Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

AIM:To determine if esophageal capsule endoscopy(ECE)is an adequate diagnostic alternative to esophagogastroduodenoscopy(EGD)in pre-bariatric surgery patients.METHODS:We conducted a prospective pilot study to assess the diagnostic accuracy of ECE(PillCam ESO2,Given Imaging)vs conventional EGD in pre-bariatric surgery patients.Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled.All patients underwent ECE followed by standard EGD.Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings.The gold standard was the findings on EGD.RESULTS:Ten patients with an average body mass index of 50 kg/m2were enrolled and completed the study.ECE identified 11 of 14(79%)positive esophageal/gastroesophageal junction(GEJ)findings and 14of 17(82%)combined esophageal and gastric findings identified on EGD.Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD(P=0.64 for esophageal/GEJ and P=0.66 for combined esophageal and gastric findings respectively).Of the positive esophageal/GEJ findings,ECE failed to identify the following:hiatal hernia in two patients,mild esophagitis in two patients,and mild Schatzki ring in two patients.ECE was able to identify the entire esophagus in 100%,gastric cardia in0%,gastric body in 100%,gastric antrum in 70%,pylorus in 60%,and duodenum in 0%.CONCLUSION:There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.     

Safety and utility of capsule endoscopy for infants and young children

AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.     

OMOM胶囊内镜在无症状人群体检中的应用

目的 探讨OMOM胶囊内镜在无症状人群体检中应用价值.方法 受检者为2005年8月-2010年3月到北京军区总医院消化内科进行胶囊内镜检查的无症状体检人群,受检者按就诊的时间顺序随机分为研究组(A组)、对照组(B组)、自身对照组(C组).A组受检者按一定体位进行胶囊内镜检查,送服胶囊后立即依次平卧位3 min,左侧卧位3 min,右侧卧位3 min,半卧位3min,观察食管黏膜情况,再观察胃依次左侧卧位10 min,平卧位10 min,右侧卧位10 min,站立位10 min,随后可自由活动,直至胶囊内镜排出体外.B组受检者按常规要求进行胶囊内镜检查.C组受检者进行胶囊内镜检查后即安排胃镜和结肠镜检查.结果 A组和B组胶囊内镜食管运行平均时间和胃排空平均时间差异均有统计学意义(P＜0.05);但A组和B组胶囊内镜排出平均时间差异无统计学意义(P＞0.05).A组和C组胶囊内镜食管运行平均时间和排出平均时间差异均有统计学意义(P＜0.05);但A组和C组胶囊内镜胃排空平均时间差异无统计学意义(P＞0.05).90例A组受检者中检出消化道病变者28例,检出率31.11％;160例B组受检者中检出消化道病变者42例,检出率26.25％;110例C组受检者中检出消化道病变者43例,检出率39.09％.A组和B组食管病变检出率比较差异具有统计学意义(P＜0.05).结论 胶囊内镜在特定体位下可以提高食管及胃病变检出率.胶囊内镜检查可以指导胃镜及结肠镜检查能更有效提高消化道疾病检出率,用于无症状人群体检无疑是一种安全、无创、无痛苦的消化道检查方法.     

小肠腔内超声在小肠疾病诊断中的初步应用研究

目的 研究小肠腔内超声(ISIU)对小肠正常组织的影像学表现及对小肠病变的诊断价值.方法 对2011年12月至2012年12月经胶囊内镜、胃镜、结肠镜及双气囊小肠镜检查中筛选出的50例患者,行小肠腔内超声检查,观察其正常组织结构及病变小肠的超声内镜学表现.发现小肠病变者加行经腹超声(US)及螺旋CT(SCT)检查,研究ISIU对小肠正常组织及部分病变的临床诊断价值.结果 50例入选患者中,完成ISIU检查共47例,其中发现小肠病变10例.所发现病变中,ISIU诊断出全部病例,US、SCT分别诊断出1例和3例.经ISIU观察正常小肠肠壁图像可分6层,但空肠与回肠在ISIU下表现不完全相同,各有其特点.结论 ISIU可提供高分辨率的正常小肠壁结构的各层次图像,并可对病变的来源及内部回声进行清晰的观察,从而有助于提高小肠疾病的诊断率.     

胶囊内镜在不明原因消化道出血诊断中的应用

背景：胶囊内镜是明确不明原因消化道出血（OGIB）的检查手段之一,其诊断率可能受到检查时机和出血自然病程的影响。目的：探讨胶囊内镜在OGIB诊断中的应用价值和最佳检查时机。方法：收集2010年10月～2012年6月厦门大学附属中山医院46例接受胶囊内镜检查的OGIB患者。回顾性分析胶囊内镜检查诊断OGIB的阳性率、疑诊率、敏感性、特异性、阳性预测值和阴性预测值,比较不同检查时机对OGIB检出率的影响。结果：胶囊内镜检查诊断OGIB的阳性率为71．7％,疑诊率为13．0％,阴性率为15．2％,诊断敏感性、特异性以及阳性预测值、阴性预测值分别为96．3％、75．0％、92．9％、85．7％。活动性出血组的检出率显著高于出血停止组（96．3％对68．4％,P=0．030）,显性出血者的检出率与隐性出血者相比差异无统计学意义（100％对75．0％,P=0．148）。出血停止≤2周者的检出率显著高于出血停止〉2周者（90．9％对37．5％,P=0．041）。结论：胶囊内镜是诊断OGIB的一种安全、有效的检查手段,出血后尽早行胶囊内镜检查可能提高阳性诊断率并为进一步干预创造条件。     

Longest duration of retention of video capsule: A case report and literature review

Video capsule endoscopy (VCE) is a safe innovative tool for investigating obscure gastrointestinal bleeding, Crohn’s disease and other small bowel pathologies. The capsule is usually excreted with faeces within 24-48 h. Retention of capsule rarely occurs, and it usually depends on the indication of VCE. The longest reported case of capsule retention in the literature is 2.5 years. Surgical approach is considered effective to retrieve the retained capsule. We present a case of asymptomatic retention of capsule for four and half years in a 49-year-old man who underwent VCE to explore the cause of obscure gastrointestinal bleeding. It was successfully retrieved endoscopically. We will also briefly review the literature regarding the causes, different presentations and management of capsule retention.     

