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Pezzoli A, Guarino M, Fusetti N, Pizzo E, Simoni M, Simone L, Cifalà V, Solimando R, Perna B, Testino G, Pellicano R, Caio G, Lungaro L, Caputo F, Zoli G, Merighi A, DE Giorgio R. Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study. Minerva Gastroenterol (Torino) 2023; 69:388-395. [PMID: 35708039 DOI: 10.23736/s2724-5985.22.03220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy (CE) in patients aged over 80 years. METHODS In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected. RESULTS Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (P<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. CONCLUSIONS Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.
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Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Nadia Fusetti
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Elena Pizzo
- Department of Applied Health Research, University College of London, London, UK
| | - Marzia Simoni
- Epidemiological Unit of CNR Institute of Clinical Physiology, Pisa, Italy
| | - Loredana Simone
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Viviana Cifalà
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Riccardo Solimando
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Regional Centre on Alcohol, ASL3 San Martino Hospital, Genoa, Italy
| | | | - Giacomo Caio
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Lisa Lungaro
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alberto Merighi
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Roberto DE Giorgio
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
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Thurm T, Gluck N, Barak O, Deutsch L. Octa-nonagenarians can perform video capsule endoscopy safely and with a higher diagnostic yield than 65-79-year-old patients. J Am Geriatr Soc 2022; 70:2958-2966. [PMID: 35788980 PMCID: PMC9796662 DOI: 10.1111/jgs.17953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Video capsule endoscopy (VCE) is an effective, noninvasive modality for small bowel (SB) investigation. Its usage in the older adults is rising. However, data in octa-nonagenarians regarding diagnostic yield and motility are lacking. Our aim was to evaluate and compare safety and efficacy of VCE between age subgroups of older adult patients. METHODS This was a retrospective study of prospectively documented data. All consecutive VCEs of patients ≥65 years (01/2010-12/2017) were included. Patients unable to swallow the capsule or videos with significant recording technical malfunction were excluded. The cohort was divided into the younger group aged 65-79 years old and octa-nonagenarians aged ≥80 years old. Indications for referral, diagnostic yield and transit times were compared between groups. RESULTS A total of 535 VCEs were performed in 499 older adult patients (51.2% males); 82.8% were 65-79 years old and 17.2% were ≥80 years old. The ≥80-year-old group had higher rates of clinically significant findings (52.7% vs. 40.0%, p = 0.025), active bleeding (12.5% vs. 6.5%, p = 0.053) and angioectasia (36.0% vs. 23.4%, p = 0.014). Crohn's disease was newly diagnosed in approximately 8% of the entire cohort and 12% of the ≥80 years old. Anemia was the most common indication in both groups, followed by overt bleeding in the ≥80-year-old group (25% vs. 9.9% in 65-79-year-old group, p < 0.001) and Crohn's disease in the 65-79 years old (17.2% vs. 5.4% in ≥80 years old, p = 0.004). Groups were comparable in transit time and cecal documentation rates. CONCLUSIONS In octa-nonagenarians, VCE is as safe as in younger older-adults with a higher diagnostic yield of significant and treatable conditions.
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Affiliation(s)
- Tamar Thurm
- Department of Gastroenterology and Liver DiseasesTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael,Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Nathan Gluck
- Department of Gastroenterology and Liver DiseasesTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael,Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Orly Barak
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael,Geriatric DivisionTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael
| | - Liat Deutsch
- Department of Gastroenterology and Liver DiseasesTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael,Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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Small Bowel Malignancies in Patients Undergoing Capsule Endoscopy for Iron Deficiency Anemia. Diagnostics (Basel) 2021; 12:diagnostics12010091. [PMID: 35054257 PMCID: PMC8774472 DOI: 10.3390/diagnostics12010091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Small bowel malignancies are rare and usually asymptomatic or symptoms are nonspecific. Therefore, small bowel tumors are difficult to diagnose. In patients with iron deficiency anemia (IDA) who have negative bidirectional endoscopy results, the small bowel may be considered the source of bleeding. However, in asymptomatic IDA patients with negative bidirectional endoscopy results, evidence supporting the routine use of capsule endoscopy (CE) is insufficient. CE can be considered in selected patients with recurrent or persistent IDA. The frequency of small bowel malignancies is low in patients undergoing CE for IDA, but the usefulness of CE for the diagnosis of small bowel malignancies in younger age groups with IDA has been reported. For patients with risk factors for small bowel malignancy, investigation of the small bowel should be considered. Efforts should be made to prevent adverse events, such as capsule retention or capsule aspiration, through meticulous history taking and endoscopic capsule delivery as necessary.
