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Hirata I, Tsuboi A, Matsubara Y, Sumioka A, Takasago T, Tanaka H, Yamashita K, Takigawa H, Urabe Y, Oka S. Clinical usefulness and acceptability of small-bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients. DEN OPEN 2025; 5:e389. [PMID: 38845631 PMCID: PMC11154819 DOI: 10.1002/deo2.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/09/2024]
Abstract
Objectives We aimed to evaluate the usefulness and acceptability of CapsoCam Plus (CapsoCam) in Japanese patients. Methods This retrospective single-center study enrolled 930 patients with suspected small-bowel bleeding (SSBB) who underwent capsule endoscopy. Thirty-three patients using CapsoCam and PillCam SB3 (SB3) were matched using propensity score matching. The diagnostic yield and the acceptability of CapsoCam were evaluated. Results There was no SSBB case where capsule endoscopy was performed within 48 h of bleeding. CapsoCam had a significantly higher observation rate of the entire small bowel (97% vs. 73%, p = 0.006) and Vater's papilla (82% vs. 15%, p < 0.001) than SB3. The reading time of CapsoCam was significantly longer than that of SB3 (30 vs. 25 min, p < 0.001), and CapsoCam's time from the capsule endoscopy swallowing to read completion was longer than that of SB3 (37 vs. 12 h, p < 0.001). The two groups showed no difference in the capsule endoscopy findings according to the P classification. Notably, 85% of the patients using CapsoCam reported examination distress as "not at all" or "almost not," and 94% reported swallowing difficulty as "very easy" or "easy." Conclusions CapsoCam took time to read; however, it is a well-tolerated examination with a high observation rate of Vater's papilla and entire small-bowel mucosa. Detectability of bleeding sources was comparable in both modalities for cases of occult SSBB and overt SSBB more than 48 h after bleeding. CapsoCam is a useful modality for patients with SSBB.
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Affiliation(s)
- Issei Hirata
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuka Matsubara
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Akihiko Sumioka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Takeshi Takasago
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hidenori Tanaka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Ken Yamashita
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hidehiko Takigawa
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuji Urabe
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Shiro Oka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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Topa M, Rimondi A, Sorge A, Smania V, Scaramella L, Nandi N, Cavallaro F, Vecchi M, Elli L, Tontini GE. Incomplete small bowel capsule endoscopy: Risk factors and cost-effectiveness of real-time viewing. Endosc Int Open 2024; 12:E842-E848. [PMID: 38966319 PMCID: PMC11221906 DOI: 10.1055/a-2333-8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/06/2024] [Indexed: 07/06/2024] Open
Abstract
Background and study aims International guidelines recommend real-time viewing (RTV) in capsule endoscopy for gastric emptying monitoring, yet it is often overlooked in clinical practice. We aimed to assess risk factors for incomplete small bowel capsule endoscopy (SBCE) and evaluate the clinical relevance and cost-effectiveness of RTV implementation. Methods We included consecutive SBCEs from 2013 to 2020. RTV was not applied per local protocol. We used multivariate logistic regression to identify risk factors for incomplete SBCE, including prolonged gastric transit time (GTT) and prolonged small bowel transit time (SBTT). Results Analyzing 858 SBCEs, we observed a completion rate of 94.6%. Prolonged GTT and SBTT were present in 4.9% and 18.2% of complete SBCEs, and in 13% ( P =0.03) and 10.8% ( P =0.24) of incomplete SBCEs, respectively. Only 0.7% (6 of 858) had incomplete SBCE with prolonged GTT. In both univariate and multivariate analysis, a modifiable (prolonged GTT odds ratio [OR] 2.9; 95% confidence interval [CI] 1.1-7.5) and two unmodifiable risk factors (inpatient status OR 2.3; 95% CI 1.1-4.5) and history of incomplete SBCE (OR 4.2; 95% CI 1.3-13.7) were independently linked to higher incomplete SBCE rates. The pretest completion probability was 90.5% and 95.8% in patients with and without unmodifiable risk factors, respectively ( P <0.01). The direct cost of systematic RTV adoption and prokinetics administration would be €5059, aiming to identify and treat each case of prolonged GTT associated with incomplete SBCE. Conclusions Modern devices make incomplete SBCE rare, usually not tied to prolonged GTT. In a low-incidence scenario, widespread RTV use brings high costs and uncertain effectiveness.
