Capsule Endoscopy In Group Research Articles

Capsule endoscopy in Crohn's disease surveillance: A monocentric, retrospective analysis in Italy.

Crohn's disease (CD) is a potentially debilitating condition that burdens Italian healthcare substantially. The symptomatic management relies on prompt therapy adjustment to reduce flares and follow-up diagnostic inputs to maximise remission. Capsule endoscopy (CE) has introduced advantages in CD diagnostics, allowing the direct inspection of the entire gastrointestinal mucosa. The diagnostic procedure is comparable in effort to standard ileocolonoscopy (IC) but requires no anaesthesia. Whether CE follow-up improves clinical outcomes remains to be defined. To provide a preliminary evaluation of CE in terms of clinical outcomes with respect to the standard of care ileocolonoscopy/MRE in Italy. This retrospective analysis utilises anonymised, monocentric data from the S. Orsola-Malpighi Hospital IBD database in Bologna, Italy, collected between 1999 and 2019. Out of 421 adult patient records, 100 were included in the analysis (50 per arm, matched per demographic and clinical characteristics). The CE represented the intervention arm, whereas ileocolonoscopy/magnetic resonance enterography was the standard of care. The use of biologics, symptomatology course, and surgery were the outcomes. The two techniques performed similarly overall. In general, no significant difference emerged in the use of biologics. The use of biologics appears reduced in the CE group, only in L4 patients after the first follow-up year. Similarly, surgery was seemingly less frequent among L4 patients in the CE group. No difference was found between groups in flare occurrence and duration. CE patients might have experienced longer and earlier first remissions, but no long-term difference persisted. The CE group showed an apparent reduction in biologics and surgery, limiting to L4 diagnoses. More extensive, prospective, multicentre, randomised studies must corroborate these preliminary findings.

Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study.

Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy (CE) in patients aged over 80 years. In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected. Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (P<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.

Capsule Endoscopy Is Useful for Postoperative Tight Control Management in Patients with Crohn's Disease.

In Crohn's disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied. We aimed to assess this postoperative activity using capsule endoscopy (CE) and analyze the association between treatment optimization based on CE findings and the long-term course. In patients who underwent intestinal resection, we performed CE and assessed the endoscopic activity using the Lewis score within 3months postoperatively (1st CE) and during follow-up. Postoperative treatments were adjusted according to clinical symptoms or CE findings (severity of 1st CE or worsening of follow-up CEs). Hospitalization, repeat surgery, or endoscopic dilation defined the primary outcome. Among the CE group (N = 48), 85.7% (1st CE) and 79.2% (2nd CE) exhibited endoscopic activities indicating residual or recurrent lesions. Postoperative treatments were adjusted according to clinical symptoms in the non-CE group (N = 57) and clinical symptoms or CE findings in the CE group. Compared to the non-CE group, the CE group had significantly fewer primary outcomes. Patients with treatment adjustments based on CE findings had even lower primary outcome rate. Multivariate analysis identified the CE group as an independent protective factor (hazard ratio = 0.45, 95% confidence interval = 0.20-0.96). Treatment adjustments based on CE findings showed a stronger protective effect (0.30, 0.10-0.75). Postoperative repeated CE enabled us to assess residual and recurrent lesions accurately before clinical symptoms appeared. The regular assessment of endoscopic activity and subsequent treatment optimization have the potential for improving postoperative course.

