modalities for small bowel disease was 41% (95% CI 35.6-45.9); 37% (95% CI 29.6-44.1) for occult gastrointestinal bleeding; and 45% (95% CI 30.9-58.0) for Crohn's disease. Failure to visualize the caecum occurred in 13%, significantly more often in occult bleeders (17%) than in patients with Crohn's disease (8%) (P < 0.006). Adverse events were recorded in 29 patients (6%). Capsule retention was more frequent in patients with Crohn's disease (3% vs. 1%, OR 4.37). CONCLUSIONS: Capsule enteroscopy proved significantly superior to push enteroscopy and small bowel radiology in the diagnosis of ileal diseases. Capsule enteroscopy is safe, though prior radiology is still necessary to rule out small bowel strictures in patients with known or suspected Crohn's disease.

Adult↗

Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology.

OBJECTIVE: Small bowel pathology can be diagnosed using enteroscopy (which has limitations) and by x-ray (which is not sensitive for flat lesions). For the first time ever, we used a new technique, wireless-capsule video endoscopy, to diagnose small bowel pathology. Our aim was to prove the effectiveness and safety of this technology. METHODS: We used the Given (M2A) system in 35 patients, aged 18-80 yr, who suffered from unexplained GI bleeding or in whom there was a clinical suspicion of small bowel disease. All patients had a small bowel x-ray. Patients with suspected narrowing of the bowel or a clinical suspicion of intestinal obstruction, or with a history of major abdominal surgery, were excluded from the study. No pregnant women or patients with diabetes mellitus were included. RESULTS: Abnormal findings were found in 29 of 35 (82.9%) patients. Twenty-two of 29 (75.9%) patients had significant pathological findings explaining their clinical situation. Diagnostic yield was therefore 62.9% (22 of 35 patients). Among the various findings, the capsule detected ulcers, erosions, angiodysplasia, and submucosal lesions. The source of bleeding was found in 15 of 20 patients with iron deficiency anemia. There were no immediate significant side effects and none reported up to 1 month after ingestion of the capsule. The capsule was evacuated by all patients. CONCLUSIONS: The wireless-capsule video endoscope, in our study of feasibility, was proven to be a safe, painless, ambulatory, and effective procedure, with a high diagnostic yield. Its major importance is in diagnosing small bowel pathology where all other imaging techniques have failed.

Adult↗

Capsule endoscopy: improving transit time and image view.

AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor. RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology. The grade of cleaning of the entire study group was 3.27+/-1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion. CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.

Adolescent↗

Actively bleeding Dieulafoy's lesion of the small bowel identified by capsule endoscopy and treated by push enteroscopy.

Dieulafoy's lesion is an unusual cause of recurrent GI bleeding. This report describes a case of actively bleeding Dieulafoy's lesion of the small bowel in which the diagnosis was made by capsule endoscopy, followed by treatment with the use of push enteroscopy. The case illustrates that capsule endoscopy and enteroscopy are highly complementary in patients with small bowel diseases.

Arteries↗

Capsule endoscopy for the detection of bleeding Meckel's diverticulum. A case report.

The case of a 59-year-old man with a history of recurrent severe gastrointestinal bleeding due to Meckel's diverticulum is described. The diagnosis was achieved by means of capsule endoscopy. The histological examination revealed the presence of Meckel's diverticulum with ectopic gastric mucosa. The use of capsule endoscopy for the detection of Meckel's diverticulum is discussed.

Capsule Endoscopes↗

Capsule endoscopy in obscure gastrointestinal bleeding--an Indian experience.

BACKGROUND: Obscure gastrointestinal bleeding (OGIB) is a common indication for capsule endoscopy (CE). Reports on diagnostic yield of CE in this situation show a wide variation. We evaluated the diagnostic yield and clinical impact of CE in patients with OGIB. METHODS: We reviewed the medical records of patients with OGIB who underwent CE at our institution between June 2002 and October 2005. RESULTS: 154 patients (mean age 47 [SD 17] years; 117 men), including 74 with overt OGIB and 80 with occult OGIB, underwent CE. CE yielded positive findings in 57 of 74 patients (77%) with overt OGIB and 22 of 80 (27%) of those with occult OGIB (p < 0.0001); the overall positive diagnostic yield was 52%. NSAID-induced lesions (15%), angiodysplasias (14%) and aphthous ulcers (12%) were the most frequent findings. CE helped in planning further management in 79% of patients with overt OGIB and 26% of those with occult OGIB. CONCLUSION: CE is a useful diagnostic technique in patients with OGIB, especially those with overt OGIB.

Adult↗

Small bowel obstruction by wireless enteroscopic capsule and unrecognized intestinal stricture.

The wireless enteroscopy capsule (WEC) was approved for noninvasive visualization of small bowel. We report an unusual case of a previously healthy man with history of bowel resection and anastomosis who developed small bowel obstruction after ingestion of a WCE. At operation, an anastomotic stricture site was noted and the WEC was proximal to this stricture, causing obstruction. This case emphasizes the importance of a good history and physical examination, as well as vigilant follow-up and retrieval of WEC.

Anastomosis, Surgical↗