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Affiliation(s)
- Matilde Topa
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Rimondi
- Post graduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Veronica Smania
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Topa M, Nandi N, Scaramella L, Puricelli M, Pennazio M, Sidhu R, Sanders DS, Tontini GE, Penagini R, Vecchi M, Elli L. Clinical impact of videocapsule endoscopy and device-assisted enteroscopy in non-bleeding small bowel lesions. Therap Adv Gastroenterol 2023; 16:17562848231176424. [PMID: 37435179 PMCID: PMC10331340 DOI: 10.1177/17562848231176424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are part of the diagnostic and therapeutic work-up of indications other than suspected small bowel bleeding (OSBB). The literature is currently lacking studies describing these procedures in this particular setting. Objectives We assessed the clinical impact of VCE and DBE in a large monocentric cohort of OSBB patients, as compared to a control group of suspected small bowel bleeding (SSBB) patients who underwent enteroscopy over the same period. Design Monocentric, retrospective, cohort study. Methods We collected the data of consecutive patients with OSBB undergoing VCE and/or DBE from March 2001 to July 2020. The demographic and clinical parameters of the patients, technical characteristics, and adverse events for each procedure were collected. The impact of VCE and DBE was defined in terms of diagnostic yield (DY). The patients were subdivided according to the main indication into four groups: celiac disease, Crohn's disease (CD), neoplasia, and persistent gastrointestinal symptoms. Results A total of 611 VCEs and 387 DBEs were performed for OSBB. The main indications were complicated celiac disease and CD. The DYs of VCE and DBE overall were 53 and 61.7%, respectively, with some variance among the four groups. We report no statistical differences in the DY of VCE and DBE in SSBB vs OSBB (57.7% vs 53%, p = 0.0859 and 68.8% vs 61.7%, p = 0.0582, respectively). OSBB patients were significantly younger than those with SSBB. However, similarly to SSBB (k = 0.059), poor agreement between the enteroscopic techniques was found in the OSBB population (k = 0.109). The safety of both procedures in OSBB was comparable to that in SSBB patients. Conclusion VCE and DBE are effective and safe in suspected OSBB, where their role is similar to that in SSBB, their main indication.
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Affiliation(s)
- Matilde Topa
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Puricelli
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Reena Sidhu
- Academic Department of Gastroenterology and Liver Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David S. Sanders
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, Milan 20122, Italy
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Singla N, Inavolu P, Jagtap N, Singh AP, Kalapala R, Memon SF, Katukuri GR, Pal P, Nabi Z, Ramchandani M, Lakhtakia S, Banerjee R, Reddy PM, Tandan M, Reddy N. Small Bowel Capsule Endoscopy: Experience from a single large tertiary care centre. Endosc Int Open 2023; 11:E623-E628. [PMID: 37614640 PMCID: PMC10442921 DOI: 10.1055/a-2096-2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/20/2022] [Indexed: 08/25/2023] Open
Abstract
Background and study aims Capsule endoscopy (CE) has transformed examination of the small bowel (SB), once considered a dark continent. The present study aimed to describe the indications, diagnostic yield, practical issues and complications of CE in one of the largest tertiary center in India. Patients and methods This retrospective analysis from a prospectively maintained database, conducted from January 2013 to June 2021 included 1155 CEs performed during this period. Patient medical records were reviewed for indications, results, and complications of CE. Results A total of 1154 patients (809 males and 345 females), mean age 53 years (range 6-87 years), one capsule got stuck in the esophagus, were included in the study. Active SB bleeding had no effect on SB transit time (324.7±161 minutes, n = 137 patients with active bleed vs 310.6±166.9 minutes, n = 1017 patients without active bleed; P = 0.35). The indication and diagnostic yield (DY) of CE were potential overt SB bleed (68.6% & 43.9%), potential occult SB bleed (8.2% and 40%), chronic diarrhea (7.9% and 28.4%), abdominal pain (6.5% and 21.3%), anemia (5.9% and 57.9%), and suspected/known case of Crohn's disease (2.3% & 56.5%) respectively. The DY for patients with age ≥60 years was similar to those with age < 60 years (61.9% vs. 51.8% respectively; P = 0.4). 21 patients (1.8%) had capsule retention of which six (0.5%) had to be referred for surgery. Conclusions CE is a safe and effective investigation with ever increasing range of indications. Potential SB bleed remains the most common indication for CE with high detection rate.
