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Thwaites PA, Yao CK, Halmos EP, Muir JG, Burgell RE, Berean KJ, Kalantar‐zadeh K, Gibson PR. Review article: Current status and future directions of ingestible electronic devices in gastroenterology. Aliment Pharmacol Ther 2024; 59:459-474. [PMID: 38168738 PMCID: PMC10952964 DOI: 10.1111/apt.17844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices. AIM To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract. METHODS We performed a detailed literature search to inform this narrative review. RESULTS Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment. CONCLUSIONS The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.
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Affiliation(s)
- Phoebe A. Thwaites
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Chu K. Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Emma P. Halmos
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Jane G. Muir
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Rebecca E. Burgell
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Kyle J. Berean
- Atmo BiosciencesMelbourneVictoriaAustralia
- School of Engineering, RMIT UniversityMelbourneVictoriaAustralia
| | - Kourosh Kalantar‐zadeh
- Faculty of Engineering, School of Chemical and Biomolecular EngineeringThe University of SydneyCamperdownNew South WalesAustralia
| | - Peter R. Gibson
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
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Arzivian A, Wiseman E, Ko Y. Capsule endoscopy retention in the upper esophagus: A comprehensive literature review. Medicine (Baltimore) 2023; 102:e35113. [PMID: 37682178 PMCID: PMC10489204 DOI: 10.1097/md.0000000000035113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Capsule endoscopy is the first-line investigation for small bowel disorders. Capsule retention in the small bowel is the most common adverse event. Retention has also been reported in the upper esophagus; however, guidance for diagnosis and management is lacking. This review aims to summarize the diagnostic workup and management of this complication. We conducted a systematic literature review by searching 5 databases; relevant keywords and MeSH terms were used. Exclusion criteria included publications of non-adult patients in non-English languages. Data from eligible studies were analyzed using IBM SPSS 29. Twelve case reports were found (9 males, median age of 76 years); 10 capsule retentions in Zenker's diverticulum and 2 in the cricopharyngeus. Most patients were asymptomatic before capsule endoscopy. Capsule retention was symptomatic in half of the patients (6/12). A neck X-ray confirmed the diagnosis in all patients. Endoscopic capsule retrieval was achieved by different tools (9/12) (Roth's net was the most used tool, 6 patients); retrieval required rigid endoscopy in a few cases (3/12). Endoscopic capsule re-insertion was successful; using an overtube to bypass the upper esophagus was the safest method. In conclusion, capsule retention in the upper esophagus is uncommon yet exposes patients to the risk of unnecessary procedures. Symptoms of swallowing and medium-to-large size Zenker's diverticulum should be considered contra-indications for capsule endoscopy. Neck and chest X-rays are required for elderly patients who do not pass the capsule 2 weeks after ingestion. Endoscopic retrieval using Roth's net and re-insertion through an overtube should be considered first-line management.
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Affiliation(s)
- Arteen Arzivian
- Endoscopy Unit, Macquarie University Hospital, Macquarie Park, NSW
| | - Elke Wiseman
- Endoscopy Unit, Macquarie University Hospital, Macquarie Park, NSW
| | - Yanna Ko
- Endoscopy Unit, Macquarie University Hospital, Macquarie Park, NSW
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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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Grounds GS, Dent H, Nunes C, Dhar V. Tubeless field anaesthesia for surgical removal of an aspirated endoscopy capsule. Anaesth Rep 2023; 11:e12242. [PMID: 37588044 PMCID: PMC10425334 DOI: 10.1002/anr3.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Capsule endoscopy is a safe, minimally invasive procedure used to investigate gastrointestinal bleeding of unknown origin that persists or recurs after a negative initial endoscopy. The most common adverse effects of capsule endoscopy include abdominal pain, nausea and vomiting. Capsule pulmonary aspiration, although a rare complication, has been reported in the literature. Most reported cases resolve without further medical intervention. In these cases, the capsule is either expelled by coughing, or it re-enters the oropharynx and is then swallowed. In a small number of cases, the capsule remains in the lung, unable to be expectorated. This requires prompt diagnosis and emergency bronchoscopic removal under general anaesthesia. Due to the smooth, rounded surfaces of the capsule, it may be difficult to grasp, and consequently extraction may be technically challenging. The existing literature contains limited documentation on anaesthetic and surgical approaches for managing an aspirated endoscopy capsule. In this case report, we present the management of an aspirated endoscopy capsule in a district general hospital, in which thoracic surgery was not available. Local resources were used to manage this potentially life-threatening complication without patient transfer. In our case, we provided a tubeless field to optimise surgical access. This facilitated the successful surgical extraction of the endoscopy capsule from the left main bronchus.
