Is formal training necessary for capsule endoscopy?: The largest gastroenterology trainee study with controls

BACKGROUND: Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified. AIMS AND METHODS: To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees. RESULTS: Trainees were better at determining the gastric emptying time (p=0.013) and more likely to record true positives compared to the students (p=0.037). They were also less likely to record false positives (p=0.005) and more likely to reach the correct diagnosis (p=0.001, OR 3.6, CI 1.8-7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training. CONCLUSION: This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.     

OMOM胶囊内镜对小肠疾病的诊断价值

目的:探讨国产OMOM胶囊内镜对消化道疾病,特别是小肠疾病的诊断价值。方法:总结分析我院2011年5月至2014年5月来自门诊和住院的不明原因消化道出血及腹痛腹胀腹泻等患者共56例。所有患者进行OMOM胶囊内镜检查前均行胃镜、肠镜及消化道钡餐检查,未发现可解释疾病的病因。结果:所有患者均完成检查,56例检出小肠疾病40例(71.4%),不明原因消化道出血组26例检出小肠疾病23例88.4%(23/26),腹痛腹胀腹泻等组30例检出小肠疾病17例56.6%(17/30)。结论:国产OMOM胶囊内镜对小肠疾病诊断率高,操作简单、安全,且价格低、无创伤。可作为小肠疾病的常规筛查手段。     

Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: A prospective multicentre study

BackgroundOesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam^®Eso capsule endoscopy in this setting.MethodsProspective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam^®Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures.Results80 patients (80% males, mean age: 57 ± 12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2–930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication.ConclusionThis study demonstrates that accuracy of PillCam^®Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam^®Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.     

A pilot study of capsule endoscopy after a standard meal for the detection and grading of oesophageal varices in cirrhotic patients

Background

Capsule endoscopy has been proposed as an alternative to fibreoptic endoscopy for oesophageal varices evaluation in cirrhotics. However, it shows only moderate sensitivity compared to fibreoptic endoscopy.

Aim

To compare post-meal capsule endoscopy to fibreoptic endoscopy, based on the hypothesis that meal-induced increase of portal pressure can enhance its sensitivity.

Methods

Twenty-five patients were submitted to fibreoptic endoscopy and, after a standard meal, capsule endoscopy.

Results

Post-meal capsule endoscopy detected varices in the 18 patients in whom fibreoptic endoscopy detected varices plus 3 more subjects (sensitivity 100%, specificity 70%); large varices in the 4 patients in whom fibreoptic endoscopy graded varices as large, plus 5 more subjects; red markers in the 5 patients in whom fibreoptic endoscopy detected red markers, plus 3 more subjects. High-risk varices were identified in 11 patients by post-meal capsule endoscopy and in 10 by fibreoptic endoscopy (sensitivity 100%, specificity 93.8%).

Conclusions

Post-meal capsule endoscopy identified more varices, large varices and red markers than fibreoptic endoscopy. The two methods detected similar proportions of high-risk varices. These data suggest that a standard meal can enhance the sensitivity of capsule endoscopy in the detection and grading of oesophageal varices in cirrhotics.     

基于网络药理学研究丹蛭降糖胶囊治疗糖尿病的分子机制

目的 采用网络药理学方法研究丹蛭降糖胶囊治疗糖尿病的潜在分子机制。方法 借助中药系统药理学平台和Swiss Target Prediction数据库检索丹蛭降糖胶囊的化学成分、对应作用靶标及靶标基因。通过GeneCards获取糖尿病相关靶点,将复方活性成分靶点和糖尿病靶点构建韦恩图,以寻找交集靶点,获得丹蛭降糖胶囊治疗糖尿病的预测靶标。利用Cytoscape 3.7.2软件构建药材-化合物-靶点（基因）网络,筛选关键化合物。利用STRING网站建立交集靶点蛋白相互作用网络,选出关键靶点基因。借助R软件对共同靶点进行GO分析和KEGG通路富集分析。结果 丹蛭降糖胶囊作用于糖尿病的活性成分有25个,相关靶基因76个。GO和KEGG分析结果显示,丹蛭降糖胶囊治疗糖尿病的机制共涉及1 702条生物学过程和149条信号通路。结论 丹蛭降糖胶囊治疗糖尿病的关键成分槲皮素、木犀草素、山奈酚等可能通过对AGE-RAGE、IL-17、TNF、HIF-1等信号通路的调控,最终达到治疗糖尿病的效果。其作用机制可能与抗炎,降低氧化应激水平,参与细胞的凋亡与损伤有关。     

冠心舒通胶囊对ApoE－/－小鼠动脉粥样硬化斑块内MMP-9和TIMP-1表达的影响

目的 观察中成药冠心舒通胶囊对高脂饮食喂养ApoE^－/－小鼠主动脉粥样硬化斑块病理变化、人组织型基质金属蛋白酶抑制剂1（TIMP-1）、基质金属蛋白酶9（MMP-9）表达的影响,探讨冠心舒通胶囊对粥样斑块稳定性的影响以及对相关机制进行初步研究。方法 将8周龄雄性ApoE^－/－小鼠30只给予高脂喂养,12周时随机分为：模型组、冠心舒通胶囊高剂量［1.8 g/（kg·天）］组和冠心舒通胶囊低剂量［0.6 g/（kg·天）］组,喂养12周后处死,取主动脉中段,大体标本油红O染色观察斑块面积,冰冻切片后HE染色观察斑块厚度,冰冻切片免疫荧光法检测斑块内TIMP-1、MMP-9表达情况。结果 与模型组相比,冠心舒通胶囊组平均斑块浸润面积减小（P<0.05）,弥漫程度减轻,斑块厚度降低,MMP-9表达减少,而且冠心舒通胶囊高剂量组与低剂量组相比,各项统计指标亦有统计学意义（P<0.05） ,TIMP-1表达未见明显变化。结论 冠心舒通胶囊可以对抗ApoE^－/－小鼠动脉粥样硬化斑块的形成和进展,以及通过降低斑块内MMP-9表达,从而抑制胶原纤维分解,稳定易损粥样斑块。     

