Multicenter retrospective evaluation of capsule endoscopy in clinical routine

BACKGROUND AND STUDY AIMS: The small bowel is anatomically difficult to examine; disease conditions are rarely located in it, but can be serious. Neither conventional radiography nor push enteroscopy has sufficient sensitivity and specificity to detect distinct lesions. Wireless capsule endoscopy can theoretically allow imaging of the entire small bowel, with only minimal discomfort for the patient. PATIENTS AND METHODS: Between November 2001 and May 2003, 191 patients received 195 capsules. Data were collected retrospectively from consecutive patients in three centers. The indications for capsule endoscopy were obscure or occult bleeding, suspected Crohn's disease, or other reasons in 151, 25, and 15 patients, respectively. The clinical outcome after 6 months was evaluated on the basis of interviews with patients or relatives. RESULTS: Visualization of the entire small bowel was adequate in 78.4 % of the examinations. The colon was not reached in 16.9 % of cases, and there were minor technical problems in 4.6 %. Relevant pathological findings were identified in 56.2 % of 151 patients with obscure bleeding or iron-deficiency anemia (64 % of whom received blood transfusions). The most common findings were angiodysplasia in 39.7 % of cases and ulcers of the small bowel in 7.3 %. In addition, individual cases of tumors and parasitic worms were detected. Seven of the 25 patients with suspected Crohn's disease (28 %) had the disease confirmed. Three of five patients with polyposis syndrome of the colon were found to have polyps in the small bowel. CONCLUSIONS: Wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure bleeding or iron-deficiency anemia. In patients with Crohn's disease, the method may be helpful in establishing or ruling out the diagnosis.     

Capsule endoscopy in patients with suspected Crohn's disease and negative endoscopy

BACKGROUND AND STUDY AIMS: The aim of the present study was to assess the value of capsule endoscopy in the diagnostic work-up of patients in whom there is a clinical suspicion of small bowel Crohn's disease that cannot be confirmed using traditional techniques. PATIENTS AND METHODS: A total of 21 patients (14 men, seven women; mean age 43 +/- 8 years) with a clinical and biochemical suspicion of Crohn's disease were included in the study. Conventional imaging work-up, including upper and lower endoscopy, as well as a small-bowel follow-through, was carried out in all of the patients. RESULTS: Pathological findings were not observed in 12 of the 21 patients (57 %). In the other nine patients (43 %), lesions supporting the diagnosis of Crohn's disease were seen. The most frequent findings were located in the distal ileum and included aphthae, lineal and serpiginous ulcers, and fissures. Four patients had lesions in the jejunum. One patient showed erosions in the distal duodenum, jejunum, and ileum. No adverse effects of the technique were observed in any of the patients. CONCLUSIONS: Capsule endoscopy is a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques.     

胶囊内镜在消化道疾病诊断中的应用

【目的】探讨胶囊内镜对消化道疾病的诊断价值。【方法】对150例疑似消化道疾病或不能耐受胃镜检查的患者施行胶囊内镜检查,统计检查结果。【结果】150例患者中消化道病变检出率高达78．6％（118／150）。不明原因消化道出血患者小肠病变占71．0％（49／69）,慢性腹痛患者中单纯小肠病变59．2％（29／49）,慢性腹胀患者中单纯小肠病变占11.1％（3／27）,慢性腹泻患者中单纯小肠病变占40．0％（2／5）。【结论】胶囊内镜对小肠疾病具有较高检出率,且安全、无创。     

