How helpful is capsule endoscopy to surgeons？

Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.     

Colon capsule endoscopy: Current status and future directions

Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.     

Wireless capsule video endoscopy：Three years of experience

AIM:To review and summerize the current literatue regarding M2A wireless capsule endoscopy.METHODS:Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed.RESULTS:Review of the literature dearly showed that capsule endoscopy was superior th enteroscopy,small bowel follow through and computerized tomography in aptients with obscure qastrointestinal bleeding,iron deficiency anemia,or suspected Crohn‘s disease.It was very sensitive for the diagnosis of small bowel tumors and for survailance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposeis syndrome.Its role in celiac disease and in patients with kmown Crohn‘s disease was currently being investigated.CONGLUSION:Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through,enteroscopy and entero-CT in establishing the diagnosis of many small bowel pathologyes.     

Video capsule endoscopy: what is the future?

Video capsule endoscopy (VCE) that was launched 10 years ago has become a first-line procedure for examining the small bowel, especially in the case of obscure gastrointestinal bleeding. Other major indications include Crohn disease (CD), celiac disease, and intestinal polyposis syndrome. In the case of small bowel diseases, the use of VCE must be integrated in?a?global diagnostic and therapeutic approach. More recently, wireless endoscopy has been adapted for examining the colon, opening up larger perspectives for colorectal cancer screening or colon examination. Technologic modifications of the second-generation colon capsule increase the sensitivity of this method for detecting polyps. Other new developments, including remote magnetic manipulation, power management, drug delivery capsule, microbiopsy capsule, and adaptation of technologies such as chromoendoscopy, are sure to enhance the capabilities of wireless endoscopy in gastrointestinal disorders.     

Wireless capsule video endoscopy:Three years of experience

AIM:To review and summerize the current literatueregarding M2A wireless capsule endoscopy.METHODS:Peer reviewed publications regarding the useof capsule endoscopy as well as our personal experiencewere reviewed.RESULTS:Review of the literature dearly showed that capsuleendoscopy was superior to enteroscopy,small bowel followthrough and computerized tomography in patients withobscure gastrointestinal bleeding,iron deficiency anemia,or suspected Crohn's disease.It was very sensitive for thediagnosis of small bowel tumors and for survailance of smallbowel pathology in patients with Gardner syndrome orfamilial adenomatous polyposis syndrome.Its role in celiacdisease and in patients with known Crohn's disease wascurrently being investigated.CONCLUSION:Capsule video endoscopy is a superior andmore sensitive diagnostic tool than barium follow through,enteroscopy and entero-CT in establishing the diagnosis ofmany small bowel pathologies.     

At a watershed? Technical developments in wireless capsule endoscopy

This article reviews some of the technical developments that allowed the introduction of the wireless capsule 10 years ago into human usage. Technical advances and commercial competition have substantially improved the performance of clinical capsule endoscopy, especially in optical quality. Optical issues including the airless environment, depth of focus, dome reflection, the development of white light light-emitting diodes, exposure length and the advent of adaptive illumination are discussed. The competition between charge coupled devices and complementary metal oxide silicone technologies for imaging, lens improvements and the requirements for different frame rates and their associated power management strategies and battery type choices and the introduction of field enhancement methods into commercial capsule technology are considered. Capsule technology stands at a watershed. It is mainly confined to diagnostic small intestinal imaging. It might overtake other forms of conventional diagnostic endoscopy, especially colonoscopy but also gastroscopy and esophagoscopy but has to improve both technically and compete in price. It might break out of its optical diagnostic confinement and become a therapeutic modality. To make this leap there have to be several technical advances especially in biopsy, command, micromechanical internal movements, remote controlled manipulation and changes in power management, which may include external power transmission.     

Does capsule endoscopy impact clinical management in established Crohn's disease?

BackgroundCapsule endoscopy (SBCE) has developed a relevant role in patients with established Crohn's Disease (CD). However, evaluation of the impact in clinical management has been scarce.AimsTo evaluate therapeutic impact of SBCE in an 11-year real-life cohort of known CD patients.MethodsRetrospective single center study including all patients with established CD submitted to SBCE procedure from 01/01/2008 to 31/12/2019. Patency capsule was used in selected patients. Small bowel mucosal inflammation was quantified using Lewis score. Therapeutic impact was defined as a change in CD-related treatment recommended based on SBCE results. Patients were assigned to four groups regarding SBCE indication: staging, flare, post-op and remission.ResultsFrom the 432 SBCE performed 87.5% were conclusive. Active disease was present in 63.7 of patients; 41.6% mild inflammation and 21.9% moderate-to-severe activity. A change of management was guided by SBCE in 51.3% of procedures: 199 (46.1%) escalation and 23 (5.3%) de-escalation, with significant changes in all groups. Escalation increased with disease activity: 57.8% in mild and 89.5% in moderate-to-severe disease. De-escalation was conducted in 13.9% procedures with mucosal healing and 1.1% with mild disease.ConclusionSBCE is a useful tool for guiding therapeutic management in CD patients both for treatment escalation and de-escalation.     

