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At least 145 records · Page 8Linked to original sources
PubMed1993

Coeliac disease. Diagnostic and therapeutic pitfalls.

Gluten-free diet (GFD) as the standard treatment for coeliac disease (CD) was discovered by Dicke. In 1989 Holmes attributed a protective role to GFD with regard to the development of malignancy in untreated CD. Gluten sensitivity is in general an asymptomatic condition. The identification of subclinical cases is becoming a major topic of current interest. Defining high-risk groups for coeliac disease is mandatory. The evaluation of small-intestine biopsies (SIB), however, is much more complicated, as was suggested in the past. Recognition of the Corazza sign and rediscovery of the endoscopic guided capsule may well be of help. Screening patients with a high-risk of CD with a minimal number of tests prior to SIB makes more and more sense. Therefore intestinal permeability tests might be helpful. GFD appears simple, but in practice it represents a challenge to patients, dietitians and physicians. Management of coeliac disease seems much more complicated, as was thought in the early 1980s.

Biopsy↗
PubMed2002

Small bowel biopsy in Swedish paediatric clinics.

AIM: A correct diagnosis of coeliac disease, one of the most common chronic diseases in Swedish children, demands small bowel biopsy, which can be performed endoscopically or by means of a peroral capsule. Recently there was a debate among Swedish paediatric gastroenterologists, with some advocating the cessation of capsule biopsy in favour of endoscopic biopsies. To gain information on which to base a recommendation for which technique to use, the Swedish Working Group for Childhood Coeliac Disease was commissioned to carry out a national questionnaire study on current small bowel biopsy routines in Swedish paediatric clinics. METHODS: A questionnaire concerning biopsy routines in the year 2000 was sent to all paediatric clinics performing biopsies. A reply was obtained from 39 of 40 clinics, covering 98% of the Swedish population. RESULTS: Some 1400 biopsies were performed, 64% of which were capsule biopsies and 36% endoscopic. Three clinics performed all biopsies endoscopically and 11 clinics all via a capsule. At endoscopy all children were under deep sedation or full anaesthesia, while most children undergoing capsule biopsy were under light or deep sedation. The oxygen saturation was monitored during endoscopy but less often or never during routine capsule biopsy. The presence of the parents during biopsy varied according to the degree of sedation: at 97% of the clinics performing capsule biopsy on children under light sedation, the parents were present during the whole procedure, whereas no parents were present at clinics where the biopsy was performed endoscopically under anaesthesia. CONCLUSION: Compared with the results of a similar questionnaire concerning biopsy routines performed in the early 1990s, children are now more effectively sedated. Furthermore, there is an obvious trend from capsule towards endoscopic biopsy. Both the endoscopic and the capsule biopsy techniques are useful and satisfactory for obtaining small bowel mucosal samples providing that the children are effectively sedated. For practical and economic reasons the capsule biopsy technique will probably continue to be used, although to a lesser extent than today.

Biopsy↗
PubMed1972

Double-blind trial of carbenoxolone sodium capsules in duodenal ulcer therapy, based on endoscopic diagnosis and follow-up.

A high-dose double-blind trial of carbenoxolone sodium capsules (Duogastrone) in the treatment of duodenal ulceration was combined with endoscopic diagnosis and follow-up. Thirty-one ambulant patients with an endoscopically visible duodenal ulcer were allocated at random to a 12-week course of treatment with either carbenoxolone sodium 300 mg daily or a placebo. Symptomatic and endoscopic follow-up was performed at 2-4 weeks, 6-8 weeks, and 12-16 weeks. Carbenoxolone was shown to increase the rate of healing of duodenal ulcers in the early stages of treatment, but by 12 weeks there was no difference between the two groups. There was no significant difference in symptomatic improvement between the two groups at any stage of treatment. Side effects, especially hypokalaemia, were prominent in the patients treated with carbenoxolone. There was a poor relation between endoscopic and symptomatic improvement in patients on either form of treatment.

Adult↗
PubMed1977

Carbenoxolone sodium capsules in the treatment of duodenal ulcer. An endoscopic controlled trial.

Eighty-six patients with duodenal ulcer were treated in a multicentre controlled trial with carbenoxolone capsules (Duogastrone, 50 mg four times a day for six weeks) or a placebo. Sixty-nine patients accepted endoscopy at the beginning and end of the treatment. Symptomatic responses and endoscopic improvement were significantly greater in those receiving the active preparation than in those receiving the control capsules, complete, endoscopically assessed, healing being achieved in 65% and 20%, respectively, of individuals having accepted endoscopy, after six weeks' treatment. Side-effects of salt and water retention or hypokalaemia were noted in over a quarter of those receiving the carbenoxolone capsules, but none of the adverse effects was severe enough to necessitate withdrawal of treatment.