546 Inpatient Status Is Associated With Incomplete Capsule Endoscopy Examinations: A Systematic Review and Meta-Analysis

INTRODUCTION: Capsule endoscopy (CE) has been increasingly used for the diagnosis of small bowel pathology, mainly, obscure gastrointestinal bleeding. Incomplete examination can lead to delayed intervention. Possible risks of incomplete examination have been extensively studied. We hypothesized that hospitalized patients might be at higher risk of incomplete examination due to acute illness. Therefore, we conducted a systematic review and meta-analysis to assess the effect of inpatient status on the completion of CE. METHODS: Unrestricted searches of MEDLINE, EMBASE, Cochrane bibliographic databases were performed inception through March 2019 for studies comparing CE completion rates in hospitalized vs. non-hospitalized patients. Results were screened for relevance and eligibility criteria. Relevant data was extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias RESULTS: A total of 6 retrospective studies published between 2010-2018 were included examining 2,467 patients who underwent CE (702 inpatient vs 1,763 outpatient) were included. Outpatient CE completion rate was significantly higher compared to inpatient with an OR of 4.48 (95% CI 1.99-10.09; I2 = 85%). In three studies, small bowel transit time found to be shorter in the outpatient CE group with mean difference of -14.51 minutes (95%CI -34.87-5.84), however, this did not reach statistical significance. No publication bias was noted. CONCLUSION: Our findings suggests that outpatient CE was associated with higher completion rates than inpatient CE. This could be related to prolonged small bowel transit time in hospitalized patients related to acute illness, comorbidities, narcotic use, and bed rest which are more prevalent in hospitalized compared to non-hospitalized patients. Our findings suggest that it might be prudent to reserve CE examinations to the outpatient setting when possible.

Usefulness of small bowel reexamination in obscure gastrointestinal bleeding patients with negative capsule endoscopy findings: Comparison of repeat capsule endoscopy and double-balloon enteroscopy.

Although capsule endoscopy (CE) is a noninvasive diagnostic tool for patients with obscure gastrointestinal bleeding (OGIB), bleeding lesions are often not detected. No strategies have been established to determine whether CE or double-balloon enteroscopy (DBE) should be performed after negative CE. Among 652 patients who underwent CE for OGIB, a total of 359 patients had negative findings. Of these, 41 and 48 patients underwent repeat CE and DBE for small bowel reexamination, respectively. We compared the rate of positive findings between the two groups. The findings were considered positive if mucosal break, vascular lesion, tumor, or active bleeding was observed. The rate of positive findings in the repeat CE group was significantly higher than that in the DBE group (73.2% vs. 39.6%; p = 0.001). Logistic regression analysis showed that the repeat CE group was significantly associated with positive findings (odds ratio (OR), 4.2; 95% confidence interval (CI), 1.7-10.2; p = 0.002). Inverse probability of treatment-weighted analysis revealed that repeat CE was significantly associated with positive findings (OR, 4.4; 95% CI, 1.6-12.2; p = 0.004). Reexamination via CE appears to have more diagnostic value than DBE for OGIB patients with negative CE findings.

A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding

Background: Recently, diagnosis of obscure gastrointestinal bleeding (OGIB) has improved greatly due to introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). However, the efficacy of CE over DBE in patients with previous OGIB remains unclear. This study aimed to compare, in terms of diagnostic yield, the efficacy of DBE with that of CE in patients with previous OGIB.Patients and methods: We enrolled 223 consecutive patients with previous OGIB who were treated between May 2007 and March 2012. We retrospectively evaluated the respective diagnostic yields of CE and DBE in patients with previous OGIB using propensity score-matching analysis. We compared the diagnostic yield of CE with that of DBE.Results: The diagnostic yields were 41.9% in DBE group and 11.6% in CE group, respectively (p < .01). On logistic regression analysis, DBE was significantly superior to CE after matching (Odds ratio [OR], 4.25; 95% confidence interval [CI], 1.43–12.6; p < .01), even after adjustment for propensity score (OR, 5.65; 95% CI, 1.56?20.5; p < .01).Conclusions: Our results indicate that DBE might be more useful and perhaps safer than CE in achieving a positive diagnosis in patients with previous OGIB.

Obscure Gastrointestinal Bleeding: Capsule or Balloon?

