胶囊内镜对结肠的检查

目的: 探讨节能控制、体位调整及适时进食在胶囊内镜完成小肠检查基础上对结肠检查的作用.方法: 对我院内镜室2008-11/2009-05收治的76例患者进行胶囊内镜检查, 所有病例均排除肠梗阻. 将患者分为2组: 第1组常规检查组( n = 39);第2组体位控制组( n = 37), 患者吞服胶囊后, 在胃窦反复拍照过程中通过图文系统发送命令减少拍照频率及灯光亮度以节约电能, 观察进入小肠后让患者离开, 2 h再到内镜室观察, 若胶囊进入结肠则采取平卧且臀部稍高的位体, 同时进食普通食物观察胶囊运行,进入肝曲后采用左侧卧体位, 过脾曲后改用平卧. 所有患者胶囊电源耗尽后取回记录仪, 同时作X光透视, 了解胶囊在患者体内的位置.结果: 对照组39例患者胶囊在结肠内工作时间为4±0.9 h, 4例(10.3%)胶囊到达直肠, 35例胶囊停留于回盲部处. 在回盲部处发现息肉2例(5.1%). 体位控制组胶囊在结肠工作时间5±0.7 h, 进食后结肠运动活跃, 其中19例(51.4%)于工作时间内到达升结肠以外的结肠部位. 检出结肠阳性患者7例(18.9%). 2组胶囊内镜结肠运行时间和疾病检查阳性率差别有统计学意义( P<0.05), 对结肠检查有效率差别有显著统计学意义( P<0.01).结论: 胶囊内镜检查过程采用节能控制、体位调整及进食刺激方法, 有助于增加胶囊内镜有效工作时间内在结肠的运行, 提高结肠疾病检出率.     

结肠胶囊内镜在结直肠癌筛查中的应用

结直肠癌是危害人民健康的一种常见恶性肿瘤,筛查是降低结直肠癌发病率和病死率最有效的手段。结肠镜检查是结直肠癌筛查指南中推荐的首要方法,但依从性欠佳。结肠胶囊内镜是一种新开发的非侵入性结肠内镜检查技术, 舒适性较传统的结肠镜检查明显提升。本文对结肠胶囊内镜在结直肠癌筛查中的应用情况做一综述。     

The colon - the latest terrain for capsule endoscopy.

Colonoscopy is the gold standard for evaluating pathologies of the large bowel, including screening for colorectal cancer. The technological features of current colonoscopes have not progressed much in recent years except for improved image and video display. The technique requires intubation and insufflation of the colon which are operator-dependent and involve a learning curve. Colonoscopy is an invasive procedure whose overall risk of complications is approximately 0.3%, increasing to 2% when polypectomy is performed. The PillCam Colon capsule endoscope (Given Imaging Ltd., Yoqneam, Israel) was developed for use as a safe, minimally invasive, non-sedation requiring, patient-friendly modality to visualize the colon. Only the interpretation of findings requires expertise. PillCam capsule endoscopy could be an alternative approach to colonoscopy for screening large populations. We report the first clinical investigations of the safety, feasibility and performance of colon capsule endoscopy compared with standard colonoscopy.     

胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄(44.2±14.6)岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性(Kappa值和P值),并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例;而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%(19/19),肠道清洁度优良率达79%(15/19),检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄(44.2±14.6)岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性(Kappa值和P值),并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例;而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%(19/19),肠道清洁度优良率达79%(15/19),检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄（44.2±14.6）岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性（Kappa值和P值）,并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例 而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%（19/19）,肠道清洁度优良率达79%（15/19）,检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

结肠胶囊内镜探索与展望北大核心CSCD

结肠胶囊内镜(colon capsule endoscopy,CCE)是胶囊内镜家族的新成员,它的出现将推动全消化道胶囊检查的实现。经过不断的探索,两代CCE在电池续航能力、自主控制及精准定位等技术上有所改进,在筛查结肠癌、监测炎症性肠病方面拥有了更高的灵敏度和特异度。文章就CCE的发展历程、应用现状进行总结,以期让读者了解其临床操作流程及适用人群,并对其面临主要难题以及发展方向进行探讨。     

Predictive factors for inadequate bowel cleansing in colon capsule endoscopy

Background and aimsAchieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking. The aim of this study was to assess the predictive factors of poor bowel cleansing in the CCE setting.MethodsIn this observational study, 126 patients who underwent CCE at two tertiary care hospitals were included between June 2017 and January 2020. Participants prepared for bowel cleansing with a 1-day clear liquid diet, a 4-L split-dose polyethylene glycol regimen and boosters with sodium phosphate, sodium amidotrizoate and meglumine amidotrizoate. Domperidone tablets and bisacodyl suppositories were administered when needed. Overall and per-segment bowel cleansing was evaluated using a CCE cleansing score. Simple and multiple logistic regression analysis were carried out to assess poor bowel cleansing and excretion rate predictors.ResultsOverall bowel cleansing was optimal in 53 patients (50.5%). Optimal per-segment bowel cleansing was achieved as follows: cecum (86 patients; 74.8%), transverse colon (91 patients; 81.3%), distal colon (81 patients; 75%) and rectum (64 patients; 66.7%). In the univariate analysis, elderly (OR, 1.03; 95% CI (1.01–1.076)) and constipation (OR, 3.82; 95% CI (1.50–9.71)) were associated with poor bowel cleansing. In the logistic regression analysis, constipation (OR, 3.77; 95% CI (1.43–10.0)) was associated with poor bowel cleansing. No variables were significantly associated with the CCE device excretion rate.ConclusionOur results suggest that constipation is the most powerful predictor of poor bowel cleansing in the CCE setting. Tailored cleansing protocols should be recommended for these patients.     