血脂康对不稳定型心绞痛伴肝酶升高患者的疗效与安全性

目的探讨血脂康对不稳定型心绞痛伴肝酶升高患者的疗效与安全性。方法纳入96例服用阿托伐他汀后引起肝酶升高3倍以上的不稳定型心绞痛患者。随机均分为3组,每组32例患者,A组停阿托伐他汀;B组阿托伐他汀减半;C组更换为血脂康。总疗程为4周,治疗前后测定总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三脂(TG)、高敏C反应蛋白(hs-CRP)、丙氨酸转氨酶(ALT)。随访主要不良心血管事件(MACEs),包括心源性死亡、致死性心肌梗死(MI)、非致死性MI、猝死发生情况。结果与治疗前比较,治疗4周后三组患者ALT水平均显著下降,治疗前后比较有统计学差异(P0.05),A、C组患者ALT水平下降较B组患者更显著,与B组患者比较有统计学差异(P0.05),A、C组之间ALT水平比较,无统计学差异(P0.05)。B、C组患者治疗4周后TC、LDL-C、TG、hs-CRP水平均下降,治疗前后比较有统计学差异(P0.05);C组患者HDL-C水平较治疗前升高(P0.05),治疗前后比较有统计学差异(P0.05);A组患者TC、LDL-C、TG、hs-CRP水平下降不明显,治疗前后比较无统计学差异(P0.05)。与A组患者治疗后比较,C组患者TG、hs-CRP水平明显下降,差异有统计学意义(P0.05)。A组、B组、C组MACEs事件发生率分别为12.5%、9.4%、3.1%,组间比较差异有统计学意义(P0.05)。结论他汀引起肝酶显著升高的不稳定型心绞痛患者,换用血脂康安全有效。本研究入选患者病例数较少,有待更多的试验证实。     

Virtual chromoendoscopy in small bowel capsule endoscopy: New light or a cast of shadow?

AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy(SBCE). METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE(SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement(FICE) settings and Blue Filter(BF) by two gastroenterologists with ex-perience in SBCE, blinded to each other's findings, whoranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa(k) coefficient. Lesions selected for the study included angioectasias(n = 39), ulcers/ero-sions(n = 49) and villous edema/atrophy(n = 12). RESULTS: Overall, the delineation of lesions was im-proved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percent-age of agreement between investigators of 89%(k = 0.833), 85%(k = 0.764), 66%(k = 0.486) and 79%(k = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4%(k = 0.910), 81.6%(k = 0.714) and 91.7%(k = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7%(k = 0.802), 79,6%(k = 0.703) and 91.7%(k = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioecta-sias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [k = not available(NA)], 75.5%(k = NA) and 66.7%(k = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a per-centage of agreement of 76.9%(k = 0.558), 81.6%(k = 0.570) and 25.0%(k = NA), respectively.CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.     

通心络胶囊治疗非ST段抬高型急性心肌梗死的效果及对心肌组织灌注水平的影响

目的探讨通心络胶囊治疗非ST段抬高型急性心肌梗死(NSTEMI)的效果及对心肌组织灌注水平的影响。方法 2017年2月-2018年4月我院收治的100例NSTEMI患者,按照随机数表法分为观察组及对照组各50例,对照组给予常规抗心肌缺血治疗及抗凝治疗,观察组在对照组基础上加服通心络胶囊。比较两组临床总有效率、冠状动脉造影TIMI血流分级及并发症情况。结果观察组临床总有效率为88.00%明显高于对照组66.00%(P<0.05);观察组TIMI分级中0级、1级比例较对照组明显减少,2级、3级比例较对照组明显增加(P<0.05);观察组并发症总发生率20.00%与对照组总发生率24.00%差异不显著(P>0.05)。结论应用通心络胶囊治疗NSTEMI能够有效提高患者疗效,改善心肌组织灌注水平,并发症较少。     

愈肝龙胶囊联合恩替卡韦治疗乙型肝炎肝纤维化临床观察

目的:研究愈肝龙胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化的临床疗效。方法:将符合纳入标准的116例慢性乙型肝炎肝纤维化患者随机分为观察组64例和对照组52例,两组患者均给予恩替卡韦抗病毒治疗,观察组加用愈肝龙胶囊。观察两组患者治疗前与治疗36个月后肝硬度值(LSM)、超声影像学指标(门静脉内径、脾脏厚度)、血清肝纤维化指标4项(HA、LN、C-Ⅳ、PC-Ⅲ)、肝功能(ALT、AST、PLT、Alb、TBil)、APRI指数的变化。结果:两组患者治疗36个月后,观察组的LSM值、肝纤维化指标(C-Ⅳ)、肝功能(ALT、AST、PLT、Alb、TBil)以及APRI指数优于治疗前(P<0.05),且与对照组比较差异有显著性意义(P<0.05)。结论:复方中成药愈肝龙胶囊联合恩替卡韦改善慢性乙型肝炎肝患者肝纤维化与肝功能的效果优于单用恩替卡韦。