Adult↗
PubMed1987

Critical evaluation of a pressure-sensitive capsule for measurement of esophageal varix pressure. Studies in vitro and in canine mesenteric vessels.

The accuracy and reliability of a noninvasive pressure-sensitive capsule for the endoscopic measurement of esophageal varix pressure was evaluated. Capsule pressure was correlated with direct intraluminal pressure measurements. The influence of vessel wall tension on capsule pressure was also assessed. In vitro studies demonstrated an excellent correlation (r greater than or equal to 0.94; p less than 0.001) between the pressure obtained with the capsule and intraluminal pressure over a range of vessel diameters and wall thicknesses. In vivo correlation of pressures obtained with the capsule with direct venous pressure measurements was excellent (r = 0.85). However, this correlation decreased with a decrease in vessel diameter (group 1 diameter greater than or equal to 10 mm, r = 0.95; group 2 diameter greater than or equal to 5 mm but less than 10 mm, r = 0.75; group 3 diameter greater than or equal to 3 mm but less than 5 mm, r = 0.81). This decrease in accuracy was significant (p less than 0.001) between group 1 and groups 2 and 3. In vitro and in vivo, capsule pressure variability was significantly greater (p less than 0.001) in vessels of smaller diameter. Wall tension significantly influenced capsule pressure (p less than 0.05), although this effect was only seen in large "vessels" with a diameter beyond a clinically relevant range. Therefore, despite obtaining technically acceptable capsule pressure measurements in ideal experimental conditions, the accuracy and variability of these measurements are limited by vessel size.

Animals↗
PubMed2005

The evolution of endoscopy: wireless capsule cameras for the diagnosis of occult gastrointestinal bleeding and inflammatory bowel disease.

Occult gastrointestinal bleeding and lesions associated with inflammatory bowel disease represent a diagnostic dilemma because they often lie in areas of the small bowel that are difficult to access with flexible fiberoptic endoscopy. Capsule endoscopy has been developed to access these areas in a way that avoids the pain and anesthesia risks of push endoscopy. The diagnostic yield of capsule endoscopy has proven to be superior to both flexible small-bowel endoscopy and radiologic studies in several prospective trials. Capsule endoscopy transmits a large number of images that do not correlate well with the standard endoscopic view, creating a diagnostic challenge for the endoscopist. Complications of this procedure include capsule retention in diverticulae or at stricture sites. The technology of this procedure continues to evolve through improving image resolution and diagnostic accuracy. Capsule endoscopy also represents an overall economic saving despite a high unit price compared with the expense of repeat diagnostic testing. Because the diagnostic yield of capsule endoscopy is nearly twofold greater than conventional endoscopy, it has become the procedure of choice for the dilemma of assessing small-bowel pathology for many clinicians. Further studies are needed to determine whether the capsule endoscope can replace conventional endoscopy in the first-line diagnosis of pathology in other parts of the alimentary tract.

Capsules↗
PubMed2004

Wireless capsule endoscopy in the evaluation of the esophagus.

Wireless capsule endoscopy is an exciting and innovative technology that allows direct visualization of areas of the small bowel that were previously inaccessible to the "umbilicated" endoscope except during intraoperative enteroscopy. The wireless capsule endoscope permits noninvasive small bowel endoscopy in the ambulatory setting and has been proven to be a significant advance in the evaluation of patients with challenging small intestinal disease.

Contraindications↗
PubMed2006

Successful wireless capsule endoscopy for a 2.5-year-old child: obscure gastrointestinal bleeding from mixed, juvenile, capillary hemangioma-angiomatosis of the jejunum.

The lesion responsible for obscure gastrointestinal bleeding in the pediatric population may not be determined with standard primary endoscopic methods. Wireless capsule endoscopy, now a first-line modality for evaluation of the small bowel in the adult population, is a tool that may be useful among children. We report a case of a 2.5-year-old girl who presented with melenic stools. Upper and lower endoscopy, Meckel scans, and mesenteric angiography yielded negative results. Wireless capsule endoscopy identified numerous abnormal, dilated, blood vessels in the proximal jejunum, with associated fresh blood. The patient underwent surgical exploration, with resection of the affected portion of the jejunum. Pathologically, the dilated blood vessels were consistent with mixed, juvenile, capillary hemangioma-angiomatosis of developmental or congenital origin. The patient fared well postoperatively, with no additional bleeding in 9 months of follow-up monitoring. This case report highlights the use of capsule endoscopy in the diagnosis and successful treatment of gastrointestinal bleeding in a young infant. This is the youngest reported patient treated with the use of wireless capsule endoscopy in the pediatric population.