Technical modification of the double-balloon endoscopy to access to the proximal side of the stenosis in the distal colon

BACKGROUND: The inability to pass endoscopes beyond strictures is a considerable problem in patients with a colonic stricture. METHODS: In patients with bowel obstruction, we have modified the insertion method for double-balloon endoscopy with a long, transnasal decompression tube. OBSERVATIONS: We have succeeded in reaching the proximal side of the stricture from the oral approach across the entire small bowel in a patient. CONCLUSIONS: This modified double-balloon enteroscopy is useful for patients with bowel obstruction in whom a long decompression tube is already placed.     

Flow cytometry of polypoid neoplasms of the colon resected by endoscopy

Sixty-one neoplastic polypoid lesions of the large bowel and rectum, obtained by endoscopic resection, were submitted to cytofluorometric measurements. This study was performed on archival formalin fixed and paraffin embedded material using the method of Hedley. Coefficient of variation, DNA Index, DNA aneuploidy, proliferative activity were statistically correlated to histological grading (according to U.I.C.C.) and to the presence of trophic changes (epithelial displacement, hemorrhage, mucus discharge. Compared with morphological findings, cytofluorometric results revealed that DNA aneuploidy appeared only when intraepithelial carcinomatous changes were present, and was found in 50 percent of microinvasive carcinoma. The proliferative activity was significantly increased in intraepithelial carcinomas, with a significant enlargement of the coefficient of variation. This change may reflect initial disorders in DNA content of neoplastic cells. On the other hand, there was no significant difference between lesions with and without trophic alterations. These findings confirm that this increase is an independent phenomenon during tumor progression.     

Histamine inactivation in the colon of pigs in relationship to abundance of catabolic enzymes

Objective. Catabolism of histamine plays a crucial role in the intestine in preventing intoxication by luminal histamine. Two enzymes are involved, namely histamine N-methyltransferase (HMT) and diamine oxidase (DAO). The purpose of this study was to find a link between histamine catabolism and the activities of HMT and DAO.

Material and methods. Epithelia of porcine proximal colon were mounted in Ussing chambers. After mucosal addition of ³H-histamine (100 µmol·l^?1) and ¹⁴C-mannitol, the appearance of non-catabolized histamine, ³H-histamine label (hist-rad) and ¹⁴C-mannitol label were measured in parallel on the serosal side. Activities of HMT and DAO were determined in the proximal colon and proximal jejunum.

Results. Differences between the fluxes of histamine and hist-rad indicated catabolic conversion of 81.4±1.6% histamine during epithelial transit. Fluxes of hist-rad and histamine increased linearly with increasing mannitol fluxes but the percentage of catabolized histamine was not related to either mannitol or hist-rad fluxes. However, the percentage of catabolized histamine rose with increasing DAO activity. Given a negative correlation between DAO and HMT activities, the fraction of catabolized histamine decreased with increasing HMT activity. HMT activity was comparable in the colon and jejunum, but DAO activity was approximately nine times higher in the jejunum.

Conclusions. Permeation, but not the relative efficiency of catabolism, of histamine depends on epithelial/paracellular tightness. While previous studies have shown that colonic HMT essentially catabolizes the bulk of histamine during permeation, DAO activity seems to be more variable and limiting for the overall efficiency of the catabolic process.     

Histamine inactivation in the colon of pigs in relationship to abundance of catabolic enzymes

OBJECTIVE: Catabolism of histamine plays a crucial role in the intestine in preventing intoxication by luminal histamine. Two enzymes are involved, namely histamine N-methyltransferase (HMT) and diamine oxidase (DAO). The purpose of this study was to find a link between histamine catabolism and the activities of HMT and DAO. MATERIAL AND METHODS: Epithelia of porcine proximal colon were mounted in Ussing chambers. After mucosal addition of (3)H-histamine (100 micromol x l(-1)) and (14)C-mannitol, the appearance of non-catabolized histamine, (3)H-histamine label (hist-rad) and (14)C-mannitol label were measured in parallel on the serosal side. Activities of HMT and DAO were determined in the proximal colon and proximal jejunum. RESULTS: Differences between the fluxes of histamine and hist-rad indicated catabolic conversion of 81.4+/-1.6% histamine during epithelial transit. Fluxes of hist-rad and histamine increased linearly with increasing mannitol fluxes but the percentage of catabolized histamine was not related to either mannitol or hist-rad fluxes. However, the percentage of catabolized histamine rose with increasing DAO activity. Given a negative correlation between DAO and HMT activities, the fraction of catabolized histamine decreased with increasing HMT activity. HMT activity was comparable in the colon and jejunum, but DAO activity was approximately nine times higher in the jejunum. CONCLUSIONS: Permeation, but not the relative efficiency of catabolism, of histamine depends on epithelial/paracellular tightness. While previous studies have shown that colonic HMT essentially catabolizes the bulk of histamine during permeation, DAO activity seems to be more variable and limiting for the overall efficiency of the catabolic process.