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Wang YC, Pan J, Liu YW, Sun FY, Qian YY, Jiang X, Zou WB, Xia J, Jiang B, Ru N, Zhu JH, Linghu EQ, Li ZS, Liao Z. Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis. BMC Gastroenterol 2020; 20:364. [PMID: 33138792 PMCID: PMC7607645 DOI: 10.1186/s12876-020-01491-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. METHODS Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. RESULTS In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI] 0.59-0.89%), 0.75% (95% CI 0.43-1.13%), 0.00% (95% CI 0.00-0.00%), 0.94% (95% CI 0.65-1.28%), 0.67% (95% CI 0.32-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (- 0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time (P = .0006 and P < .0001).. CONCLUSIONS VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).
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Affiliation(s)
- Yuan-Chen Wang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jun Pan
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Ya-Wei Liu
- Department of Gastroenterology, The First Medical Center of PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Feng-Yuan Sun
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Yang-Yang Qian
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Xi Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Wen-Bin Zou
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Ji Xia
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Bin Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Nan Ru
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jia-Hui Zhu
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - En-Qiang Linghu
- Department of Gastroenterology, The First Medical Center of PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Zhao-Shen Li
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Zhuan Liao
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
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Indications for and diagnostic yield of capsule endoscopy in the elderly. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.08.009] [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: 11/18/2022] Open
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Pérez-Cuadrado-Robles E, Zamora-Nava LE, Jiménez-García VA, Pérez-Cuadrado-Martínez E. Indications for and diagnostic yield of capsule endoscopy in the elderly. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:238-244. [PMID: 29456092 DOI: 10.1016/j.rgmx.2017.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.
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Affiliation(s)
| | - L E Zamora-Nava
- Departamento de Endoscopia, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Joosten E. Iron deficiency anemia in older adults: A review. Geriatr Gerontol Int 2017; 18:373-379. [PMID: 29094497 DOI: 10.1111/ggi.13194] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/24/2022]
Abstract
Anemia in older adults is a risk factor for numerous negative outcomes. There is no standard definition, but in most studies, anemia is defined as a hemoglobin value <12 g/dL for women and <13 g/dL for men. Absolute iron deficiency anemia is defined as the combination of anemia and the absence of total body iron. Serum ferritin is the most frequently used diagnostic parameter, but its concentration increases with age and in the presence of inflammatory diseases. Other laboratory tests, such as transferrin saturation, soluble transferrin receptor and the soluble transferrin receptor/ferritin index might provide useful information, but there is a wide variety in the cut-off values and interpretation of the results. Recent research regarding hepcidin as a central regulator of iron homeostasis is promising, but it has not been used yet for the routine diagnosis of iron deficiency anemia. In older iron deficiency anemia patients, an esophagogastroduodenoscopy and colonoscopy should be initiated in order to identify the underlying bleeding cause. CT colonography can replace a colonoscopy, and in specific cases, a video capsule is recommended. It remains crucial to keep in mind which potential benefits might be expected from these investigations in this vulnerable population, taking into account the comorbidity and life expectancy, and one should discuss in advance the possible therapeutic options and complications with the patient, a family member or a proxy. Oral iron administration is the standard treatment, but parenteral iron is a convenient and safe way to provide the total iron dose in one or a few sessions. Geriatr Gerontol Int 2018; 18: 373-379.
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Affiliation(s)
- Etienne Joosten
- Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Nennstiel S, Machanek A, von Delius S, Neu B, Haller B, Abdelhafez M, Schmid RM, Schlag C. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United European Gastroenterol J 2017; 5:1129-1135. [PMID: 29238592 DOI: 10.1177/2050640617704366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/12/2017] [Indexed: 12/13/2022] Open
Abstract
Background In obscure gastrointestinal bleeding, angioectasias are common findings in video capsule endoscopy (VCE). Objective The objective of this study was to identify predictors and characteristics of small bowel angioectasias. Methods Video capsule examinations between 1 July 2001 and 31 July 2011 were retrospectively reviewed. Patients with obscure gastrointestinal bleeding were identified, and those with small bowel angioectasia were compared with patients without a definite bleeding source. Univariate and multivariable statistical analyses for possible predictors of small bowel angioectasia were performed. Results From a total of 717 video capsule examinations, 512 patients with obscure gastrointestinal bleeding were identified. Positive findings were reported in 350 patients (68.4%) and angioectasias were documented in 153 of these patients (43.7%). These angioectasias were mostly located in the proximal small intestine (n = 86, 56.6%). Patients' age >65 years (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.36-3.38, p = .001) and overt bleeding type (OR 1.89, 95% CI 1.22-2.94, p = .004) were identified as significant independent predictors of small bowel angioectasia. Conclusion Angioectasias are the most common finding in VCE in patients with obscure gastrointestinal bleeding. They are mostly located in the proximal small bowel and are associated with higher age and an overt bleeding type.