Angiomatosis↗
PubMed2006

[Identification of a Meckel's diverticulum bleeding by urgent capsule endoscopy].

A 10 year-old patient was admitted to our hospital due to severe gastrointestinal bleeding. His symptoms included hematochezia and fainting. Neither emergency upper endoscopy nor colonoscopy had identified the site of bleeding. During the colonoscopy they noticed that fresh blood entered the cecum from the ileum. An urgent capsule endoscopy was performed 8 hours after the patient admission. They placed the capsule with specific endoscopic technique into the proximal duodenum under general anesthesia. During 3,5 hours by the small bowel passage the capsule moved to the ileum and a focal bleeding lesion was detected at this site, suggesting the typical picture of bleeding Meckel's diverticulum. The patient was transfused by 1 unit of blood, with a minimum haemoglobin level 95 g/l. By surgery the ulcerated Meckel's diverticulum was identified and resected. Histopathology showed ectopic gastric mucosa. Surgical resection of the diverticulum resulted complete healing of this patient. The capsule endoscopy diagnosis was prompt, precise, and the all examinations were carried out within 24 hours. Involving urgent small bowel capsule endoscopy into the diagnostic workup of the obscure bleeding patient could considerably shorten the time to achieve a correct diagnosis and allowed the early institution of definitive treatment. By this one could spare a great number of costly alternative investigations with low diagnostic yield.

Child↗
PubMed2006

Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: feasibility, safety, and efficacy of a manometry-guided procedure.

BACKGROUND AND STUDY AIMS: The aim of the study was to evaluate the safety, feasibility, and efficacy of transnasal placement of the Medtronic Bravo capsule for wireless esophageal pH monitoring. PATIENTS AND METHODS: Forty patients with symptomatic gastroesophageal reflux disease were prospectively evaluated. All patients underwent upper gastrointestinal endoscopy and esophageal manometry. The Bravo capsule was then introduced transnasally and released 5 cm above the upper margin of the lower esophageal sphincter. Serial radiographs were performed weekly until capsule release. RESULTS: Of the 40 patients who were evaluated, 38 (95 %) were eligible to undergo the procedure. Transnasal placement proved impossible in one patient (2.5 %). Overall, a total of 39 procedures were performed in 38 patients (the procedure was repeated in one patient because of accidental intragastric fixation). Esophageal placement was successful in 36/39 procedures (92.3 %). The mean duration of the procedure was 10 minutes (range 5 - 16 minutes). Adverse events were noted in five of the 39 procedures (12.8 %), mild epistaxis in two patients (5.1 %) and pharyngeal irritation in three patients (7.7 %). After the procedure, a slight "foreign body" sensation was reported by 20 of the 36 patients (55.5 %) who had undergone successful esophageal placement; two patients (5.5 %) experienced severe retrosternal pain necessitating endoscopic removal of the capsule. At the end of the study, 34 of the 38 patients (89.5 %) stated that they would be willing to undergo the test again if necessary. CONCLUSIONS: Transnasal placement of the Bravo pH capsule is safe, well tolerated, does not require sedation, and avoids endoscopy and its complications.

Adult↗
PubMed2001

Usefulness of endoscopic small intestinal biopsies in children with coeliac disease.

Small intestinal biopsy is the most important diagnostic method in the routine evaluation of children with chronic diarrhoea and malabsorption. At present morphological alterations are considered essential in the diagnosis of coeliac disease (CD) and the presence of a normal small bowel biopsy specimen, observed in patients eating a diet containing gluten, rules out the diagnosis of CD. The small intestinal biopsy can be carried out either by blind suction capsule or by endoscopic forceps. In everyday clinical practice endoscopic duodenal biopsies, if taken and handled suitably, are accepted as equivalent to capsule biopsies from the proximal jejunum. In the study we reported some patients in whom has been possible to demonstrate the presence of total villous atrophy in one biopsy, while other duodenal samples taken in different duodenal portions were normal or showed mild lymphocytes and plasmacells infiltrations of the lamina propria. In patients with this type of biopsy pathology, wherein flat mucosa has been found even close to normal mucosa, the possible explanation is mucosal patchiness. The occurrence of patchly distributed intestinal atrophy in children suffering of CD raises the question of the validity of using the peroral capsule, widely believed to be the best standard for the diagnosis of CD. In our opinion, small intestinal biopsies obtained via endoscopy are more reliable than the peroral capsule biopsies in order to identify patchy mucosal atrophy and could be very useful for a correct diagnosis in CD patients.