高清智能电子染色内镜联合放大内镜对食管早癌及癌前病变的诊断价值

目的探讨高清智能电子染色内镜（i-Scan）联合放大内镜对食管早癌、癌前病变的诊断价值。方法选取我院经病理学检查证实为食管早癌患者100例（早癌组）、200例发生食管癌癌前病变（癌前病变组）的患者的内镜检查资料进行数据分析,以病理学结果作为金标准,计算i-Scan联合放大内镜下、白光内镜单独及联合应用时诊断食管早癌及癌前病变的检出率及诊断指标。结果i-Scan对食管早癌的诊断检出率为88.00%,癌前病变检出率为82.50%,轻度不典型增生检出率为28.00%,中度不典型增生检出率29.00%;白光内镜对食管早癌的诊断检出率为57.00%,癌前病变检出率为56.00%,轻度不典型增生检出率为16.00%,中度不典型增生检出率为17.00%;i-Scan对上述病变的检出率均高于白光内镜,差异具有统计学意义（P < 0.05）。i-Scan对食管黏膜重度不典型增生检出率（25.50%）与白光内镜（22.50%）比较,差异无统计学意义（P>0.05）;i-Scan联合放大内镜检查对100例食管早癌患者、200例食管癌前病变患者诊断的IPCL分型与病理类型对比,结果显示：100例食管早癌患者中有12例诊断为A型、将中度不典型增生患者中的2例诊断为B1型,将重度不典型增生患者中的4例诊断为B1型;白光内镜鉴别诊断食管早癌、食管癌癌前病变的敏感度为57.00%,特异性为56.00%;i-Scan鉴别诊断食管早癌、食管癌癌前病变的敏感度为88.00%,特异性为82.50%;i-Scan联合放大内镜检查鉴别诊断食管早癌、食管癌癌前病变的敏感度为88.00%,特异性为97.00%。结论iScan联合放大内镜对食管早癌、癌前病变的鉴别诊断具有较高的敏感度和特异性。     

Crohn's disease and ulcerative colitis. Evaluation with double-contrast barium examination and endoscopy

Double-contrast barium examination of the colon can demonstrate the changes associated with inflammatory bowel disease more completely and specifically than the single-contrast barium study. However, endoscopy is slightly more sensitive than double-contrast examination for detection of disease. In general, between 18% and 20% of patients with Crohn's disease or ulcerative colitis may be expected to have normal radiographic findings but endoscopically detectable disease. However, most false-negative double-contrast colon studies are associated with mild or minimal findings at proctosigmoidoscopy. Although double-contrast radiography may be less sensitive than endoscopy in detection of inflammatory bowel disease, it has similar accuracy for classification and differentiation. Most studies indicate an accuracy of 95% to 98% in differentiating Crohn's disease and ulcerative colitis, due to the fact that morphologic changes detected by the double-contrast mucosal study rarely overlap in the two diseases. Double-contrast barium examination and endoscopy are complementary studies, and the use of both may provide valuable information for evaluation of patients with suspected inflammatory bowel disease.     

Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis

BACKGROUND AND STUDY AIMS: It is still difficult to visualize changes in the small intestine. Wireless capsule enteroscopy is a new method that promises to provide new insights into the small intestine. In a prospective study, the diagnostic yield of wireless enteroscopy was therefore compared with computed tomography (CT) enteroclysis. PATIENTS AND METHODS: Twenty-two patients with suspected small-bowel pathology underwent CT enteroclysis and wireless capsule enteroscopy examinations, conducted by two independent blinded investigators. The results of the two investigations (diagnoses and the number, extent, and location of lesions detected) were compared by a third investigator. RESULTS: The patients included in the study had obscure gastrointestinal bleeding (n = 8), Crohn's disease (n = 8), unexplained diarrhea (n = 5), or suspected carcinoid tumor (n = 1). Pathological lesions were detected using capsule enteroscopy in 13 patients (59 %) and using CT enteroclysis in eight (36 %; P = 0.12). In seven patients (one case each of colonic Crohn's disease, diverticulitis, Meckel's diverticulum, carcinoid tumor, mesothelioma, colonic polyps, and irritable bowel syndrome), no pathological changes were found in the small intestine using either method. The diagnosis was established by wireless capsule enteroscopy in four patients with obscure bleeding, whereas CT enteroclysis was positive in only one patient ( P = 0.1). Crohn's disease was found in two patients with unexplained diarrhea. Small-bowel lesions were identified in six patients with known Crohn's disease using capsule enteroscopy or CT enteroclysis. The only side effect of wireless capsule enteroscopy observed was abdominal pain in one patient with Crohn's disease. There were no serious side effects with CT enteroclysis. CONCLUSIONS: Wireless capsule enteroscopy detects more small-bowel lesions than CT enteroclysis in patients with obscure gastrointestinal bleeding and Crohn's disease.     