See “Roles of Capsule Endoscopy and Single-balloon Enteroscopy in Diagnosing Unexplained Gastrointestinal Bleeding” by Shohei Ooka, Kiyonori Kobayashi, Kana Kawagishi, et al., on page 56-60 Obscure gastrointestinal bleeding (OGIB) is defined as overt or obscure gastrointestinal bleeding of unknown origin despite an initial endoscopic evaluation including colonoscopy and esophagogastroduodenoscopy. The majority of patients with OGIB have a bleeding source in the small intestine. In past decades, the evaluation of the small bowel was extremely limited because of difficult intubation using conventional endoscopes. However, this limitation has been overcome by technical advances including capsule endoscopy (CE), balloon-assisted enteroscopy (BAE), and computed tomography or magnetic resonance enterography. The main strength of CE is noninvasive exploration of the entire small bowel. Complete small bowel evaluation can be performed in 79% to 90% of patients, and the diagnostic yield in patients with suspected small bowel bleeding is 38% to 83% [1]. BAE is distinguished by its diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was described first and single-balloon enteroscopy (SBE) followed. The basic techniques and mechanisms of SBE are similar to those of DBE. Although DBE appeared to be superior to SBE in complete small bowel evaluation, diagnostic yield, ability to treat, and complication rates are similar between DBE and SBE [2]. In this issue of Clinical Endoscopy, Ooka et al. [3] reported that the rate of positive findings for OGIB was significantly higher with SBE (73.6%) than with CE (47.5%), and SBE may be more appropriate for overt OGIB. However, caution is required in the interpretation of the results of this report. CE was performed before SBE in 28.5% of the SBE group in this study. CE is useful for screening before performing BAE in patients with OGIB, and CE before BAE is known to increase the diagnostic and therapeutic yields [4]. In this study, CE might have improved the diagnostic yield in the SBE group, although CE was performed in a part of the SBE group. CE can also guide the insertion route of BAE. An oral approach is usually preferred when a lesion is located within the proximal two-thirds of the small bowel. In this issue of Clinical Endoscopy, it did not appear that a bidirectional approach was tried, because SBE was performed in 91 patients and the oral and anal approaches in 43 and 48, respectively. When an oral or anal approach fails to detect significant findings or reach the targeted lesion, the other route can be tried in practice. A 73.6% diagnostic yield by SBE in patients with OGIB is relatively surprising, even though only one route was tried in all cases. Diagnostic yield of CE and BAE for patients with overt bleeding is higher than that for patients with occult bleeding, and the diagnostic yield for patients with ongoing overt bleeding is higher than that for patients with previous overt bleeding. In Ooka’s study [3], the percentage of patients with overt bleeding was higher in the SBE group than in the CE group (80.8% vs. 58.4%), and ongoing overt bleeding was also more frequent (100.0% vs. 90.9%) in the SBE group. The results might have changed if the authors performed multivariate analyses according to the amount and timing of bleeding. Actually, CE and BAE are not competitive, but complementary. According to the American College of Gastroenterology guidelines, CE should be considered a first-line procedure for suspected small bowel bleeding, and BAE should be attempted if a small bowel lesion is strongly suspected based on clinical presentation and abnormal CE results [5]. However, the results of Ooka’s study do not seem to be sufficient to change current diagnostic guidelines for small bowel bleeding.

PWE-439 Delivering training in small intestinal capsule endoscopy: report of the inaugural uk regional deanery training day

