Endoscopic approach to capsule endoscope retention

In recent years, wireless capsule endoscopy has become increasingly indicated and utilized in the diagnosis and management of small bowel disorders. As such, its most common complication, capsule retention, has become a more frequently encountered clinical entity. Historically, when medical management of capsule retention has failed, patients have been sent directly to surgery. However, recent advances in small bowel enteroscopy have demonstrated a high success rate and safety profile in retrieving retained capsules. These approaches appear to be a viable alternative to surgery in many clinical scenarios. This article discusses both standard and advanced endoscopic approaches to capsule retention, and presents an algorithmic approach to their utilization.     

New frontiers in capsule endoscopy

Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well-established tool for evaluating the entire small bowel for manifold pathologies. CE far exceeded our early expectations by providing us with a tool to establish the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohn's disease, polyposis syndrome, and others. Recent evidence has shown CE to be superior to other imaging modalities, such as small bowel follow-through X-ray, colonoscopy with ileoscopy, computerized tomographic enterography, magnetic resonance enteroclysis, and push enteroscopy, for diagnosing small bowel pathologies. Gastroenterologists would prefer the convenience of a single capsule that can create images of the area from the oral cavity to the anal canal in one 'shot'. Because of anatomic and physiologic differences in the GI tract, however, it may not be possible to use the same capsule and so we would need a different one for each organ. In addition to the pioneer small bowel capsule, there is now an esophageal capsule, and a colonoscopy capsule will soon be available. The ideal CE should be capable of performing a biopsy or carrying out an online analysis (an 'optical' biopsy) and 'stop' bleeding by an epinephrine injection, a heat probe, argon plasma coagulation, etc. The ultimate capsule would include special detectors for white blood cells, and it would check oncological markers (e.g. CEA, CA 19-9), perform serology tests (e.g. antiendomysial, IgE), and measure various cytokines, pH levels, temperature and pressure, as well as deliver drugs. The capsule's motility feature in the small bowel may open a window to study the pathophysiology of relatively elusive medical entities, such as irritable bowel syndrome. The optimal capsule needs to contain an automatic computerized system for automatic detection of pathologies, such as that present in the ECG-Holter recording, in order to overcome the drawback of time-consuming viewing. Our dream is that endoscopists will be able to 'control and steer' the CE, as they are able to do in standard endoscopy. This would mean being able to maintain the capsule steady in a selected area and hold the view in order to have more time to examine the opposite wall of the bowel. In conclusion, future gastroenterologists will have a number of CEs from which to choose, according to the purpose of the evaluation, whether it be diagnostic and/or therapeutic. Just as the idea of a swallowed capsule taking images as it travels along the human anatomy was once in the realm of sheer fantasy, we have every reason to believe that the ultimate CE will become a reality in the not far distant future.     

强力天麻杜仲胶囊治疗椎-基底动脉供血不足的疗效观察

目的观察强力天麻杜仲胶囊对椎-基底动脉血流速度和血浆内皮素(ET)、血栓素B2(TXB2)、6-酮-前列腺素(6-Keto-PGF1α)、血管紧张素Ⅱ(AngⅡ)的影响。方法110例椎-基底动脉供血不足(VBI)病人随机分为3组,治疗组40例,口服强力天麻杜仲胶囊;对照组40例,口服通心络胶囊;基础组30例,静滴金络通。治疗组和对照组均联合基础治疗。采用TCD和放射免疫学方法观察椎-基底动脉血流速度和血浆ET、TXB2、6-Keto-PGF1α、AngⅡ的变化。结果强力天麻杜仲胶囊对VBI的症状改善有效率达92.5%,与通心络比较无统计学意义(P>0.05)。并且能有效加快椎-基底动脉的血流速度,同时能显著降低血浆中ET、TXB2、AngⅡ水平,升高6-Keto-PGF1α的含量。结论强力天麻杜仲胶囊治疗VBI有效。     