Adolescent↗
PubMed2005

[Latest progress of minimally-invasive medical systems in the field of alimentary tract diagnosis and treatment].

The capsule-style micro-system is a hot spot of minimally-invasive medical instruments. Progresses of some typical capsule-style micro-systems, such as the wireless endoscope, site specific delivery capsule (SSDC), alimentary tract sampling capsule, PH capsule, etc. are introduced here in detail. The research activities in China and the developing trend of capsule-style micro-systems are discussed too.

Drug Delivery Systems↗
PubMed2003

Ambulatory esophageal pH monitoring using a wireless system.

OBJECTIVE: Limitations of catheter-based esophageal pH monitoring are discomfort, inconvenience, and interference with normal activity. An alternative to conventional pH monitoring is the wireless Medtronic Bravo pH System. The aim of this study was to evaluate the safety, performance, and tolerability of this system. METHODS: A total of 44 healthy subjects and 41 patients with gastroesophageal reflux disease (GERD) were studied for a 2-day period. The pH telemetry capsule was positioned transorally 6 cm above the squamocolumnar junction using endoscopic measurement. The signal transmitted from the capsule was received and recorded by a small, pager-sized receiver, and pH data were subsequently uploaded to a computer for analysis. RESULTS: Successful 24-h pH studies were completed in 82 subjects (96%). During the 24-h study period the median percentage of the time that pH was <4 was 2.3% (95th percentile, 5.9%) in controls and 6.5% (range, 0.8-27.6) in GERD patients. In 76 subjects (89%), 36-48 h recordings were obtained. For the extended period the median percentage of the time that pH was <40 was 2.0% (95% percentile, 5.3%) in controls and 6.6% (range, 1.0-26.7) in GERD patients. Capsules required endoscopic removal in three subjects (4%). Optimal sensitivity in distinguishing controls from reflux patients was achieved when analyzed from the perspective of the worst of the 2 days. CONCLUSIONS: The wireless Bravo pH System successfully recorded esophageal acid exposure in 96% of the patients during a 24-h period and in 89% of subjects for >36 h. The 95th percentile for the 2-day recordings in control subjects was 5.3%, slightly higher than observed with conventional systems.

Adult↗
PubMed1984

Endoscopic evaluation of the effect of indomethacin capsules and suppositories on the gastric mucosa in rheumatic patients.

Twelve patients with rheumatic diseases took part in a 6-week double-blind crossover trial comparing 14 days of oral with 14 days of rectal indomethacin treatment, 50 mg 3 X /day, with a 14-day placebo period. The patients had a gastroscopic and a proctoscopic examination after each of the 3 periods. The gastric acid production, serum concentrations and the 24-h urine excretion of indomethacin was measured. Both indomethacin capsules and suppositories caused an equal amount of gastric damage, indicating that the irritative effect of indomethacin on the gastric mucosa is not a local effect, but due to a systemic effect of indomethacin. Although the suppositories caused some mucus discharge no mucosal damage was found by proctoscopy.

Adult↗
PubMed2005

Laparoscopy-assisted exploration of obscure gastrointestinal bleeding after capsule endoscopy: the Korean experience.

BACKGROUND: Obscure gastrointestinal bleeding (OGB) is generally defined as recurrent acute or chronic bleeding for which no source has been identified by routine radiologic and endoscopic examination. The aim of this study was to report our early experiences detecting small bowel bleeding by capsule endoscopy (CE) and the results of laparoscopy assisted surgery for OGB. MATERIALS AND METHODS: Seventy-five patients with OGB were examined by CE. Twelve of 24 patients in the active bleeding group underwent laparoscopic or laparoscopy assisted surgery and we carried out intraoperative enteroscopy to find the focus of the bleeding. RESULTS: Laparoscopic localization of the lesion was successful for 4 patients-those with Meckel's diverticulum, gastrointestinal stromal tumor, lymphoma, and ischemic necrosis. In 3 cases in which there was no natural passage of the capsule endoscope, lesions were identified by small bowel exploration through simple palpation by hand. Intraoperative enteroscopy was performed extracorporeally in 5 cases through a minilaparotomy window using an extended incision of a port site less than 7 cm in length. The lesions that were identified by CE preoperatively were resected successfully, via laparoscopic or laparoscopy-assisted surgery. The gastrointestinal bleeding has not recurred during the postoperative follow-up period (mean, 10.6 months). CONCLUSION: The laparoscopic approach can be chosen for surgical management of OGB patients with active bleeding whose lesions have been identified by CE. This approach allows minimally invasive surgical treatment for ongoing OGB.

Adolescent↗