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Affiliation(s)
- Neeraj Singla
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradev Inavolu
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rakesh Kalapala
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Partha Pal
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Manu Tandan
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Jiang B, Qian YY, Wang YC, Pan J, Jiang X, Zhu JH, Qiu XO, Zhou W, Li ZS, Liao Z. A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule. BMC Gastroenterol 2023; 23:76. [PMID: 36927462 PMCID: PMC10019395 DOI: 10.1186/s12876-023-02696-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUNDS AND AIMS Complete and consecutive observation of the gastrointestinal (GI) tract continues to present challenges for current endoscopy systems. We developed a novel upper and mid gastrointestinal (UMGI) capsule endoscopy using the modified detachable string magnetically controlled capsule endoscopy (DS-MCE) and inspection method and aimed to assess the clinical application. METHODS Patients were recruited to undergo UMGI capsule endoscopy followed by esophagogastroduodenoscopy. All capsule procedures in the upper gastrointestinal (UGI) tract were conducted under the control of magnet and string. The main outcome was technical success, and the secondary outcomes included visualization of the UMGI tract, examination time, diagnostic yield, compliance, and safety evaluation. RESULTS Thirty patients were enrolled and all UMGI capsule procedures realized repeated observation of the esophagus and duodenum with detection rates of 100.0%, 80.0%, and 86.7% of Z-line, duodenal papilla, and reverse side of pylorus, respectively. String detachment was succeeded in 29 patients (96.7%) and the complete examination rate of UMGI tract was 95.45% (21/22). All UMGI capsule procedures were well tolerated with low discomfort score, and had a good diagnostic yield with per-lesion sensitivity of 96.2% in UGI diseases. No adverse events occurred. CONCLUSIONS This new capsule endoscopy system provides an alternative screening modality for the UMGI tract, and might be indicated in cases of suspected upper and small bowel GI bleeding. Trial registration DS-MCE-UGI and SB, NCT04329468. Registered 27 March 2020, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04329468 .
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Affiliation(s)
- Bin Jiang
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
- Department of Gastroenterology, The First Naval Hospital of Southern Theater Command, Zhanjiang, 524005, Guangdong, China
| | - Yang-Yang Qian
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Yuan-Chen Wang
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Jun Pan
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Xi Jiang
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Jia-Hui Zhu
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Xiao-Ou Qiu
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Wei Zhou
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China
| | - Zhuan Liao
- Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Shanghai, 200433, China.
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Lin Y, Zhang C, Liu C, Ma X, Yang Q, Guan B, Liu Z. Imaging-Navigated Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1199:87-106. [PMID: 37460728 DOI: 10.1007/978-981-32-9902-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
It is vitally important to guide or navigate therapeutic proceedings with a direct and visual approach in order to carefully undertake precision medical manipulations and efficiently evaluate the treatments. Imaging-navigated surgery is one of the common and prevailing technologies to realize this target, and more importantly it merges visualized medicine into next-generation theranostic paradigms in modern medicine. Endoscopes, surgical robots, and nanorobots are three major domains in terms of imaging-navigated surgery. The history of endoscopy has seen upgraded developments since the early 1800s. In contrast, surgical robots have been widely used and investigated in recent years, and they came into clinical uses only in the past decades. Nanorobots which closely depend on innovated and multifunctional biomaterials are still in their infancy. All these imaging-navigated technologies show similar and apparent advantages such as minimal invasiveness, minimized pain, positive prognosis, and relatively expected recovery, which have greatly improved surgery efficiency and patients' life quality. Therefore, the imaging-navigated surgery will be discussed in this chapter, and advanced clinical and preclinical medical applications will also be demonstrated for a diverse readers and comprehensive understanding.
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Affiliation(s)
- Yandai Lin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chen Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Chenxi Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xinyong Ma
- Division of Academic & Cultural Activities, Academic Divisions of the Chinese Academy of Sciences, Beijing, China
| | - Qiang Yang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Binggang Guan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhe Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
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7
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Elli L, Scaramella L, Tontini GE, Topa M, Conte D, Sidhu R, Rondonotti E, Penagini R, Vecchi M. Clinical impact of videocapsule and double balloon enteroscopy on small bowel bleeding: Results from a large monocentric cohort in the last 19 years. Dig Liver Dis 2022; 54:251-257. [PMID: 34373230 DOI: 10.1016/j.dld.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 07/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Suspected small bowel bleeding (SSBB) is the main indication for videocapsule endoscopy (VCE) and double balloon enteroscopy (DBE). We assessed the impact of both modalities in a large cohort of SSBB patients in a European tertiary center. METHODS We retrospectively evaluated consecutive patients with SSBB undergoing VCE and/or DBE from March 2001 to July 2020. Demographic/clinical parameters, anticoagulant therapies, technical characteristics and adverse events were collected, as well as diagnostic yield (DY), VCE-DBE concordance, hemoglobin (Hb) values before and after DBE, and complications. RESULTS 807 VCEs and 407 DBEs were performed in 751 patients. The DY was significantly higher in DBE compared with VCE (68.8% vs 57.7%), with the highest (75%) yield for overt active SB bleeding. The agreement between VCE and DBE was generally suboptimal (k = 0.059). This improved in cases where both procedures were done within 1-5 days of the other (k = 0.323). Post-procedural Hb values were significantly higher. In patients treated with direct oral anticoagulants (DOACs), there were no differences in DY, complications or Hb values compared with non-DOAC patients. CONCLUSION VCE and DBE play a pivotal role in the diagnostic and therapeutic approach to SSBB, having a high clinical impact even in patients treated with DOACs.
