Análisis histórico de la experiencia en cápsula endoscópica de intestino delgado en un hospital terciario español

Introduction

Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004.

Utilidad clínica de la videocápsula endoscópica en el estudio de patologías de intestino delgado en Colombia: resultados de un registro nacional

IntroductionThe small bowel capsule endoscopy (SBCE) has revolutionised the study of small bowel diseases. The objective of this study is to determine the indications, findings and diagnostic yield of SBCE in a national registry.Patients and methodsAn observational, analytical cross-sectional study was carried out, analysing the SBCE records at seven centres in the country, where different variables were collected.Results1,883 SBCEs were evaluated. The average age was 55.4 years (5.6-94.2). The most frequent indications were suspicion of small bowel bleeding (SBB) (64.4%), study of Crohn's disease (15.2%) and chronic diarrhoea (11.2%). 54.3% were prepared with laxatives. The most frequent lesions found were erosions/ulcers (31.6%), angioectasias (25.7%) and parasitosis (2.7%). The diagnostic yield (P1 + P2, Saurin classification) of SBCE in SBB was 60.6%, being higher in overt SBB (66.0%) compared to occult SBB (56.0%) (P = .003). The studies with better preparation showed higher detection of lesions (93.8% vs. 89.4%) (OR = 1.8, CI: 95%: 1.2-2.6; P = .004). The SBCE complication rate was 3.1%, with complete SB visualisation at 96.6% and SB retention rate of 0.7%. 81.5% of SBCEs were performed on an outpatient basis, and presented a greater complete SB visualisation than hospital ones (97.1% vs. 94.3%) (OR = 2.1, CI: 95%, 1.2-3.5; P = .008).ConclusionsThe indications, findings and diagnostic performance of SBCEs in Colombia are similar to those reported in the literature, with a high percentage of complete studies and a low rate of complications.     

Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano

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.

Pillcam SB3 vs. Pillcam SB2: ¿pueden los avances tecnológicos de la cápsula endoscópica mejorar el rendimiento diagnóstico en pacientes con hemorragia de intestino delgado?

Introduction and objectiveThe SB3 capsule endoscopy system has better image resolution and the capacity to increase the number of images from 2 to 6 frames per second. Small bowel bleeding is the most common indication. The aim To determine if the advances in capsule endoscopy technology increase diagnostic yield in cases of small bowel bleeding, according to the Saurin classification.Material and methodsA retrospective, observational, analytic, cross-sectional study included 100 SB2 capsule endoscopies and 100 SB3 capsule endoscopies in patients that presented with small bowel bleeding. The findings obtained with both systems were evaluated. The lesions identified by the two capsules were categorized using the Saurin classification. The relation between the lesions identified with the SB3 and those found with the SB2 was identified through a logistic regression analysis.ResultsIn the SB2 capsule endoscopy group, 60% were women, patient age was 59 years (42.2, 73), and intestinal transit time was 271 min (182, 353). In the SB3 group, 57% were women, patient age was 60 years (42.5, 73), and intestinal transit time was 277 min (182, 352). There were no significant differences in the identification of P0 and P2 lesions between the two systems. The SB3 capsule endoscope identified more P1 lesions (p = 0.020, OR: 2.35, 95% CI:1.12-4.90). There was no significant difference in relation to location of the lesions in the small bowel.ConclusionsA greater number of P1 lesions were detected through the technologic advances made in SB3 capsule endoscopy, but the diagnostic yield for P2 lesions was not modified.     

Utilidad de la cápsula endoscópica en el diagnóstico de la enfermedad injerto contra huésped gastrointestinal

Introduction and aimGraft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD.Materials and methodsA retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard.ResultsTwenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively.ConclusionsCapsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.     

Cápsula endoscópica para el estudio de patologías de intestino delgado: experiencia en una institución privada en México

Introduction and aimsCapsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders.Material and methodsA retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined.ResultsA total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously.ConclusionsThe frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.     

Influencia de la experiencia acumulada del explorador en el valor predictivo negativo de la cápsula endoscópica

Introduction

The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed.

Enteroscopia de doble balón: indicaciones,abordajes, eficacia diagnóstica y terapéutica y seguridad. Experiencia temprana de un solo centro

Introduction and aims

Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications.

Exposición a radiación diagnóstica en pacientes con enfermedad de Crohn: estudio retrospectivo en un hospital medio y sus factores predictivos

Introduction

It is estimated that diagnostic medical radiation exposure may be responsable for 0.5-2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually requiere multiple ionizing radiation test.

Preguntas y errores en el diagnóstico y manejo de la anemia en pacientes con hemorragia digestiva

Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.     

Uso de la cápsula endoscópica en enfermedad inflamatoria intestinal en práctica clínica en España. Resultados de una encuesta nacional

IntroductionSmall bowel capsule endoscopy (SBCE) is a non-invasive diagnostic technique whose use in inflammatory bowel disease (IBD) has spread. A panenteric capsule, PillCam Crohn's (PCC), has recently been developed. We lack information on the availability and use of the CEID and PCC in our environment.MethodsWe conducted an electronic and anonymous survey among the members of the Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) [Spanish Working Group on Crohn's Disease and Ulcerative Colitis] and the Asociación Española de Gastroenterología (AEG) [Spanish Association of Gastroenterology], consisting of 37 multiple-choice questions.ResultsOne hundred and fifty members participated, the majority dedicated to IBD (69.3%). 72.8% worked at centres with an IBD unit. 79% had SBCE available at their hospital, 14% referred patients to another centre; 22% had a PCC available, 9% referred patients to another centre. 79.3% of respondents with available SBCE used it in a small percentage of patients with IBD and 15.6% in the majority. The most frequent scenarios were suspicion of Crohn's disease (76.3%), assessment of inflammatory activity (54.7%) and assessment of the extent of the disease (54.7%). More than half (59.7%) preferentially used the Patency capsule to assess intestinal patency. Almost all respondents (99.3%) considered that training resources should be implemented in this technique.ConclusionsSBCE is widely available in Spanish hospitals for the management of IBD, although its use is still limited. There is an opportunity to increase training in this technique, and consequently its use.