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Schuster KF, Thompson CC, Ryou M. Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding. Clin Endosc 2024; 57:73-81. [PMID: 37253640 PMCID: PMC10834283 DOI: 10.5946/ce.2022.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 03/06/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND/AIMS Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model. METHODS A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated. RESULTS All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract. CONCLUSION This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.
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Affiliation(s)
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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2
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Galloro G, Musella M, Siciliano S, Berardi G, Vitiello A, Velotti N, Rizzello F, Gionchetti P, Calabrese C. New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era. Endosc Int Open 2022; 10:E183-E191. [PMID: 35178336 PMCID: PMC8847058 DOI: 10.1055/a-1723-3109] [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: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P = 0.73). Conclusions Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
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Affiliation(s)
- Giuseppe Galloro
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Mario Musella
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Saverio Siciliano
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Giovanna Berardi
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Antonio Vitiello
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Nunzio Velotti
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Fernando Rizzello
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Paolo Gionchetti
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
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Hanscom M, Stead C, Feldman H, Marya NB, Cave D. Video Capsule Endoscopy and Device-Assisted Enteroscopy. Dig Dis Sci 2022; 67:1539-1552. [PMID: 34383197 PMCID: PMC8358900 DOI: 10.1007/s10620-021-07085-0] [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] [Accepted: 04/20/2021] [Indexed: 12/09/2022]
Abstract
Mark Hanscom Courtney Stead Harris Feldman Neil B. Marya David Cave.
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Affiliation(s)
- Mark Hanscom
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Courtney Stead
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Harris Feldman
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Neil B. Marya
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - David Cave
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
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Meltzer AC, Limkakeng AT, Gentile NT, Freeman JQ, Hall NC, Vargas NM, Fleischer DE, Malik Z, Kallus SJ, Borum ML, Ma Y, Kumar AB. Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial. J Am Coll Emerg Physicians Open 2021; 2:e12579. [PMID: 34723247 PMCID: PMC8544929 DOI: 10.1002/emp2.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for upper endoscopy (EGD). We conducted a clinical trial to determine if ED risk stratification with video capsule endoscopy (VCE) reduces hospitalization rates for low-risk to moderate-risk patients with suspected upper GI bleeding. METHODS We conducted a randomized controlled trial at 3 urban academic EDs. Inclusion criteria included signs of upper GI bleeding and a Glasgow Blatchford score <6. Patients were randomly assigned to 1 of the following 2 treatment arms: (1) an experimental arm that included VCE risk stratification and brief ED observation versus (2) a standard care arm that included admission for inpatient EGD. The primary outcome was hospital admission. Patients were followed for 7 and 30 days to assess for rebleeding events and revisits to the hospital. RESULTS The trial was terminated early as a result of low accrual. The trial was also terminated early because of a need to repurpose all staff to respond to the coronavirus disease 2019 pandemic. A total of 24 patients were enrolled in the study. In the experimental group, 2/11 (18.2%) patients were admitted to the hospital, and in the standard of care group, 10/13 (76.9%) patients were admitted to the hospital (P = 0.012). There was no difference in safety on day 7 and day 30 after the index ED visit. CONCLUSIONS VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended.
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Affiliation(s)
- Andrew C. Meltzer
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Nina T. Gentile
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Jincong Q. Freeman
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nicole C. Hall
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nataly Montano Vargas
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Zubair Malik
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Samuel J. Kallus
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Marie L. Borum
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Yan Ma
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Anita B. Kumar
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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5
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Nam JH, Lee KH, Lim YJ. Examination of Entire Gastrointestinal Tract: A Perspective of Mouth to Anus (M2A) Capsule Endoscopy. Diagnostics (Basel) 2021; 11:diagnostics11081367. [PMID: 34441301 PMCID: PMC8394372 DOI: 10.3390/diagnostics11081367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Capsule endoscopy (CE) is the only non-invasive diagnostic tool that enables the direct visualization of the gastrointestinal (GI) tract. Even though CE was initially developed for small-bowel investigation, its clinical application is expanding, and technological advances continue. The final iteration of CE will be a mouth to anus (M2A) capsule that investigates the entire GI tract by the ingestion of a single capsule. This narrative review describes the current developmental status of CE and discusses the possibility of realizing an M2A capsule and what needs to be overcome in the future.