Effect of capsule placement with transnasal endoscopy

Aim: One of the prohibiting factors in achieving complete small bowel capsule endoscopy is slow gastric transit of the capsule. The present study retrospectively investigated the success rate of, and the time required for, transnasal endoscope‐assisted capsule placement to assess its clinical utility. Methods: In 24 of 27 patients who underwent capsule placement assisted by a transnasal endoscope, the capsule was successfully transported to and released in the duodenum (capsule placement group). For each patient in the capsule placement group, three age‐ and sex‐matched patients who underwent conventional capsule endoscopy were assigned as controls (n = 72). Gastric transit time, small bowel transit time, and rate of capsule arrival at the cecum within 8 h were compared between the two patient groups. Results: Among the 27 patients in whom capsule placement was carried out, the capsule was successfully placed in the duodenum in 24 patients (88.9% success rate). In the capsule placement group, gastric transit time was significantly shorter (10.5 vs 46.2 min, P = 0.0021), small bowel transit time was significantly longer (354.7 vs 301.3 min, P = 0.0134), and completion rate (capsule arrival at the cecum within 8 h) was significantly higher (83.3 vs 61.1%, P = 0.0455) than in the control group. There were no procedural accidents associated with capsule placement. Conclusion: Transnasal endoscope‐assisted capsule placement appears to be a safe and reliable procedure, achieving complete small bowel capsule endoscopy, and is considered clinically useful.     

Capsule endoscopy of the future: What’s on the horizon?

Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review,we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings.Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.     

胸痹通胶囊治疗冠心病的临床观察

目的 探讨胸痹通胶囊治疗冠心病的疗效及机制。方法 将96例冠心痛病人随机分为胸痹通胶囊组（治疗组）49例及心可舒组（对照组）47例，分别用胸痹通胶囊和心可舒治疗1个疗程，观察两组的临床疗效及血脂、血液流变学等指标。结果 经治疗1个疗程后治疗组临床症状，总有效率93．9％明显优于对照组的78．7％（P〈0．05）。治疗组治疗后胆固醇、三酰甘油均较治疗前有明显降低；治疗组血液流变学指标与治疗前比较，除红细胞比容、血沉外均有明显降低（P〈0．01）。结论 胸痹通胶囊对冠心病有良好的治疗效果，其作用优于心可舒。     

Training in video capsule endoscopy: Current status and unmet needs

Since its introduction to clinical practice nearly 20 years ago, wireless capsule endoscopy has revolutionized the landscape in the diagnosis and management of small bowel diseases. Over the past 10 years, capsule endoscopy has evolved beyond the small intestine and a range of capsules are now available to examine the esophagus, stomach and colon. Because of its ease of use, tolerability, paucity of complications and ability to visualize the entire gastrointestinal tract, capsule endoscopy has entered the mainstream of clinical practice. This review of the literature summarizes the current state of capsule training and highlights the limited data available to assess reader competence and standards expected of an independent practitioner. There are neither standardized teaching strategies nor national or international metrics for accreditation of physicians and nonphysicians interested in mastering this examination. Summating the few publications, there appears to be consensus that diagnostic expertise improves with experience, and that trainees should be fully supervised for at least 20 full case studies. Formative and summative assessment is advisable and the number of taught cases should not be the sole determinant of competence. The review also highlights differences in recommendations from major national gastroenterology societies. Finally, the authors discuss areas of unmet needs in teaching and learning for capsule endoscopy.     

POSSIBILITY OF THE DEVELOPMENT AND CLINICAL USE OF A CAPSULE ULTRASOUND ENDOSCOPE

Development of technology has made it possible to produce the micromachine. In the field of endoscopy, wireless capsule endoscopy (CE) has been developed and opened up a new field in endoscopic study. The common indication in clinical cases is limited to the diagnosis of lesions in the deeper small intestine. Clinical application of this system is increasing at a remarkable rate, though target organs and endoscopic performance are limited. On the other hand, endoscopic ultrasound (EUS) technology has advanced rapidly during the last 20 years. The improvement of ultrasound scanners, including the size of the scanner, quality of image and plural changeable frequency has been successfully developed. On the basis of these technological advances, we can discuss the potential ability of developing a capsule ultrasound endoscopy.     