Introduction Capsule endoscopy (CE) is widely used to image the small intestine. No formal training programme for CE exists in the UK, commercially run courses are available. The BSG CE group is developing formalised accreditation processes through which trainees will pass as part of their standard specialist training in gastroenterology, the level will depend on whether they wish to offer CE as a sub specialist interest. Regionally delivered training provides an opportunity to introduce CE, a valuable rsesource where training opportunities remain otherwise limited. We delivered the first regional training day in CE in January 2014 and describe its format and subsequent feedback. Method Health Education South West (Peninsula and Severn Deaneries) run combined specialist training days for gastroenterology trainees. In January 2014, we delivered the first regional training day on CE in the UK. Trainees attended as part of their bi-monthly regional training programme. The teaching was provided by a consultant gastroenterologist with a wide experience in capsule endoscopy, supported by two colleagues. Following an introductory lecture, each trainee had access to an individual laptop loaded with interpretation software. 15 cases were studied throughout the day, demonstrating a wide variety of small intestinal pathology commonly seen with CE. The trainees were asked to give feedback at the end of the day and subsequently asked to complete a follow up online survey regarding their CE experiences during the following year. Results 13 trainees attended (52%). Feedback on the day was graded as good/ very good (7/13) to excellent (4/13), 2 non responders. The use of individual laptops was particularly appreciated. 11 subsequently responded to the online survey (92%). All found the day useful. 3/11 (27%) intended to offer CE as a skill for Consultant applications. Prior to the session only 1 attendee had reported any CE, their training was adhoc informal departmental learning. This increased to 3 attendees at 1 year follow up (27%). Of those who had not reported any CE subsequently, 63% cited the reason as lack of the service at their current/ previous placement, whereas 38% had opportunity, but limited training time to do so. Trainee requests for CE after the training day increased by 27%, the majority of requests for iron deficiency anaemia. 56% of trainees felt a regional or national course such as this should be mandatory for all trainees and form part of core competence expected for CCT. Conclusion Regionally delivered CE training as part of specialist training programme offers a unique opportunity for CE training in a group environment, until now only available commercially. UK trainess should have access to such training as part of their structured specialist training programme. Disclosure of interest None Declared.

Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding?

Capsule endoscopy (CE) is currently recommended as the first-line study in the evaluation of obscure gastrointestinal bleeding (OGIB), while computed tomography (CT) is often thought of as complementary to CE. This study evaluated CT as a first-line study in OGIB and compared it with CE. Ninety-nine patients with OGIB who received both CE and CT were included. CT included conventional CT and CT enterography (CTE). Patients were divided into two groups: the CT before CE group (CT first group n=75) and the CE before CT group (CE first group n=24). The two groups were compared retrospectively. Overt OGIB was present in 92% of patients. Mucosal lesions (46%) were the most common diagnoses, while tumors accounted for 7%. The diagnostic yield of CE was significantly higher than that of CT for both groups (CT first group, p<0.001; CE first group, p=0.013). In the CT first group, the diagnostic yield using both CT and CE (48/75; 64%) was significantly higher than that for CT alone (12/75; 16%, p=0.005). In the CE first group, the diagnostic yield with both CT and CE versus CE alone was 70.9% versus 62.5%, respectively, with a significant difference (p=0.045). There was no significant clinical difference associated with the order in which the tests were performed. However, CE and CT, when used together, had a significantly greater diagnostic yield than did CE or CT when used alone.

Capsule Endoscopy or Angiography in Patients With Acute Overt Obscure Gastrointestinal Bleeding: A Prospective Randomized Study With Long-Term Follow-Up

Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram. Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality. A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P = 0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P = 0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality. In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.

Endoscopic capsule placement improves the completion rate of small-bowel capsule endoscopy and increases diagnostic yield

The methods for increasing the rate of complete small-bowel examinations by capsule endoscopy (CE) demonstrate conflicting results, and it is unknown whether improving the completion rate of CE transit is correlated with improvement in diagnostic yield. The aim of this study was to determine whether a higher rate of complete small-bowel examinations results in a higher diagnostic yield of CE. Case-control comparison. Tertiary care university hospital. A total of 273 patients underwent conventional CE (group A), and 261 patients underwent real-time CE (group B). Furthermore, the patients in groups A and B were divided into 2 subgroups by pyloric transit time (A1, A2 and B1, B2, respectively). After swallowing the capsule, each patient was monitored with a real-time viewer in group B, and the patients underwent endoscopic placement if the capsule was delayed in the esophagus or stomach. Pyloric transit time, small-bowel transit time, the rate of complete small-bowel examinations, and the diagnostic yield. The rate of complete small-bowel examinations was significantly higher in group B than in group A (87.4% vs 78.0%, respectively; P = .004). The diagnostic yield was significantly higher in group B2 than in group A2 (60.0% vs 41.7%, respectively; P = .019). Nonrandomized study. Endoscopic placement improves the rate of complete small-bowel examinations, resulting in a higher diagnostic yield of CE.