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Affiliation(s)
- Ji Hyung Nam
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
| | - Kwang Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
| | - Yun Jeong Lim
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
- Correspondence: ; Tel.: +82-31-961-7133
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Cañamares-Orbís P, Lanas Arbeloa Á. New Trends and Advances in Non-Variceal Gastrointestinal Bleeding-Series II. J Clin Med 2021; 10:jcm10143045. [PMID: 34300211 PMCID: PMC8303152 DOI: 10.3390/jcm10143045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.
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Affiliation(s)
- Pablo Cañamares-Orbís
- Gastroenterology, Hepatology and Nutrition Unit, San Jorge University Hospital, 22004 Huesca, Spain
- Correspondence:
| | - Ángel Lanas Arbeloa
- IIS Aragón, CIBERehd, 50009 Zaragoza, Spain;
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain
- University of Zaragoza, 500009 Zaragoza, Spain
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Jiang XL, Wang JS, He JH. Summary of The Third Capsule Endoscopy Global Summit. Shijie Huaren Xiaohua Zazhi 2021; 29:210-216. [DOI: 10.11569/wcjd.v29.i4.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In order to emphasize the epidemic prevention during capsule endoscopy examinations, exhibit the latest achievements of capsule endoscopy, and strengthen international exchanges and cooperation in capsule endoscopy products, quality control, R&D, clinical applications, and talents, The Third Capsule Endoscopy Global Summit was held in Chongqing, China. The summit invited foreign experts to live online and remotely broadcast special academic speeches. The invited domestic experts brought the latest academic reports on the spot. A total of 17 medical experts presented a number of latest technologies and academic achievements in the field of capsule endoscopy from five levels. Professor Xue-Liang Jiang, President of the World Chinese Digestive Society and Editor-in-Chief of the World Chinese Journal of Digestology, was invited to give a report on the clinical application of capsule endoscopy.
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Affiliation(s)
- Xue-Liang Jiang
- Digestive Center of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, Shandong Province, China
| | - Jin-Shan Wang
- Jinshan Science & Technology Limited Company, Chongqing 404100, China
| | - Jian-Hua He
- Jinshan Science & Technology Limited Company, Chongqing 404100, China
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8
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Shah N, Chen C, Montano N, Cave D, Siegel R, Gentile NT, Limkakeng AT, Kumar AB, Ma Y, Meltzer AC. Video capsule endoscopy for upper gastrointestinal hemorrhage in the emergency department: A systematic review and meta-analysis. Am J Emerg Med 2020; 38:1245-1252. [PMID: 32229221 DOI: 10.1016/j.ajem.2020.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The assessment of the severity of upper gastrointestinal hemorrhage in emergency department (ED) patients is difficult to assess with commonly available diagnostic tools. Small studies have shown that video capsule endoscopy (VCE) is a promising risk-stratification method and may be better than current clinical decision rules such as the Rockall score and the Glasgow Blatchford score. This review aims to assess the accuracy of VCE to detect active upper gastrointestinal hemorrhage compared to a reference standard. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was used to perform a review of studies that have measured the diagnostic accuracy of VCE. Studies were included if they measured ED use of VCE for upper GI hemorrhage as compared to a reference standard of an esophagogastroduodenoscopy (EGD). A meta-analysis was performed on select patients using a fixed effects and random-effects model to determine the primary outcome of diagnostic test accuracy. RESULTS 40 studies were screened for eligibility and five studies representing 193 patients met the inclusion and exclusion criteria. All patients received both a VCE and an EGD. The sensitivity and specificity of VCE were 0.724 and 0.748, respectively. The diagnostic odds ratio was 6.29 (95% CI: 3.23-12.25) and the summary receiver operating characteristic curve was 0.782. CONCLUSIONS VCE demonstrated high accuracy for detecting upper GI hemorrhage in this meta-analysis of existing studies. In light of the potential advantages of VCE in the ED, further research is warranted to further establish its role.