Efficiency of bowel preparation for capsule endoscopy examination：A meta-analysis

Good preparation before endoscopic procedures is essential for successful visualization. The small bowel is difficult to evaluate because of its length and complex configuration. A meta-analysis was conducted of studies comparing small bowel visualization by capsule endoscopy with and without preparation. Medical data bases were searched for all studies investigating the preparation for capsule endoscopy of the small bowel up to July 31, 2007. Studies that scored bowel cleanness and measured gastric and small bowel transit time and rate of cecum visualization were included. The primary endpoint was the quality of bowel visualization. The secondary endpoints were transit times and proportion of examinations that demonstrated the cecum, with and without preparation. Meta-analysis was performed with StatDirect Statistical software, version 2.6.1 （http：// statsdirect.com）. Eight studies met the inclusion criteria. Bowel visualization was scored as ＂good＂ in 78% of the examinations performed with preparation and 49% performed without （P 〈 0.0001）. There were no significant differences in transit times or in the proportion of examinations that demonstrated the cecum with and without preparation. Capsule endoscopy preparation improves the quality of small bowel visualization, but has no effect on transit times, or demonstration of the cecum.     

Wireless capsule pH monitoring: does it fulfil all expectations?

pH monitoring has been used as a diagnostic tool in gastro-oesophageal reflux disease (GERD) for many years. Recent studies have shown that wireless capsule pH monitoring is better tolerated and interferes less with daily activities as compared to traditional catheter-based pH monitoring. Moreover, prolonged recording time (48 h instead of 24 h) is possible with wireless pH monitoring. The main secondary effect of wireless capsule pH monitoring is induction of thoracic discomfort in 10-65% of the patients, which can vary from mild foreign body sensation to severe chest pain. Sensitivity and specificity of wireless capsule monitoring is comparable to that of traditional pH monitoring. It has not been proven yet that better tolerability and a longer recording time increases the diagnostic yield of wireless capsule monitoring in GERD.     

Is a 2-liter PEG preparation useful before capsule endoscopy?

AIMS: Small bowel contents can sometimes hamper the quality of capsule images. Our aim was to investigate the effect of PEG administered prior to capsule endoscopy (CE) upon quality of images, gastrointestinal transit time, and detection rate of small bowel bleeding lesions in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: Forty-two consecutive patients were included. CE was performed following a 12-hour fasting period. The 16 first patients (Group A) received no preparation and the following 27 patients (Group B) received 2 L of PEG the night before. The quality of images was assessed at both in duodenojejunum and ileum level, using a scale including the presence of air bubbles, biliary secretion, and residue (1-4). RESULTS: Quality of images were not different in Group A compared with Group B in the duodenojejunum and in the ileum. Gastric transit time tended to be shorter in Group A compared with Group B (25.5 vs. 45.7 minutes) (P = 0.15), whereas small bowel transit was not different between both groups (271 vs. 288 minutes). Total small bowel CE examination was complete in Group A and in 24 of 26 in Group B (not significant). Potential bleeding lesions were seen in 8 patients in Group A and 12 in Group B (not significant). CONCLUSION: Our retrospective study suggests that 2 L PEG preparation seems able to improve neither the quality of CE images nor its diagnostic performance. Moreover, in our study, PEG tended to increase gastric emptying time and may constitute a limitation for small bowel complete examination.     

Evaluation of RAPID<Superscript>®</Superscript> 5 Access software for examination of capsule endoscopies and reading of the capsule by an endoscopy nurse

Background

Since capsule endoscopy (CE) is time consuming, one possible cost-effective strategy could be the use of an expert endoscopic assistant and available software to select images. Aims were to examine the clinical utility of RAPID^® 5 Access software and find the optimum setting mode for reading. We also evaluated whether a nurse could preview the CE video and detect significant lesions accurately.

Methods

The capsule images in 14 volunteers with known mucosal injury induced by low dose aspirin and in 30 patients who were known to have a variety of significant lesions were selected. Using three setting modes of RAPID^® 5 Access software, the detection rate and reading time for CE images by two well-trained physicians and one expert nurse were compared.

Results

There was no significant difference in detection rate among the three readers. The detection rate using Quickview RAPID^® 5 Access was significantly higher than that using RAPID^® Reader version 4.1. Comparison among the three modes of RAPID^® 5 Access showed that auto mode as well as displaying a single image at 12 fps was superior in the detection rate of denuded redness, while its reading time was longer compared to the other modes. Some significant lesions were not detected by using Quickview and Quadview modes.

Conclusions

RAPID^® 5 Access improves diagnostic yield, reducing reading time; however, it is still unacceptable because of the diagnostic miss rate and may be useful as an ancillary reading tool. Developing further improved software and training expert assistants for reading capsule images are necessary.

     

Bleeding Dieulafoy’s-like lesions of the gut identified by capsule endoscopy

Dieulafoy’s-like lesions (DLs-like) represent a cause of obscure gastrointestinal bleeding, enteroscopy being the main diagnostic and therapeutic procedure. Frequently, more than one enteroscopy is needed to identify the bleeding vessel. In our practice, video capsule endoscopy (VCE) identified and guided therapy in four cases of DLs-like; three of them were localized on the small bowel. We report, for the first time, a diagnosis of colonic DL-like performed by colon capsule endoscopy. Two patients presented with severe cardiovascular disorders, being hemodynamically unstable during VCE examination. Based on the VCE findings, only one invasive therapeutic procedure per patient was necessary to achieve hemostasis. VCE and enteroscopy may be regarded as complementary procedures in patients with gut DLs-like.