Effect of erythromycin on image quality and transit time of apsule endoscopy: A two-center study

To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. We conducted a retrospective, blinded (to the type of preparation) review of 100 CE studies, 50 with no preparation with prokinetics from one medical center (Group A) and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B). Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. The erythromycin group had a slightly shorter gastric transit time (21 min vs 28 min, with no statistical significance). SB transit time was similar for both groups (all P > 0.05). Total transit time was almost identical in both groups. The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37). Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P > 0.05). Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.

Wireless Capsule Endoscopy for Evaluation of Phenotypic Expression of Small-Bowel Polyps in Patients with Peutz-Jeghers Syndrome and in Symptomatic First-Degree Relatives

Peutz-Jeghers syndrome (PJS) is an inherited gastrointestinal hamartomatous polyposis disorder. Small-bowel intussusception and bleeding are the most common complications, and malignancy may also occur. Survey of the gastrointestinal tract, particularly of the small bowel, is difficult and current recommendations for management syndrome are ambiguous. We evaluated the feasibility of capsule endoscopy for identifying phenotypic expression of small-bowel polyps in patients with full-blown PJS and a previous diagnosis of gastrointestinal polyposis, and in symptomatic kindred of PJS patients with no previous diagnosis of gastrointestinal polyposis. Two groups were studied: group A consisted of 14 patients with gastrointestinal polyposis, eight of whom had undergone previous small-intestine surgery; group B consisted of six symptomatic first-degree relatives of PJS patients; these patients had previous negative gastrointestinal endoscopic examinations. Numerous polyps were detected in all patients in group A. Most polyps were sessile, but the larger polyps tended to be pedunculated. Polyp density was highest in the jejunum (greater than in the ileum and duodenum). Seven patients had at least one large polyp (> 11 mm) and five of these patients subsequently underwent enteroscopy, which revealed that capsule endoscopy had correctly identified all the patients with large polyps, but had missed 20 % of the total number of large polyps in these patients. No polyps were detected by capsule endoscopy in group B patients, despite the excellent visualization of the small intestine. In all patients, the capsules were expelled within 24 hours, without complications, and the procedure was well tolerated. Capsule endoscopy is an effective and well-tolerated method for evaluating small-bowel pathology in patients with PJS.

Capsule Endoscopy: Improving the Transit Time and the Image View

Background: The capsule endoscopy (CE) record video images during natural propulsion through the small bowel. Practical experience has shown that visualization of the entire small bowel mucosa may sometimes be hindered by the presence of residual material. Shorting the transit times of the CE through the stomach and small bowel might help the time needed to read the CE as well the short life of the CE battery(7±1 hours) and may be insufficient to image the entire small bowel. Aims: To evaluate the effect of various methods of small bowel preparation on the quality of visualization of the entire small bowel mucosa. Material and Methods:. 95 patients underwent CE by easily swallowing the capsule. They were divided into three study groups according to the preparation used. Group A (n = 26) by polyethylene glycol liter (PEG) or with sodium phosphate (SP) 12 hours prior to the CE study. Group B (n = 29) by Erythromycin one hour prior to the CE study and Group C (n = 40) with no preparation. One (1.05%) case had no natural excretion. Visualization ranged from good through satisfactory and poor. Results: The mean emptying gastric time was 41.7±51.5 minutes and the transit time of the small bowel was 225±80.6 minutes. In elderly people the emptying gastric time was significantly longer (163.7 min.), in patient prepared by PEG or SP (P 0.05) compare to the other preparation. The gender and the presence pathology had no effect on the study group The grade of the cleaning of the all study group was 3.27±1.1, the worst quality of image were significantly (P= 0.05) in the Erythromycin group compare to the other sub-group. The age, gender and the presence pathology had no effect on the quality of the cleaning of the small bowel study group. One (1.05%) case had no natural excretion. Visualization ranged from good through satisfactory and poor. Conclusions: Erythromycin have shorter time in the stomach but have a negative effect on the quality of the image in the small bowel. The preparation with in PEG or SP have a negative effect on the transit time of the small. The quality of the visualization in Erythromycin group was the worst.