振源胶囊联合坦度螺酮胶囊治疗哮喘患者伴发焦虑疗效分析

目的探讨振源胶囊联合坦度螺酮胶囊治疗支气管哮喘伴发焦虑患者的疗效和不良反应。方法 76例支气管哮喘伴发焦虑患者随机分成两组,合用组为振源胶囊胶囊联合坦度螺酮胶囊治疗,单用组为坦度螺酮胶囊,疗程为6周。采用汉密顿焦虑量表(HAMA)评定疗效,用症状量表(TESS)评定用药不良反应。结果治疗6周末,合用组有效率为86.84%,单用组有效率为73.68%,两组比较差异有显著性(χ2=2.08,P<0.05)。两组TESS评分比较差异有显著性(t=5.22,P<0.05)。结论振源胶囊联合坦度螺酮胶囊治疗老年支气管哮喘伴发抑郁患者疗效好,安全性高,依从性好。     

美常安联合盐酸左氧氟沙星胶囊治疗急性感染性腹泻的疗效观察

目的观察美常安联合盐酸左氧氟沙星胶囊治疗急性感染性腹泻的治疗效果。方法173例急性感染性腹泻患者随机分为3组,联合用药组60例,口服美常安胶囊合盐酸左氧氟沙星胶囊治疗;美常安组55例,口服美常安胶囊;左氧氟沙星组58例,口服盐酸左氧氟沙星胶囊,3组疗程3～5d。观察临床疗效。结果发热症状治疗3d后,联合用药组与美常安组比较P〈0．05,与左氧氟沙星组比较P〉0．05,美常安组与左氧氟沙星组比较P〉0．05;腹痛、里急后重、黏液便症状治疗3d及5d后比较3组均P〉0．05;发热症状治疗5d后3组比较均P〉0．05。止泻时间联合用药组与美常安组、左氧氟沙星组比较均P〈0．05;美常安组与左氧氟沙星组比较P〉0．05。3组疗效比较有统计学意义（P〈0．05）。其中联合用药组疗效优于美常安组及左氧氟沙星组。结论联合用药比单独用美常安胶囊或盐酸左氧氟沙星胶囊能较快缓解临床症状,缩短病程,而单独应用美常安胶囊或盐酸左氧氟沙星胶囊的疗效差异不大。     

Engineering of vault nanocapsules with enzymatic and fluorescent properties

One of the central issues facing the emerging field of nanotechnology is cellular compatibility. Nanoparticles have been proposed for diagnostic and therapeutic applications, including drug delivery, gene therapy, biological sensors, and controlled catalysis. Viruses, liposomes, peptides, and synthetic and natural polymers have been engineered for these applications, yet significant limitations continue to prevent their use. Avoidance of the body's natural immune system, lack of targeting specificity, and the inability to control packaging and release are remaining obstacles. We have explored the use of a naturally occurring cellular nanoparticle known as the vault, which is named for its morphology with multiple arches reminiscent of cathedral ceilings. Vaults are 13-MDa ribonucleoprotein particles with an internal cavity large enough to sequester hundreds of proteins. Here, we report a strategy to target and sequester biologically active materials within the vault cavity. Attachment of a vault-targeting peptide to two proteins, luciferase and a variant of GFP, resulted in their sequestration within the vault cavity. The targeted proteins confer enzymatic and fluorescent properties on the recombinant vaults, both of which can be detected by their emission of light. The modified vaults are compatible with living cells. The ability to engineer vault particles with designed properties and functionalities represents an important step toward development of a biocompatible nanocapsule.     

Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.     

Patency and agile capsules

Small bowel strictures can be missed by current diagnostic methods. The Patency capsule is a new non-endoscopic dissolvable capsule which has as an objective of checking the patency of digestive tract, in a non-invasive manner. The available clinical trials have demonstrated that the Patency capsule is a good tool for assessment of the functional patency of the small bowel, and it allows identification of those patients who can safely undergo a capsule endoscopy, despite clinical and radiographic evidence of small-bowel obstruction. Some cases of intestinal occlusion have been reported with the Patency capsule, four of them needed surgery. So, a new capsule with two timer plugs （Agile capsule） has been recently developed in order to minimize the risk of occlusion. This new device stars its dissolution process earlier （30 h after ingestion） and its two timer plugs have been designed to begin the disintegration even when the device is blocked in a tight stricture.