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Affiliation(s)
- Nidhi Shah
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA.
| | - Chen Chen
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, 950 New Hampshire Ave NW, 5th Floor, Washington, DC 20052, USA.
| | - Nataly Montano
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA.
| | - David Cave
- University of Massachusetts, UMass Memorial Medical Center, University Campus, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Rebecca Siegel
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Medicine Education and Research Building (MERB), 3500 N. Broad Street, Philadelphia, PA 19140, USA.
| | - Alexander T Limkakeng
- Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Road, Box 3096, Durham, NC 27710, USA.
| | - Anita B Kumar
- The George Washington University School of Medicine and Health Sciences, Department of Medicine, Division of Gastroenterology, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA.
| | - Yan Ma
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, 950 New Hampshire Ave NW, 5th Floor, Washington, DC 20052, USA.
| | - Andrew C Meltzer
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA.
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McGoran JJ, McAlindon ME, Iyer PG, Seibel EJ, Haidry R, Lovat LB, Sami SS. Miniature gastrointestinal endoscopy: Now and the future. World J Gastroenterol 2019; 25:4051-4060. [PMID: 31435163 PMCID: PMC6700702 DOI: 10.3748/wjg.v25.i30.4051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term “Miniature GI Endoscopy”. In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.
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Affiliation(s)
- John J McGoran
- Digestive Diseases Centre, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Mark E McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States
| | - Eric J Seibel
- Department of Mechanical Engineering, University of Washington, 4000 Mason St, Seattle, WA 98195, United States
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Sarmed S Sami
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
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Jung K, Moon W. Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review. World J Gastrointest Endosc 2019; 11:68-83. [PMID: 30788026 PMCID: PMC6379746 DOI: 10.4253/wjge.v11.i2.68] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/02/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.
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Affiliation(s)
- Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
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11
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Alzoubaidi D, Lovat LB, Haidry R. Management of non-variceal upper gastrointestinal bleeding: where are we in 2018? Frontline Gastroenterol 2019; 10:35-42. [PMID: 30651955 PMCID: PMC6319149 DOI: 10.1136/flgastro-2017-100901] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
Acute upper gastrointestinal bleeding (AUGIB) is one of the most common medical emergencies in the UK. Despite advancement in technology the management of AUGIB remains a challenge. The clinical community recognise the need for improvement in the treatment of these patients. AUGIB has a significant impact on resources. Endoscopic therapy is the gold standard treatment. The mortality in AUGIB is rarely related to the presenting bleed but significantly associated with concurrent comorbidities. The cost of blood transfusion in the management of patients with AUGIB is significant and misuse of blood products has been documented nationally. Risk stratification tools such as Glasgow-Blatchford Score, Rockall Score and the AIMS65 score have allowed clinicians to triage patients appropriately in order to deliver endoscopic therapy within a suitable time frame. Endoscopic therapeutic modalities such as epinephrine injection, heat thermocoagulation and mechanical clips have had a positive impact on patient's management. However, in order to continue to improve patient's outcomes, further developments are needed.
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Affiliation(s)
- Durayd Alzoubaidi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London, London, UK
- GI Services, University College London Hospital, London, UK
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Lower Endoscopic Diagnostic Yields Observed in Non-hematemesis Gastrointestinal Bleeding Patients. Dig Dis Sci 2018; 63:3448-3456. [PMID: 30136044 DOI: 10.1007/s10620-018-5244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Location of bleeding can present a diagnostic challenge in patients without hematemesis more so than those with hematemesis. AIM To describe endoscopic diagnostic yields in both hematemesis and non-hematemesis gastrointestinal bleeding patient populations. METHODS A retrospective analysis on a cohort of 343 consecutively identified gastrointestinal bleeding patients admitted to a tertiary care center emergency department with hematemesis and non-hematemesis over a 12-month period. Data obtained included presenting symptoms, diagnostic lesions, procedure types with diagnostic yields, and hours to diagnosis. RESULTS The hematemesis group (n = 105) took on average 15.6 h to reach a diagnosis versus 30.0 h in the non-hematemesis group (n = 231), (p = 0.005). In the non-hematemesis group, the first procedure was diagnostic only 53% of the time versus 71% in the hematemesis group (p = 0.02). 25% of patients in the non-hematemesis group required multiple procedures versus 10% in the hematemesis group (p = 0.004). Diagnostic yield for a primary esophagogastroduodenoscopy was 71% for the hematemesis group versus 50% for the non-hematemesis group (p = 0.01). Primary colonoscopies were diagnostic in 54% of patients and 12.5% as a secondary procedure in the non-hematemesis group. A primary video capsule endoscopy yielded a diagnosis in 79% of non-hematemesis patients (n = 14) and had a 70% overall diagnostic rate (n = 33). CONCLUSION Non-hematemesis gastrointestinal bleeding patients undergo multiple non-diagnostic tests and have longer times to diagnosis and then compared those with hematemesis. The high yield of video capsule endoscopy in the non-hematemesis group suggests a role for this device in this context and warrants further investigation.