胶囊内镜对86例患者小肠疾病的诊断分析

目的：分析评价胶囊内镜对小肠疾病的诊断价值。方法：对86例怀疑有小肠疾病的患者行胶囊内镜检查,并分析检查结果。结果：共检出小肠病变48例（55.8%）。其中小肠血管发育异常17例,小肠绒毛萎缩10例,小肠息肉5例,小肠溃疡3例,小肠炎症8例,小肠隆起性病变2例,小肠钩虫病1例,疑似炎症性肠病1例,末端回肠炎症伴回盲部占位1例。不明原因消化道出血23例中,检查出小肠病变19例,阳性率82.6%,其中小肠血管发育异常或伴活动性出血11例,小肠溃疡3例,钩虫病1例,小肠息肉3例,小肠多发隆起灶1例。胶囊内镜正常电池范围内对小肠检查情况：86例中有14例未能完成抵达回盲部,占16.3%。但其中10例已经发现小肠病变。结论：胶囊内镜对小肠疾病诊断率高,尤其适用于不明原因的消化道出血患者。     

The role of endoscopic ultrasound in inflammatory bowel disease

Ultrasonography has been applied to the diagnosis and management of inflammatory bowel disease for over 20 years. The combination of endoscopy with ultrasound has resulted in the application of intraluminal sonographic imaging to multiple diseases, including inflammatory bowel disease. Initial efforts were focused on the sonographic assessment of disease severity as based on bowel wall thickness, but this has been inconsistently demonstrated. Furthermore, disease severity is a clinical assessment that is based on both clinical and imaging studies. Recognizing that Crohn's disease tends to be transmural and ulcerative colitis a superficial mucosal inflammatory process, hopes were raised that endosonography would be effective in discriminating cases of otherwise indeterminate colitis. Efforts to demonstrate this, however, have been largely disappointing, and EUS plays a limited role in discriminating ulcerative colitis from Crohn's disease. On a more positive note, EUS evaluation of perirectal and perianal complications of Crohn's disease has been demonstrated to be superior to fistulography, CT, and equal to or superior to MRI. Because accurate anatomic information is required to guide surgical therapy of these lesions, EUS has the potential to emerge as a powerful imaging tool in the management of perianorectal Crohn's disease.     

New aspects of Crohn disease and ulcerative colitis: current diagnosis

Differential diagnosis of inflammatory bowel disease includes careful history taking, microbiological stool tests and endoscopy. Radiological procedures are required only in patients with Crohn's disease in order to demonstrate small bowel lesions or fistulae. The clinical relevance of recent scintigraphic techniques (67-gallium-citrate, 111-indium granulocytes, 99m-technetium-sucralfate) needs further exploration. Careful follow-up of patients with ulcerative colitis and Crohn's disease is mandatory once the duration of symptoms exceeds 10 years, in view of the high risk of development of carcinoma. The search for severe dysplasia is difficult and time consuming. Certain additional tests promise to be of value in detecting early malignancy, but these are not yet suited for routine clinical follow up.     

New biomarkers of Crohn's disease: serum biomarkers and development of diagnostic tools

Crohn's disease (CD) is a complex and heterogeneous inflammatory disorder that is part of inflammatory bowel diseases. Its diagnosis is performed on clinical presentation and results of radiography, endoscopy and histological findings. New noninvasive diagnostic biomarkers are needed to allow rapid and accurate CD discrimination. Blood-derived biomarkers correlating with disease activity, supported by genetic evidences and valid for all CD patients subtypes are still missing. Hence, no biomarkers and no related diagnostic tests are recommended or used alone for CD diagnosis in clinical practice. This review describes diagnosis tests based on the detection/quantification of specific acute-phase reactant proteins, enzymes and derived antibody response developed by inflammatory bowel disease patients for pathogens or symbiotic flora determinant, as well as autoantibodies. Their power as diagnostic tools is discussed, as well as new high-throughput techniques, such as microarrays and proteomics, for the discovery of new CD clinical biomarkers and for the development of specific CD diagnostic tests. Some rapidly evolving nanotechnologies, mathematical analysis and bioinformatics methods are also mentioned to highlight their importance for further accurate CD diagnosis.     

Upper gastrointestinal tract endoscopy in inflammatory bowel disease

Upper gastrointestinal endoscopy is used to evaluate upper gastrointestinal symptoms in patients with inflammatory bowel disease. This article discusses the procedure, which may allow for the diagnosis of Crohn's disease of the esophagus, stomach, and/or duodenum. Biopsies of normal gastric mucosa in patients with indeterminate colitis may be helpful in making a diagnosis of Crohn's colitis. Upper gastrointestinal endoscopy may allow for therapeutic intervention in terms of bleeding and stricturing disease.     

Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy

BACKGROUND AND STUDY AIM: Video capsule endoscopy and push-and-pull enteroscopy (PPE), both allow a complete examination of the small bowel in patients with suspected intestinal disorders. Due to the invasiveness of PPE, indications should probably be selective. The aim of the present prospective study was to evaluate the outcome of an approach whereby capsule endoscopy was used to select patients in whom PPE was indicated. PATIENTS AND METHODS: 164 patients were included (90 men; age 54+/-18 years) with various indications for small-bowel investigation, such as obscure bleeding (n=88), suspected Crohn's (n=14) or celiac (n=12) disease, or known or strongly suspected localized diseases such as neoplasms (n = 18) for biopsy. Four patients with a suspected intestinal stenosis underwent PPE without prior capsule endoscopy. In the remaining 160 patients, who had a capsule endoscopy, PPE was selected if there were lesions requiring biopsy or angiodysplasias to be treated by argon plasma coagulation (APC). Regarding the insertion route, an anal PPE was indicated if the capsule transit time from ingestion to arrival at the lesion was >or= 75 % of the total time from ingestion to arrival at the cecum. After gut cleansing, PPE was performed with general anesthesia, and the small bowel was examined until the lesion was reached or the scope could not be advanced further. If the suspected lesion had not been reached, a second procedure was performed through the alternative route, under the same conditions. RESULTS: The diagnostic yield of capsule endoscopy was 75 %. According to the indications, 47 PPE procedures were performed in 42 patients, including 33 through the oral route, 4 through the anal route and 5 combined ones. Indications were: suspicion of intestinal tumor (n=13), celiac disease with chronic bleeding (n=4), suspicion of Crohn's disease (n=3), treatment of significant arteriovenous malformations (AVMs) (n=10), diffuse enteropathies (n=3), nonsteroidal anti-inflammatory drug (NSAID)-related conditions (n=2), and obscure digestive bleeding (n=3). Lesions detected by capsule endoscopy were reached by PPE in all but two cases. The positive predictive value (PPV) of capsule endoscopy to make a correct indication for PPE was 94.7 % and the negative predictive value (NPV) was 98.3 %. The PPV and NPV of a time index of > 0.75 to start via the anal route were 94.7 % and 96.7 %. No complications were observed and all patients were discharged the day after the procedure. Follow-up at 9 months showed that capsule endoscopy followed by PPE had positively influenced the management of 90.5 % of the patients. CONCLUSIONS: The use of capsule endoscopy as a filter for PPE results in effective management of patients with various intestinal diseases. Capsule endoscopy can also direct the choice of route of PPE; a time index of > 0.75 appears to reliably indicate an anal route so that a double procedure is required in only about 12 % of cases.     

Endoscopy of the small bowel in inflammatory bowel disease

With the heterogeneous clinical presentation of IBD, endoscopy plays an integral role in the initial diagnosis of Crohn's disease. Although radiographic tests are often supplemental in the evaluation of Crohn's disease, they previously had been the only modality available allowing for visualization of much of the small bowel. The advent of small bowel endoscopy allows for direct visualization, and often biopsy, of the small bowel, allowing for confirmation of diagnosing and extent of involvement. Currently, the only mode for obtaining biopsies from beyond the ligament of Treitz is via push enteroscopy or intraoperative enteroscopy. Knowing the extent of disease can also help explain recalcitrant symptoms or lack of response to certain therapies. With the advent of capsule endoscopy, endoscopic visualization of the entire small intestine is now possible with a relatively noninvasive test. Further advancements in capsule endoscopy may relegate push enteroscopy and intraoperative enteroscopy to those cases in which biopsies or therapy are required. In the future, total enteroscopy with new enteroscopes may become more widely available, allowing biopsies and therapy in all segments of the small intestine, without the need for operative intervention.     

胶囊内镜检查的护理

目的：探讨胶囊内镜检查的护理方法.方法：对80例疑有小肠疾病的患者行胶囊内镜检查,对所有检查者均进行检查前、检查中、检查后规范护理,以期取得较好的检查结果.结果：80例患者中,发现小肠存在病变者69例,未见异常11例,阳性率86.25％.其中小肠出血10例,小肠间质瘤3例,小肠炎症性疾病（溃疡、糜烂、充血）19例,小肠憩室3例,小肠血管病变8例,小肠多发息肉14例,克罗恩病4例,小肠肿瘤6例,钩虫病2例.图像清晰,效果满意.结论：胶囊内镜检查具有安全、无痛苦、顺应性好等优点而易被患者接受,病变检出率较高,检查中无不良反应及并发症发生.     