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Affiliation(s)
- G. S. Grounds
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - H. Dent
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - C. Nunes
- Department of GastroenterologyKent and Canterbury HospitalCanterburyKentUK
| | - V. Dhar
- Department of Ear, Nose and Throat SurgeryWilliam Harvey HospitalAshfordKentUK
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Tai FWD, Healy A, Thokala P, Chetcuti Zammit S, Sidhu R, McAlindon M. Cost comparison of oral, transnasal and magnet assisted capsule endoscopy in the examination of the upper gastrointestinal tract in patients with dyspepsia. Frontline Gastroenterol 2022; 14:300-305. [PMID: 37409341 PMCID: PMC11138180 DOI: 10.1136/flgastro-2022-102256] [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: 06/27/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Conventional oral upper gastrointestinal (GI) endoscopy can obe uncomfortable. By comparison, transnasal endoscopy (TNE) and magnet assisted capsule endoscopy (MACE) have superior tolerability. A cost comparison of competing upper GI endoscopic modalities have yet to be performed. Methods We performed a cost comparison study of oral, TNE and MACE by a combination of activity-based costing and averaging of fixed costs over 24 481 upper GI endoscopies performed for dyspepsia over a 10-year period. Results On average, 9.4 procedures were performed daily. TNE was cheapest at €125.90 per procedure, costing 30% less than oral endoscopy at €184.10 and threefold cheaper than MACE at €407.10. Flexible endoscope reprocessing cost €53.80. TNE was cheaper than oral endoscopy as sedation was not required. Oral endoscopies have a further rate of infectious complications, estimated to cost €16.20 per oral procedure in inpatient admissions. Oral and TNE equipment are more expensive to purchase and maintain than MACE costing €79 330 and €81 819, respectively compared with MACE at €15 420 per annum. However, capsule endoscopes cost significantly more per procedure at €369.00 than the consumables for flexible endoscopy (per oral €12.30, TNE €5.30). Conclusions TNE cost less to perform than conventional per oral endoscopy. The cost of capsule endoscopes will need to be reduced significantly if routine use is to be expected.
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Affiliation(s)
- Foong Way David Tai
- Academic Unit of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Ailish Healy
- Academic Unit of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Praveen Thokala
- Health Economics and Decision Science, The University of Sheffield School of Health and Related Research, Sheffield, UK
| | | | - Reena Sidhu
- Academic Unit of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Mark McAlindon
- Academic Unit of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK
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Tai FWD, Ching HL, Sloan M, Sidhu R, McAlindon M. Comparison of patient tolerance and acceptability of magnet-controlled capsule endoscopy and flexible endoscopy in the investigation of dyspepsia. Endosc Int Open 2022; 10:E735-E744. [PMID: 35692932 PMCID: PMC9187367 DOI: 10.1055/a-1790-5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Oropharyngeal intubation during Esophagogastroduodenoscopy (EGD) is uncomfortable, associated with aerosol generation and transmission of airborne microbes. Less-invasive alternatives may be better tolerated. In this study, patient tolerance and acceptability of EGD and transnasal endoscopy (TNE) have been compared with magnet-controlled capsule endoscopy (MACE). Patients and methods A comparison of MACE with EGD and TNE in the investigation of dyspepsia was performed. Factors affecting patient tolerance and acceptability were examined using the Endoscopy Concerns Scale (ECS) and Universal Patient Centeredness Questionnaire (UPC-Q). Results Patients were significantly more distressed (scoring least to most distress: 1-10) by gagging (6 vs 1), choking (5 vs 1), bloating (2 vs 1), instrumentation (4 vs 1), discomfort during (5 vs 1) and after (2 vs 1) EGD compared to MACE (all P < 0.0001). Patients were more distressed by instrumentation (5 vs 1) and discomfort during (5 vs 1) TNE compared to MACE ( P = 0.001). Patients were more accepting of MACE than EGD and TNE with a UPC-Q score (scoring least to most acceptable: 0-100) lower for EGD (50 vs 98, P < 0.0001) and TNE (75 vs 88, P = 0.007) than MACE, and a post-procedure ECS score (scoring most to least acceptable: 10-100) higher for EGD (34 vs 11, P < 0.0001) and TNE (25 vs 10.5, P = 0.001) than MACE. MACE would be preferred by 83 % and 64 % of patients even if EGD or TNE respectively was subsequently recommended to obtain biopsies in half of examinations. Conclusions Gagging and choking during instrumentation, the main causes of patient distress during EGD, occurred less during TNE but tolerance, acceptability and patient experience favored MACE.