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Sung JJY, Chiu PCY, Chan FKL, Lau JYW, Goh KL, Ho LHY, Jung HY, Sollano JD, Gotoda T, Reddy N, Singh R, Sugano K, Wu KC, Wu CY, Bjorkman DJ, Jensen DM, Kuipers EJ, Lanas A. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut 2018; 67:1757-1768. [PMID: 29691276 PMCID: PMC6145289 DOI: 10.1136/gutjnl-2018-316276] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/14/2022]
Abstract
Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.
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Affiliation(s)
- Joseph JY Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Philip CY Chiu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Francis K L Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - James YW Lau
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Khean-lee Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
| | - Lawrence HY Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jose D Sollano
- UST Hospital, University of Santo Tomas, Manila, Philippines
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Nageshwar Reddy
- Asian Institute of Gastroenterology, Asian Healthcare Foundation, Hyderabad, India
| | - Rajvinder Singh
- Department of Medicine, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical School, Shimotsuke, Japan
| | - Kai-chun Wu
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Xi’an, China
| | | | | | | | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angel Lanas
- Department of Gastroenterology, University Hospital, Zaragoza, Spain
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14
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Yung DE, Koulaouzidis A, Douglas S, Plevris JN. Earlier use of capsule endoscopy in inpatients with melena or severe iron deficiency anemia reduces need for colonoscopy and shortens hospital stay. Endosc Int Open 2018; 6:E1075-E1084. [PMID: 30211295 PMCID: PMC6133651 DOI: 10.1055/a-0640-2956] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 03/07/2018] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Capsule endoscopy(CE) is a well-established investigation for iron deficiency anemia (IDA) and melena, usually following negative upper and lower endoscopy. We aimed to study the effect of earlier CE in the investigative pathway for inpatients with IDA or melena at a large tertiary referral centre. Patients and methods We analyzed inpatients undergoing CE for IDA or melena from 2005 to 2017, without signs/symptoms suggesting lower gastrointestinal tract pathology. Patients underwent CE following negative upper and lower gastrointestinal endoscopy (Group 1), or negative upper gastrointestinal endoscopy (UGIE) only (Group 2). Results One hundred and seventy inpatients underwent CE for IDA (n = 44) and melena (n = 126). In Group 1, 46/95 (48.4%) patients had small bowel (SB) findings. CE found 16/95 (16.8 %) gastric and 12/95 (12.6 %) colon findings. Three of 12 patients with colon findings required repeat colonoscopy. One hundred and three colon investigations were carried out for 95 admissions. In Group 2, 33/75 (44.0%) patients had SB findings. There were 12/75 (16.0 %) gastric and 11/75 (14.7 %) colon findings. In patients with positive CE, significant colonic findings led to colonoscopy in 10 of 39 patients (diagnostic yield 6/10). Thirty-six patients had negative CE; 15 underwent colonoscopy (diagnostic yield 9/15). The remaining 21 of 36 patients with no further colonoscopy did not develop adverse outcomes related to colonic pathology. Twenty-six colon investigations were carried out in 75 admissions. Patients in Group 2 had shorter mean times from admission to CE (5.08 ± 3.80 vs. 6.38 ± 3.80 days; P = 0.02) and hospital stays (10.5 ± 9.58 vs. 12.5 ± 11.4 days; P = 0.04) compared to Group 1. Conclusion Earlier use of CE in inpatients with melena or IDA, no signs of lower gastrointestinal pathology and negative UGIE resulted in shortened hospital stays, significant DY from both small bowel and upper gastrointestinal tract, and two-thirds less unnecessary colon investigations without affecting clinical outcomes.
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Affiliation(s)
- Diana E. Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom,Corresponding author Diana E. Yung, MBChB Endoscopy UnitThe Royal Infirmary of Edinburgh51 Little France CrescentEH16 4SA+07789588408
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Douglas
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - John N. Plevris
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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15
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Ching HL, Healy A, Thurston V, Hale MF, Sidhu R, McAlindon ME. Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience. World J Gastroenterol 2018; 24:2893-2901. [PMID: 30018484 PMCID: PMC6048428 DOI: 10.3748/wjg.v24.i26.2893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/19/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To test the feasibility and performance of a novel upper gastrointestinal (GI) capsule endoscope using a nurse-led protocol.