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Affiliation(s)
- Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matilde Topa
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy
| | | | | | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Elosua A, Rullan M, Rubio S, Oquiñena S, Rodríguez C, Macías E, Borda A, Fernández-Urién I, Nantes Ó. Does capsule endoscopy impact clinical management in established Crohn's disease? Dig Liver Dis 2022; 54:118-124. [PMID: 34518128 DOI: 10.1016/j.dld.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Capsule endoscopy (SBCE) has developed a relevant role in patients with established Crohn's Disease (CD). However, evaluation of the impact in clinical management has been scarce. AIMS To evaluate therapeutic impact of SBCE in an 11-year real-life cohort of known CD patients. METHODS Retrospective single center study including all patients with established CD submitted to SBCE procedure from 01/01/2008 to 31/12/2019. Patency capsule was used in selected patients. Small bowel mucosal inflammation was quantified using Lewis score. Therapeutic impact was defined as a change in CD-related treatment recommended based on SBCE results. Patients were assigned to four groups regarding SBCE indication: staging, flare, post-op and remission. RESULTS From the 432 SBCE performed 87.5% were conclusive. Active disease was present in 63.7 of patients; 41.6% mild inflammation and 21.9% moderate-to-severe activity. A change of management was guided by SBCE in 51.3% of procedures: 199 (46.1%) escalation and 23 (5.3%) de-escalation, with significant changes in all groups. Escalation increased with disease activity: 57.8% in mild and 89.5% in moderate-to-severe disease. De-escalation was conducted in 13.9% procedures with mucosal healing and 1.1% with mild disease. CONCLUSION SBCE is a useful tool for guiding therapeutic management in CD patients both for treatment escalation and de-escalation.
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Affiliation(s)
- Alfonso Elosua
- Gastroenterology Unit, Hospital García Orcoyen, Calle Santa Soria 22, Estella, Navarra 31200, Spain.
| | - María Rullan
- Gastroenterology Unit, Hospital García Orcoyen, Calle Santa Soria 22, Estella, Navarra 31200, Spain
| | - Saioa Rubio
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Susana Oquiñena
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Cristina Rodríguez
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Elena Macías
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Ana Borda
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Ignacio Fernández-Urién
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Óscar Nantes
- Gastroenterology Department, Complejo Hospitalario de Navarra, Calle Irunlarrea 3, Pamplona 31008, Spain
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Enns C, Galorport C, Ou G, Enns R. Assessment of Capsule Endoscopy Utilizing Capsocam Plus in Patients With Suspected Small Bowel Disease Including Pilot Study With Remote Access Patients During Pandemic. J Can Assoc Gastroenterol 2021; 4:269-273. [PMID: 34988365 PMCID: PMC8697548 DOI: 10.1093/jcag/gwaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background CapsoCam Plus is a capsule endoscopy (CE) system that utilizes four cameras
to capture a panoramic view. This has theoretical advantage over
conventional forward-viewing CE with limited field of view. Its ease of
administration without requiring any additional equipment during the
recording also provides a unique opportunity for patients to self-administer
the test. We aimed to evaluate real-life experience using this novel system
and to determine feasibility of a remote access program. Methods Retrospective chart review was conducted for consecutive adult outpatients
who underwent CE using CapsoCam Plus. Patients with significant challenges
for in-person procedures were selected for remote access through mail
courier services. Gastric transit time, small bowel transit time, completion
rate, diagnostic yield and adverse events were compared between remote
access versus usual practice. Results Ninety-four patients (52.1% male) were included, with 28 in remote access
program. Most common indication was gastrointestinal bleeding (85.1%).
Complete examination was achieved in 87 patients. Five (5.3%)
patients’ capsule remained in stomach during the recording, while two
(2.1%) patients missed capsule retrieval. Median small bowel and gastric
transit times were 231.9 (interquartile range [IQR] 169.5–308.2) and
27.6 (IQR 13.8–63.5) minutes, respectively. Diagnostic yield was
23.4%. There was no difference in completion rate or transit times between
two groups, but diagnostic yield was higher in remote access group (odds
ratio 3.80, 95% confidence interval 1.28–11.31). One patient required
elective endoscopic retrieval of capsule. Conclusion CapsoCam Plus can be safely administered remotely with a high degree of
success, which may facilitate timely investigations while limiting
nonessential physical interactions during pandemic.