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Affiliation(s)
- Foong Way David Tai
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Hey Long Ching
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Mark McAlindon
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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McCracken M, Pathak S, Heyman MB. Aspiration of a Video Capsule Placed Endoscopically Into the Duodenum Under General Anesthesia. JPGN REPORTS 2022; 3:e157. [PMID: 37168743 PMCID: PMC10158304 DOI: 10.1097/pg9.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/04/2021] [Indexed: 05/13/2023]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Marjorie McCracken
- From the Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Sagar Pathak
- From the Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Melvin B. Heyman
- From the Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, CA
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8
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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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Ji H, Wang S, Gong Y. A Descriptive Analysis of Capsule Endoscopy Events in the FDA Manufacturer and User Facility Device Experience (MAUDE) Database. JOURNAL OF DIGESTIVE ENDOSCOPY 2021; 12:71-77. [PMID: 38770130 PMCID: PMC11104222 DOI: 10.1055/s-0041-1731960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction The malfunction of capsule endoscopy (CE) devices is a significant reason for the failure of CE procedures, which could hinder and prevent diagnosis. Unfortunately, malfunction-related adverse events (AEs) caused by CE devices are rarely reported in publications. Although most malfunction-related AEs could not lead to physical harm, they could reduce the efficiency of medical care and increase medical costs. The manufacturer and user facility device experience (MAUDE) database, a publicly accessible resource for patient safety, contains not only the common complications of CE but also valuable malfunction-related AEs, which have been underutilized. Therefore, the study aims to discover and analyze the possible AEs associated with CE and demonstrate the utility of the MAUDE reports to promote patient safety. Materials and Methods We acquired MAUDE reports of CE systems from January 01, 2008, to July 31, 2020, through a systematic search strategy. We utilized the manufacturers, brand names, and product codes as search terms from which medical device reports including structured data and narrative texts were extracted, followed by a manual review of the narrative texts, reporter occupation, device involved, event type and the phase of the event; finally, patient outcomes were recorded and analyzed as per CE categories and characteristics. Results A total of 377 CEs medical device reports were retrieved, and 342 reports were included after reviewing. There were 327 mandatory reports (96%) and 15 voluntary reports (4%). These reports referred to capsule endoscope (n = 213), sensing system (n = 66), patency capsule (n = 38), and capsule delivery device (n = 26). A total of 349 CE-related AEs were identified, including complications (n = 228), malfunction-related AEs (n = 109), and other events (n = 12). The composition of AEs was not the same for the CE devices. Complications were major AEs of capsule endoscope and patency capsule, but malfunction-related AEs were the most common in AEs of sensing systems and capsule delivery devices. Conclusion MAUDE serves as an invaluable data source for investigating malfunction-related AEs. In addition to common complications, malfunction of CE devices could threaten patient safety in CE procedures. Improving awareness of the malfunction of CE devices and raising adequate training for staff working in gastrointestinal (GI) endoscopic units could be critical and beneficial in preventing malfunction-related AEs.
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Affiliation(s)
- Hangyu Ji
- China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, People’s Republic of China
| | - Shaoli Wang
- China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, People’s Republic of China
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Texas, United States
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TeleInGEstion Remote Video Capsule Endoscope. ACG Case Rep J 2021; 8:e00609. [PMID: 34079843 PMCID: PMC8162572 DOI: 10.14309/crj.0000000000000609] [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: 10/07/2020] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
We describe 2 cases in which video capsule endoscopy was performed remotely using TeleInGEstion Remote Video Capsule Endoscopy (TIGER VCE), given limited access to endoscopy during the COVID-19 pandemic. The patients ingested the CapsoCam capsule during a televisit, and the video was subsequently reviewed remotely by the physician. TIGER VCE was used to diagnose a benign etiology of melena and used to confirm a diagnosis of Crohn's disease before the initiation of biologic therapy. These cases demonstrate the safety and efficacy of TIGER VCE. We feel that this technique may be considered as a standard ingestion technique in the future.
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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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Koulaouzidis A, Marlicz W, Wenzek H, Koulaouzidis G, Eliakim R, Toth E. Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine. Dig Liver Dis 2020; 52:1099-1101. [PMID: 32571667 PMCID: PMC7304960 DOI: 10.1016/j.dld.2020.05.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Anastasios Koulaouzidis
- The Royal Infirmary of Edinburgh, NHS Lothian, Scotland, United Kingdom,Corresponding author
| | | | | | | | - Rami Eliakim
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Ervin Toth
- Skåne University Hospital, Lund University, Malmö, Sweden
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Costache RS, Lulache AI, Jinga M, Vlăduț C, Costache DO, Radu FI. Use of prokinetics and other quality factors in capsule endoscopy - old and new insights (Review). Exp Ther Med 2020; 20:2484-2488. [PMID: 32765739 PMCID: PMC7401576 DOI: 10.3892/etm.2020.8960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Despite the extensive recent development of different techniques for endoscopic evaluation for both diagnostic and therapeutic reasons, the small bowel remains quite difficult to visualize. Capsule endoscopy and device assisted enteroscopy are presently considered the best diagnostic tools for examination of small bowel disorders, assessing diverse pathologies such as obscure gastrointestinal bleeding, iron deficiency anemia, Crohn disease, small bowel tumors and polyposis syndromes. Like any other imagistic method, it has specific indications, and contraindications, and possibly it is more important to consider limitations. In order to obtain a better result, it is necessary to respect the procedural quality indicators. Among them the use of prokinetics - diverse pharmacological substances increasing the success rate of capsule endoscopy have raised debates. Capsule endoscopy small bowel evaluation is a reliable, non-invasive and safe with many advantages and minimum risks, with a proper selection of patients, and can be used as first line investigation.