Outcome in obscure gastrointestinal bleeding after capsule endoscopy

AIM: To investigate the clinical impact of capsule endoscopy (CE) after an obscure gastrointestinal bleeding (OGIB) episode, focusing on diagnostic work-up, follow-up and predictive factors of rebleeding.METHODS: Patients who were referred to Hospital del Mar (Barcelona, Spain) between 2007 and 2009 for OGIB who underwent a CE were retrospectively analyzed. Demographic data, current treatment with non-steroid anti-inflammtory drugs or anticoagulant drugs, hemoglobin levels, transfusion requirements, previous diagnostic tests for the bleeding episode, as well as CE findings (significant or non-significant), work-up and patient outcomes were analyzed from electronic charts. Variables were compared by χ² analysis and Student t test. Risk factors of rebleeding were assessed by Log-rank test, Kaplan-Meier curves and Cox regression model.RESULTS: There were 105 patients [45.7% women, median age of 72 years old (interquartile range 56-79)] and a median follow-up of 326 d (interquartile range 123-641) included in this study. The overall diagnostic yield of CE was 58.1% (55.2% and 63.2%, for patients with occult OGIB and overt OGIB, respectively). In 73 patients (69.5%), OGIB was resolved. Multivariate analysis showed that hemoglobin levels lower than 8 g/dL at diagnosis [hazard ratios (HR) = 2.7, 95%CI: 1.9-6.3], patients aged 70 years and above (HR = 2.1, 95%CI: 1.2-6.1) and significant findings in CE (HR = 2.4, 95%CI: 1.1-5.8) were independent predictors of rebleeding.CONCLUSION: One third of the patients presented with rebleeding after CE; risk factors were hemoglobin levels < 8 g/dL, age ≥ 70 years or the presence of significant lesions.     

国产OMOM胶囊内镜的临床应用体会

目的 探讨国产OMOM胶囊内镜在消化道疾病,特别是在小肠疾病中的诊断价值.方法 总结分析我院152例患者进行胶囊内镜检查的结果、胃肠道的通过时间及不良反应.结果 本组患者中,不明原因消化道出血51例,腹痛待查或慢性腹泻伴消瘦65例,健康体检36例.胶囊内镜在胃内检查时间为12～130 min,在小肠内检查时间为192～345 min.63例检出小肠异常,其中小肠血管疾病36例,小肠炎症性疾病(溃疡、糜烂、充血、出血斑/点)12例(包括克罗恩病3例,镜下表现为线、片状环周溃疡),小肠肿瘤3例,小肠息肉6例,小肠淋巴管扩张症2例,十二指肠病变4例;另外发现胃部病变45例,未见异常44例.总阳性检出率为71.05%(108/152).结论 OMOM胶囊内镜性能稳定,图像清晰,全部获得小肠检查资料,对小肠疾病的诊断阳性率高,安全无痛苦,是小肠疾病的常用诊断方法 .     

Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

The PillCam ESO(Given Imaging,Israel) or esophageal capsule endoscopy(ECE) is a novel technique used in the diagnostic evaluation of esophagus.Many studies have been performed to compare the accuracy of ECE against the current gold standard esophagogastro-duodenoscopy and a meta-analysis recently published by Lu et al suggests that ECE may have an acceptable sensitivity and specificity in detecting esophageal varices.We would like to discuss the importance and implication of publication bias in this meta-an...     

双气囊内镜和胶囊内镜诊断小肠出血的临床评价

目的评价双气囊内镜和胶囊内镜对小肠出血的临床诊断价值。方法比较双气囊内镜、胶囊内镜及全消化道造影对小肠出血病灶的总体检出率;通过自身对照,比较双气囊内镜和胶囊内镜对小肠出血诊断率;分析胶囊内镜对1次双气囊内镜检查明确诊断率的影响。结果105例小肠出血患者中,双气囊内镜检出克罗恩病24例,腺癌15例,慢性非特异性炎症12例,不明原因小肠溃疡10例,小肠间质肿瘤8例,小肠息肉8例,小肠血管畸形出血6例,钩虫病5例,麦克尔憩室及多发憩室5例,小肠淋巴瘤3例,无明显异常9例,阳性率91．4％（96／105）。其中40例进行胶囊内镜检查,病变检出率75．0％（30／40）;75例患者全消化道造影检查,病变检出率33．3％（25／75）。根据胶囊内镜结果1次双气囊内镜检查明确诊断率90．0％（36／40）,而根据临床特征及消化道造影结果1次双气囊内镜检查明确诊断率69．2％（45／65）。结论小肠疾病的主要病因是小肠良性溃疡（包括克罗恩病）、肿瘤、慢性炎症,其次是息肉、血管畸形、寄生虫感染、麦克尔憩室及淋巴瘤等。双气囊内镜对小肠出血诊断率高于胶囊内镜,胶囊内镜能提高1次双气囊内镜明确诊断率。