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Affiliation(s)
- Chasyn Enns
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cherry Galorport
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - George Ou
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Enns
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Double-headed small-bowel capsule endoscopy: Real-world experience from a multi-centre British study. Dig Liver Dis 2021; 53:461-466. [PMID: 33574013 DOI: 10.1016/j.dld.2021.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Capsule endoscopy (CE) is well established the investigation of small-bowel (SB) pathology. We compared the use of double-headed (DH) capsules, to conventional single-headed (SH), in a real-world patient cohort in the first multicentre British study. METHODS Over 9 months, patients referred for routine SBCE at 4 tertiary referral centres in the UK underwent DH CE instead of conventional SH using MiroCamⓇ MC2000 as per local protocols. One head (L/R) was chosen at random and reported by an expert reviewer. The DH recordings, anonymised and randomised, reported by another expert or re-read after a 4-week interval. For each CE, numbers and types of findings and overall conclusion/diagnosis were compared between SH and DH examinations. RESULTS 211 CEs were performed. 7 failed to reach the SB; 204 analysed. Indications were: SB bleeding (n = 94); ?SB inflammation or reassessment of known inflammatory bowel disease (IBD) (n = 84); ?SB neoplasia including suspicious radiological imaging (n = 15); and, others e.g. ?celiac disease (n = 11). For SB bleeding: 27/94 (28.7%) examinations reported differences between SH and DH readings. In 17 (18.1%) the findings were clinically significant. SH CE missed angiectasias (5 pts), SB inflammation (7 pts), oesophagitis (2 pts) and SB masses (2 pts). In 1 patient, the extent of angiectasias seen was greater on the DH reading. For IBD: findings differed in 30/84 (35.7%) of CEs; 11 (13.1%) were clinically significant. In 5, signs of active inflammation were missed by the SH reading. In 6, assessment of extent/severity differed. For?SB neoplasia findings differed in 2/15 (13.3%) of examinations. Both were clinically significant. For others: 1/11 (9.1%) examinations differed; however, not deemed clinically significant. Overall, use of DH CE impacted the diagnosis in 30/204 (14.7%). CONCLUSIONS The use of DH CE provides more information with the potential to change clinical diagnosis and therefore management. Therefore, the routine adoption of DH CE in SB assessment should be considered.
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11
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Branchi F, Ferretti F, Orlando S, Tontini GE, Penagini R, Vecchi M, Elli L. Small-bowel capsule endoscopy in patients with celiac disease, axial versus lateral/panoramic view: Results from a prospective randomized trial. Dig Endosc 2020; 32:778-784. [PMID: 31680344 DOI: 10.1111/den.13575] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Capsule enteroscopy (CE) is recommended in the management of complicated celiac disease (CD). However, published data are derived from axial-view capsule systems. No data are available on the use of lateral/panoramic view capsules. This study aimed at evaluating the diagnostic yield and efficacy of the lateral/panoramic versus the axial view capsule system in CD. METHODS Consecutive CD patients were enrolled in a prospective monocentric study. Each patient ingested an axial (PillCam SB3) and a lateral/panoramic (CapsoCam Plus) view capsule with a 3-h interval in a randomized order. Two experts blindly evaluated the CE carried out. A third expert reviewed the videos in cases of discordance. RESULTS Twenty-five CD patients were enrolled (four males, age at CE 51.2 ± 16.6 years, age at CD diagnosis 41.7 ± 20.6, years on a gluten-free diet [GFD] 9.6 ± 9.4). Indications at CE were refractory CD in nine cases, non-responsiveness to GFD in 10 and GFD non-compliance in six. A positive finding was evidenced in 15 (60%) and 13 (52%) cases by CapsoCam and PillCam respectively (not significant). Atrophy was detected by both capsules. Considering the percentage of the small-bowel mucosa presenting atrophy signs, mean values were 22% ± 35 and 20% ± 29 for lateral/panoramic and axial systems, respectively (not significant). Compared to duodenal histology, PillCam correctly identified 80% of patients with SB atrophy, whereas CapsoCam identified 73% of cases. CONCLUSIONS Lateral/panoramic view CE is effective in the detection of small-bowel atrophy in CD and presents good sensitivity and specificity when compared to histology.