METHODS We conducted a prospective cohort analysis of patients who declined gastroscopy (oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water (containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was evaluated.
RESULTS Fifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved (graded 1-5: Poor to excellent): Oesophagus, 4.8 (± 0.5); gastro-oesophageal junction (GOJ), 4.8 (± 0.8); cardia, 4.8 (± 0.8); fundus, 3.8 (± 1.2); body, 4.5 (± 1); antrum, 4.5 (± 1); pylorus, 4.7 (± 0.8); duodenal bulb, 4.7 (± 0.7); second part of the duodenum (D2), 4.7 (± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview (P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule.
CONCLUSION The upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.
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Affiliation(s)
- Hey-Long Ching
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Ailish Healy
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Victoria Thurston
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Melissa F Hale
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Mark E McAlindon
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
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16
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Redondo-Cerezo E, Sánchez-Capilla AD, De La Torre-Rubio P, De Teresa J. Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding. World J Gastroenterol 2014; 20:15664-15673. [PMID: 25400450 PMCID: PMC4229531 DOI: 10.3748/wjg.v20.i42.15664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/09/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.
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17
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Meltzer AC, Ward MJ, Gralnek IM, Pines JM. The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED. Am J Emerg Med 2014; 32:823-32. [PMID: 24961149 PMCID: PMC4108573 DOI: 10.1016/j.ajem.2013.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVE Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low- to moderate-risk ED patients with acute upper GI hemorrhage. METHODS We constructed a model using standard decision analysis software to examine the cost-effectiveness of 4 available strategies for a base-case patient who presents to the ED with either mild- or moderate-risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (ie, endoscopic, surgical, etc) The 4 available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED; (2) risk stratification using the Glasgow-Blatchford score; (3) nasogastric tube placement; and, finally, (4) an admit-all strategy. RESULTS In the low-risk scenario, video capsule endoscopy was the preferred strategy (cost $5691, 14.69 quality-adjusted life years [QALYs]) and was more cost-effective than the remaining strategies including nasogastric tube strategy (cost $8159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs), and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate-risk scenario, video capsule endoscopy continued to be the preferred strategy (cost $9190, 14.56 QALYs) compared to nasogastric tube (cost $9487, 14.58 QALYs, incremental cost-effectiveness ratio $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.) CONCLUSION Video capsule endoscopy may be cost-effective for low- and moderate-risk patients presenting to the ED with acute upper GI hemorrhage.
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Affiliation(s)
- Andrew C Meltzer
- Department of Emergency Medicine, George Washington University, Washington, DC, USA.
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA
| | - Ian M Gralnek
- Bruce and Ruth Rappaport Faculty Of Medicine, Technion-Israel Institute Of Technology, GI Outcomes Unit, Department Of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Jesse M Pines
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
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18
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Abstract
Acute gastrointestinal (GI) bleeding is a common cause of hospitalization, resulting in about 400,000 hospital admissions annually, with a mortality rate of 5-10%. It is estimated that 5% of acute GI bleedings are of obscure origin with a normal esophagogastroduodenoscopy and ileocolonoscopy. Capsule endoscopy is the state-of-the-art procedure for inspection of the entire small bowel with a high sensitivity for the detection of causes of bleeding. In recent years, many studies have addressed the sensitivity and outcome of capsule-endoscopy procedures in patients with acute GI bleeding. This review looks at the role of capsule endoscopy in the evaluation of patients with acute GI bleeding from either the upper GI tract or small bowel.
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Affiliation(s)
- Moshe Nadler
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, 5265601, Israel
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19
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Lai C, Zhou HC, Ma M, Zhang HX, Jia X. Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohn's disease. Exp Ther Med 2013; 6:115-120. [PMID: 23935731 PMCID: PMC3735909 DOI: 10.3892/etm.2013.1113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/22/2013] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn's disease. A total of 55 cases of small bowel Crohn's disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn's disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn's disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.
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Affiliation(s)
- Can Lai
- Departments of Radiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
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