Inflammatory bowel disease

This review summarizes important publications that have appeared during the last year dealing with imaging techniques and endoscopy, as well as the management of low-grade dysplasia and stenosis in inflammatory bowel disease. Magnetic resonance enteroclysis and capsule endoscopy are currently emerging as new imaging techniques for the small bowel in Crohn's disease. While magnetic resonance enteroclysis is, at least in Europe, increasingly being used as a reference method, the value of capsule endoscopy for the management of inflammatory bowel disease is still being evaluated. Chromoendoscopy is being studied in patients with long-lasting ulcerative colitis and may be a promising and sensitive technique for the diagnosis of dysplasia. However, there are conflicting data regarding the appropriate management when low-grade dysplasia is diagnosed in patients with ulcerative colitis. Endoscopic dilation can often be successfully carried out in cases of intestinal stenosis. The results of long-term follow-up studies indicate that several dilation procedures are often necessary and that a relatively high percentage of patients still have to undergo surgery.     

Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides.

OBJECTIVE: To compare results obtained by abdominal ultrasonography with clinical findings, including endoscopic and histologic findings, to evaluate the location and activity of inflammatory bowel disease, including disease controls in children. METHODS: Ninety-two ultrasonographic scans and 41 colonoscopic examinations with biopsies were performed in 78 patients (1 month to 17.8 years of age) with Crohn's disease (n = 26), ulcerative colitis (n = 21), inflammatory bowel disease of indeterminate type (n = 2), and disease controls (other intestinal disorders, including infectious and ischemic lesions; n = 29). Laboratory parameters for inflammatory bowel disease were determined, and disease activity was assessed by a combination of clinical and laboratory data. Bowel wall thickness and echo texture were recorded in a standardized way by ultrasonography and compared with endoscopic and histologic findings in a segment-by-segment comparison. RESULTS: Sensitivity and specificity of ultrasonography in detecting patients with severe macroscopic lesions depicted on endoscopy were 77% and 83%, respectively. Sensitivity and specificity of ultrasonography in detecting patients with severe histologic inflammation were 75% and 82%. There was a statistically significant correlation between maximal bowel wall thickness and disease activity score (P < .01). CONCLUSIONS: Abdominal ultrasonography may be helpful in evaluating the location, severity, and inflammatory activity of inflammatory bowel disease in children and young adults.     

Diagnosis of acute surgical abdomen – The best diagnostic tool to reach a final diagnosiscin

ObjectiveTo evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland.MethodsData was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients' charts were searched manually and final diagnosis of each patient was recorded.ResultsOut of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation.ConclusionsAppendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.     

Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease

BACKGROUND AND STUDY AIMS: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. PATIENTS AND METHODS: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up. RESULTS: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %). CONCLUSIONS: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.     

The value of capsule endoscopy in pediatric patients with a suspicion of Crohn's disease

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the safety and usefulness of capsule endoscopy (CE) in pediatric patients with a suspicion of Crohn's disease. PATIENTS AND METHODS: CE was used in 12 patients (four girls, eight boys; age 12-16; weight range 43-87 kg). The indication was a clinical suspicion of Crohn's disease not confirmed with traditional methods. Gastroscopy, colonoscopy, and small-bowel follow-through examinations were carried out in all of the patients, without any diagnostic findings. Ileoscopy was possible in 50 % of the patients, and the ileal mucosa and biopsies were normal in all cases. RESULTS: The capsule was easily swallowed by all of the patients. They all excreted the capsule normally, and no complications were observed in any case. CE identified lesions suggestive of Crohn's disease in seven of the 12 (58.3 %), and the majority of the lesions were in the ileum. CONCLUSIONS: CE is safe in pediatric patients over 12 years of age. The procedure appears to be a very useful diagnostic tool in children with Crohn's disease.     

Colonoscopy in inflammatory bowel disease

This article discusses the important role endoscopy plays in the diagnosis and management of inflammatory bowel disease and how the procedure adds crucial information to the constellation of history, physical examination, radiographic findings, and laboratory values. Differentiation between Crohn's disease and ulcerative colitis has important ramifications for medical therapy, surgical options, and prognosis. This distinction can be accurately made in at least 85% of patients.