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Affiliation(s)
- Federica Branchi
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Ferretti
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefania Orlando
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy
| | - Gian Eugenio Tontini
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Penagini
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Elli
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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12
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Second-generation magnetically controlled capsule gastroscopy with improved image resolution and frame rate: a randomized controlled clinical trial (with video). Gastrointest Endosc 2020; 91:1379-1387. [PMID: 31981648 DOI: 10.1016/j.gie.2020.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Compared with conventional endoscopy, magnetically controlled capsule gastroscopy (MCCG) can be further optimized in gastric examination time and complete visualization of upper GI (UGI) mucosa. The second-generation MCCG (MCCG-2) was developed with higher image resolution and adaptive frame rate, and we aimed to evaluate its clinical availability for UGI examination in this study. METHODS Consecutive patients undergoing MCCG examination between May to June 2019 were prospectively enrolled and randomized to swallow the first-generation MCCG (MCCG-1) or MCCG-2 in a 1:1 ratio. The main outcomes included visualization of the esophagus and duodenum, operation-related parameters, image quality, maneuverability, detection of lesions, and safety evaluation. RESULTS Eighty patients were enrolled. In the MCCG-2 group, frames captured for esophageal mucosa and Z-line were 171.00 and 2.00, significantly increased from those in the MCCG-1 group (97.00 [P = .002] and .00 [P = .028], respectively). The gastric examination time was shortened from 7.78 ± .97 minutes to 5.27 ± .74 minutes (P < .001), with the total running time of the capsule extended from 702.83 minutes to 1001.99 minutes (P < .001). MCCG-2 also greatly improved the image quality (P < .001) and maneuverability (P < .01). No statistical difference existed in the detection of lesions between the 2 groups, and no adverse events occurred. CONCLUSIONS MCCG-2 showed better performance in mucosal visualization, examination duration, and maneuverability, making better diagnosis of UGI diseases a possibility. (Clinical trial registration number: NCT03977935.).
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13
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Tontini GE, Rizzello F, Cavallaro F, Bonitta G, Gelli D, Pastorelli L, Salice M, Vecchi M, Gionchetti P, Calabrese C. Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn's system. BMC Gastroenterol 2020; 20:97. [PMID: 32264831 PMCID: PMC7140388 DOI: 10.1186/s12876-020-01231-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A new capsule endoscopy (CE) system featuring two advanced optics for 344°-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344°-viewing in a multi-center real-life setting. METHODS Consecutive patients with suspected or established CD received the PillCam™ Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344° panoramic-view (lesions detected by camera A and B) over the standard 172°-view (lesions detected by one camera only). RESULTS Among 41 patients (aged 43 ± 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172° view, the panoramic 344°-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). CONCLUSIONS The panoramic 344°-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dania Gelli
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marco Salice
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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14
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Tontini GE, Manfredi G, Orlando S, Neumann H, Vecchi M, Buscarini E, Elli L. Endoscopic ultrasonography and small-bowel endoscopy: Present and future. Dig Endosc 2019; 31:627-643. [PMID: 31090965 DOI: 10.1111/den.13429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Stefania Orlando
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Digestive Endoscopy and Gastroenterology Unit, ASST of Cremona, Cremona, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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Hosoe N, Takabayashi K, Ogata H, Kanai T. Capsule endoscopy for small-intestinal disorders: Current status. Dig Endosc 2019; 31:498-507. [PMID: 30656743 DOI: 10.1111/den.13346] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
Small-bowel capsule endoscopy (SBCE) is used widely because of its non-invasive and patient-friendly nature. SBCE can visualize entire small-intestinal mucosa and facilitate detection of small-intestinal abnormalities. In this review article, we focus on the current status of SBCE. Several platforms for SBCE are available worldwide. Third-generation SBCE (PillCam® SB3) has a high-resolution camera equipped with an adaptive frame rate system. Several software modes have been developed to reduce the reading time for capsule endoscopy and to minimize the possibility of missing lesions. The main complication of SBCE is capsule retention. Thus, the main contraindication for SBCE is known or suspected gastrointestinal obstruction unless intestinal patency is proven. Possible indications for SBCE are obscure gastrointestinal bleeding, Crohn's disease, small-intestinal polyps and tumors, and celiac disease. Colon capsule endoscopy (CCE) can observe inflamed colonic mucosa non-invasively, and allows for the continuous and non-invasive observation of the entire intestinal tract (pan-endoscopy). Recently, application of CCE as pan-enteric endoscopy for inflammatory bowel diseases (including Crohn's disease) has been reported. In the near future, reading for CE will be assisted by artificial intelligence, and reading CE videos for long periods will not be required.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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16
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Impact of magnetic steering on gastric transit time of a capsule endoscopy (with video). Gastrointest Endosc 2018; 88:746-754. [PMID: 30005825 DOI: 10.1016/j.gie.2018.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUNDS AND AIMS Delayed gastric transit of the capsule may lead to incomplete small bowel examination, reducing the diagnostic yield. Thus, this study was designed to determine if magnetic steering could enhance capsule gastric emptying and mucosal visualization within the duodenum. METHODS The intervention group comprised 100 patients undergoing magnetic-controlled capsule endoscopy between May to September 2017 in whom magnetic control was used to assist transpyloric passage of the capsule and duodenal inspection. A cohort of 100 patients who had undergone the procedure before May 2017 was randomly selected from the database as an historic control group in whom transpyloric movement of the capsule occurred spontaneously (without magnetic assistance). The difference in the pyloric transit time (PTT) and duodenal papilla detection rate (DPDR) between the 2 groups were compared, and related factors were also investigated. RESULTS Transpyloric passage of the capsule under magnetic control was successfully performed in 59 patients (59%). Median PTT was greatly reduced in the intervention group from 58.38 minutes (range, 13.45-87.47) to 4.69 minutes (range, 1.56-55.00; P < .001), and DPDR was also greatly improved with magnetic steering (30.5% vs 9%, P < .001). Magnetic steering, male gender, and higher body mass index were independently associated with reduced gastric transit time and magnetic steering with an enhanced DPDR. CONCLUSIONS Magnetic steering of the capsule can enhance gastric emptying of the capsule and may prove useful in nonobese and female patients who appeared to have longer gastric transit time and achieved a better DPDR than that under the action of peristalsis alone. (Clinical trial registration number: NCT03441945.).