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Affiliation(s)
- Raluca Simona Costache
- Department of Gastroenterology, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Internal Medicine and Gastroenterology Discipline, ‘Carol Davila’ Central Military Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandra Ioana Lulache
- Department of Gastroenterology, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mariana Jinga
- Department of Gastroenterology, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Internal Medicine and Gastroenterology Discipline, ‘Carol Davila’ Central Military Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cătălina Vlăduț
- Department of Gastroenterology, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Daniel Octavian Costache
- Department of Research, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florentina Ioniță Radu
- Department of Gastroenterology, ‘Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, ‘Titu Maiorescu’ University, 004051 Bucharest, Romania
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Pennazio M, Rondonotti E, Pellicano R, Cortegoso Valdivia P. Small bowel capsule endoscopy: where do we stand after 20 years of clinical use? Minerva Gastroenterol (Torino) 2020; 67:101-108. [PMID: 32677419 DOI: 10.23736/s2724-5985.20.02745-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Small bowel capsule endoscopy (SBCE) was introduced into clinical practice almost 20 years ago and, nowadays, it is an essential tool for the study of the small bowel. SBCE allows a radiation-free examination of the entire mucosal surface of the small bowel with high-quality images, limited invasivity and a good safety profile. Nevertheless, the main limitation of SBCE is the lack of any possible direct therapeutic intervention. Indications for SBCE have evolved throughout the years, from "old" ones such as suspected small bowel bleeding (still the main indication for SBCE) to newer ones such as refractory celiac disease, hereditary polyposis syndromes and Crohn's disease. Thus, nowadays SBCE has a key role in the diagnostic algorithms in many conditions. Furthermore, the introduction in the SBCE field of cutting-edge technologies, as artificial intelligence systems, is likely to shorten the reading time making SBCE even more effective and easy to perform. Preliminary data are extremely promising and solid evidence is being gathered by current studies.
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | | | - Rinaldo Pellicano
- University Division of Gastroenterology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
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Mitselos IV, Katsanos K, Tsianos EV, Eliakim R, Christodoulou D. Clinical Use of Patency Capsule: A Comprehensive Review of the Literature. Inflamm Bowel Dis 2018; 24:2339-2347. [PMID: 29718225 DOI: 10.1093/ibd/izy152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Indexed: 12/13/2022]
Abstract
The patency capsule is a radiopaque, dissolvable diagnostic tool, similar in shape and size to small bowel capsule endoscopes. It was developed to offer a simple, safe, efficient, and accurate evaluation of small bowel functional patency. Although unable to provide direct visual information regarding the presence and location of strictures, masses, or luminal narrowing of the small bowel, a successful patency test minimizes the risk of retention and allows the safe administration of a capsule endoscope. However, its use entails a low risk of potentially harmful adverse events, which in their majority are indolent and resolve spontaneously. Abdominal pain and symptomatic retention are accountable for the majority of reported adverse events, whereas a limited number of reports describe life-threatening complications, namely intestinal obstruction, perforation, and intestinal ischemia. Computed tomography is the modality of choice for the identification of the exact position of an impacted patency capsule, whilst the use of plain abdominal radiographs should be avoided for the evaluation of the patency capsule position, as they provide false information. Hereby, we present a comprehensive review of the available literature regarding the characteristics, indications, clinical use, effectiveness, and adverse events of the patency capsule.10.1093/ibd/izy152_video1izy152.video15777752348001.
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Affiliation(s)
- Ioannis V Mitselos
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos Katsanos
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Epameinondas V Tsianos
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Rami Eliakim
- †Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dimitrios Christodoulou
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Skouras T, Sawbridge D, Steel A, Collins P. Aspiration of a small bowel video capsule: a rare complication. BMJ Case Rep 2018; 2018:bcr-2018-224538. [DOI: 10.1136/bcr-2018-224538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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