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Affiliation(s)
- Simon Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Annkathrin Machanek
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stefan von Delius
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bruno Neu
- Medizinische Klinik II, Krankenhaus Landshut-Achdorf, Academic Teaching Hospital, Technische Universität München, Landshut, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Christoph Schlag
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Girelli CM, Soncini M, Rondonotti E. Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding. World J Gastroenterol 2017; 23:697-702. [PMID: 28216977 PMCID: PMC5292344 DOI: 10.3748/wjg.v23.i4.697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.
METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.
RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).
CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
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The role of capsule endoscopy in the diagnosis and treatment of obscure gastrointestinal bleeding in older individuals. Eur J Gastroenterol Hepatol 2016; 28:1425-1430. [PMID: 27603298 DOI: 10.1097/meg.0000000000000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Capsule endoscopy (CE) is currently recommended as the first-line diagnostic modality for the investigation of obscure gastrointestinal bleeding (OGIB). This study aimed to evaluate the diagnostic efficacy of CE and to determine the subsequent impacts on the treatment of the OGIB episode in older individuals. METHODS Eight hundred and fifty-three patients who underwent CE for the indication of OGIB were investigated in a single center between January 2004 and December 2015. Patients were divided into two groups: those 65 years of age and older and those younger than 65 years of age. RESULTS There were no significant differences between older patients and younger patients with respect to the CE completion rate. The diagnostic yield was significantly higher in older patients than in younger patients (55.1 vs. 46.6%, P=0.021). Vascular lesions were the main cause of bleeding in the elderly, whereas ulcerated/erosive lesions were found most frequently in younger patients. Furthermore, 56.0% of older patients with positive CE results had relevant changes in their management plans and received specific treatment on the basis of CE findings. CONCLUSION Our study confirmed the important role of CE in the diagnosis of OGIB and its huge impact on decision making in the management plan for older patients.
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Mustafa BF, Samaan M, Langmead L, Khasraw M. Small bowel video capsule endoscopy: an overview. Expert Rev Gastroenterol Hepatol 2013; 7:323-9. [PMID: 23639090 DOI: 10.1586/egh.13.20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Video capsule endoscopy (VCE) is being increasingly used to investigate small bowel pathology. It is the gold standard for obscure gastrointestinal bleeding and iron deficiency anemia. VCE has been in use since 2001 and indications for its use are expanding. VCE is also a useful diagnostic tool in small bowel Crohn's disease, celiac disease, surveillance of polyps, small bowel malignancy and drug-induced small bowel injury. Although VCE is considered a safe and easy procedure, there are a few limitations. These include cost, capsule retention and inability to take a biopsy and perform any therapeutic maneuvers. Contraindications for VCE include pregnancy, patients with a swallowing disorder, history of previous abdominal surgery or concurrent abdomino-pelvic irradiation. This is an overview of VCE, its role and indications in clinical practice, potential complications and contraindications, as well as the ongoing and expected advances in the field.
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Abstract
Now, more than 10 years after the approval of video capsule endoscopy (VCE), the technology has become an essential component in the management of several clinical conditions. Currently, two capsules are approved in the USA for visualizing the small bowel mucosa, one capsule is authorized for oesophageal assessment and several others are in use or under evaluation worldwide. New investigations have focused on optical improvements, advances in intestinal cleansing and risk reduction strategies to optimize VCE methodologies in clinical care. Established indications diagnosed using VCE include unexplained gastrointestinal bleeding, small bowel Crohn's disease (in adults and children >10 years old), localization of small bowel tumours and a broad range of miscellaneous abnormalities. Investigations are ongoing to determine the utility of VCE in colon cancer screening, assessment of oesophageal disorders and diagnosis of coeliac disease. Active research is in progress into ways to improve the efficacy of VCE recording interpretation, prolong imaging time and further enhance optics and imaging methods. To expand the potential utility of VCE, novel devices that can manoeuvre within or insufflate the gut lumen, tag or biopsy suspect lesions, or target drug delivery to specific sites are in development. To facilitate these advances, consortia have been organized to promote innovative VCE technologies.
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