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17
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Beg S, Parra-Blanco A, Ragunath K. Optimising the performance and interpretation of small bowel capsule endoscopy. Frontline Gastroenterol 2018; 9:300-308. [PMID: 30245793 PMCID: PMC6145435 DOI: 10.1136/flgastro-2017-100878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/16/2017] [Accepted: 10/18/2017] [Indexed: 02/04/2023] Open
Abstract
Small bowel capsule endoscopy has become a commonly used tool in the investigation of gastrointestinal symptoms and is now widely available in clinical practice. In contrast to conventional endoscopy, there is a lack of clear consensus on when competency is achieved or the way in which capsule endoscopy should be performed in order to maintain quality and clinical accuracy. Here we explore the evidence on the key factors that influence the quality of small bowel capsule endoscopy services.
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Affiliation(s)
- Sabina Beg
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Krish Ragunath
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
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18
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Diagnostic Benefit of Simultaneous Capsule Endoscopy Using Two Different Systems. Gastroenterol Res Pract 2018; 2018:9798546. [PMID: 29997649 PMCID: PMC5994584 DOI: 10.1155/2018/9798546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/24/2017] [Accepted: 01/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Capsule endoscopy (CE) is a noninvasive test for diagnosing small bowel disorders. However, several studies reported that the CE-based visualization is suboptimal. This study, the first to use two CEs simultaneously, aimed at evaluating the diagnostic ability of dual CE. Methods Dual CE procedures were prospectively conducted. All patients completed bowel cleansing 2 hours before examination. Subsequently, they simultaneously swallowed two capsules: MiroCam (IntroMedic, Seoul, Korea) and PillCam SB3 (Medtronic, Minneapolis, USA). We assessed the completeness and feasibility of small bowel examination and the detection rate of duodenal papilla and diagnostic yield. Results Twenty consecutive patients who underwent complete small bowel examination with dual CE were enrolled in the study. The mean time of small bowel passage was 245 ± 99 min. Dual CE examination increased the duodenal papilla detection rate to up to 75% (versus PillCam SB3 alone (P = 0.031) and MiroCam alone (P = 0.063)) and overall diagnostic yield to up to 70% (P = 0.063) in comparison to single CE. Adverse events or electrical interference during data transmission between the two capsule endoscopes were not detected. Conclusions In this study, we found that dual CE enhances diagnostic accuracy and could increase the diagnostic power of existing CE systems using simply applicable methods. This trial is registered with KCT0002541.
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19
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Tontini GE, Neumann H. Non-steroidal anti-inflammatory drugs increase the risk of mucosal injuries but not of overt small bowel bleeding. Dig Endosc 2018; 30:48-49. [PMID: 28833703 DOI: 10.1111/den.12953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Helmut Neumann
- First Medical Department, University Medical Center Mainz, Mainz, Germany
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20
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Qiu EQ, Guo W, Cheng TM, Yao YL, Zhu W, Liu SD, Zhi FC. Diagnostic classification of endosonography for differentiating colorectal ulcerative diseases: A new statistical method. World J Gastroenterol 2017; 23:8207-8216. [PMID: 29290657 PMCID: PMC5739927 DOI: 10.3748/wjg.v23.i46.8207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/13/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To establish a classification method for differential diagnosis of colorectal ulcerative diseases, especially Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB).
METHODS We searched the in-patient medical record database for confirmed cases of CD, PIL and ITB from 2008 to 2015 at our center, collected data on endoscopic ultrasound (EUS) from randomly-chosen patients who formed the training set, conducted univariate logistic regression analysis to summarize EUS features of CD, PIL and ITB, and created a diagnostic classification method. All cases found to have colorectal ulcers using EUS were obtained from the endoscopy database and formed the test set. We then removed the cases which were easily diagnosed, and the remaining cases formed the perplexing test set. We re-diagnosed the cases in the three sets using the classification method, determined EUS diagnostic accuracies, and adjusted the classification accordingly. Finally, the re-diagnosing and accuracy-calculating steps were repeated.
RESULTS In total, 272 CD, 60 PIL and 39 ITB cases were diagnosed from 2008 to 2015 based on the in-patient database, and 200 CD, 30 PIL and 20 ITB cases were randomly chosen to form the training set. The EUS features were summarized as follows: CD: Thickened submucosa with a slightly high echo level and visible layer; PIL: Absent layer and diffuse hypoechoic mass; and ITB: Thickened mucosa with a high or slightly high echo level and visible layer. The test set consisted of 77 CD, 30 PIL, 23 ITB and 140 cases of other diseases obtained from the endoscopy database. Seventy-four cases were excluded to form the perplexing test set. After adjustment of the classification, EUS diagnostic accuracies for CD, PIL and ITB were 83.6% (209/250), 97.2% (243/250) and 85.6% (214/250) in the training set, were 89.3% (241/270), 97.8% (264/270) and 84.1% (227/270) in the test set, and were 86.7% (170/196), 98.0% (192/196) and 85.2% (167/196) in the perplexing set, respectively.
CONCLUSION The EUS features of CD, PIL and ITB are different. The diagnostic classification method is reliable in the differential diagnosis of colorectal ulcerative diseases.
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Affiliation(s)
- En-Qi Qiu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Wen Guo
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Tian-Ming Cheng
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Yong-Li Yao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Wei Zhu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Si-De Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
| | - Fa-Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
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Abstract
In this narrative review, invited by the Editors of Gastroenterology, we summarize recent advances in the field of gastrointestinal endoscopy. We have chosen articles published primarily in the past 2-3 years. Although a thorough literature review was performed for each topic, the nature of the article is subjective and systematic and is based on the authors' experience and expertise regarding articles we believed were most likely to be of high clinical and scientific importance.
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Affiliation(s)
| | | | | | - Amit Rastogi
- University of Kansas Medical Cancer, Kansas City, Kansas
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Rondonotti E. Capsule retention: prevention, diagnosis and management. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:198. [PMID: 28567378 DOI: 10.21037/atm.2017.03.15] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Capsule retention (CR) has been defined as capsule remaining in the digestive tract for a minimum of two weeks. CR occurs approximately in 2% of all patients undergoing small bowel capsule endoscopy (CE). Prompt diagnosis of CR is important, as it has relevant clinical implications. CR should be suspected in (I) all asymptomatic patients who do not report capsule excretion within 15 days from capsule ingestion; and (II) patients with obstructive or perforation-related symptoms in which the capsule has not been excreted, regardless of the time between the onset of symptoms and capsule ingestion. Abdominal plain X-ray is the preferred test to confirm CR. An abdominal CT scan should be performed, on individual basis, if knowledge of the precise location of the retained capsule is necessary or whenever clinically indicated. Since CR is usually asymptomatic, an initial watchful monitoring is suggested. In inflammatory bowel disease (IBD) patients, a short course of medical therapy may allow capsule excretion. Nevertheless, in long-term CR, some cases of capsule fragmentation, acute obstruction and perforation have been described. Therefore, retrieval of the retained capsule is recommended if asymptomatic CR lasts for long time. A safe capsule retrieval is usually performed by endoscopy, whereas surgery remains a viable alternative if the first is unsuccessful or when clinically indicated. Either Patency Capsule® (PC) or dedicated small bowel cross-sectional imaging techniques have been proposed to prevent CR. Both have pros and cons, but head-to-head comparative studies are lacking.
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The Effect of Prucalopride on Small Bowel Transit Time in Hospitalized Patients Undergoing Capsule Endoscopy. Can J Gastroenterol Hepatol 2017; 2017:2696947. [PMID: 29333428 PMCID: PMC5733169 DOI: 10.1155/2017/2696947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/14/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The inpatient status is a well-known risk factor for incomplete video capsule endoscopy (VCE) examinations due to prolonged transit time. We aimed to evaluate the effect of prucalopride on small bowel transit time for hospitalized patients undergoing VCE. METHODS We included all hospitalized patients who underwent VCE at a tertiary academic center from October 2011 through September 2016. A single 2 mg dose of prucalopride was given exclusively for all patients who underwent VCE between March 2014 and December 2015. VCE studies were excluded if the capsule was retained or endoscopically placed, if other prokinetic agents were given, in cases with technical failure, or if patients had prior gastric or small bowel resection. RESULTS 442 VCE were identified, of which 68 were performed in hospitalized patients. 54 inpatients were included, of which 29 consecutive patients received prucalopride. The prucalopride group had a significantly shorter small bowel transit time compared to the control group (92 versus 275.5, p < 0.001). There was a trend for a higher completion rate in the prucalopride group (93.1% versus 76%, p = 0.12). CONCLUSIONS Our results suggest that the administration of prucalopride prior to VCE is a simple and effective intervention to decrease small bowel transit time.
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