Video Capsule Endoscopy Procedures Research Articles

Video Capsule Endoscopy after Bariatric Surgery: A Tertiary Referral Center Experience

Background and Aim: Minimal data are available regarding the performance of video capsule endoscopy (VCE) in patients who underwent bariatric surgery. We aimed to report indications, feasibility, and safety of VCE performed after bariatric surgery, specifically focusing on diagnosis rates of Crohn’s disease (CD) in this population. Methods: A retrospective analysis of all VCE procedures was performed between January 2015 and December 2019. All patients who underwent bariatric surgery prior to VCE were included. Indication for VCE, ingestion methods, completion rates, retention rates, and endoscopic findings were recorded. Results: A total of 1,255 patients underwent VCE examination during the study period, of which 31 (2.5%) underwent bariatric surgery prior to VCE. The most common bariatric surgery was laparoscopic sleeve gastrectomy (16 patients, 51.6%), and the most common indication for VCE was evaluation of iron deficiency anemia (14 patients, 45.1%). The majority of patients ingested the capsule independently, without endoscopic assistance (20, 64.5%). Although a patency capsule was not used in our cohort, no events of capsule retention were documented. Mean transit time was 4.32 h. Only 4 events of incomplete examination were recorded. Over a median follow-up of 27.5 months (IQR 13.0–34.2), 10 patients (31.2%) had a final diagnosis of CD with a median Lewis score of 225 (IQR 135–900). Conclusion: VCE is a feasible and safe procedure after bariatric surgery. Oral ingestion does not carry risk of retention. It is an effective means of diagnosis of small-bowel CD in this population.

A112 VIDEO CAPSULE ENDOSCOPY REGISTRY OF ONTARIO (VCERO) - RETROSPECTIVE PHASE (NORTHERN ONTARIO REGION)

AimsThe primary aim of this project is to determine the feasibility of establishing and maintaining a registry of all video capsule endoscopy procedures performed at a large regional center. Secondary aims include the determination of indications for capsule endoscopy, quality measures, and procedural outcomes at a large regional center and the comparison of these metrics to other locations globally.MethodsA retrospective collection and analysis of all video capsule endoscopies performed at Health Sciences North in Sudbury Ontario between 2016 and 2020 has been performed. Information was collected with the aid of a standardized data collection tool and stored under anonymized patient profiles. Once this pilot registry was created, data was pooled for further analysis. Data regarding indications for capsule endoscopy, patient factors, previous investigations, anticoagulant usage, procedure interpretation, need for subsequent interventions, and need for blood transfusion among others was then established for this group. Findings were then compared to previously published regional and global norms where available.ResultsIn total 98 video capsule endoscopies encompassing 94 individual patients have been catalogued at the end of the study period. With available information through individual patient records, complete information for all fields of the standardized collection tool was obtained for 91 individual patients. The most common indications for VCE include gastro-intestinal bleeding (38%), anemia (38%), Crohn’s disease (13%) and abdominal pain (3%). In total, 45% of all procedures noted an acute finding in the report. Of VCE performed for gastro-intestinal bleeding, 50% reported on an acute finding while in those performed for anemia, 47% reported on an acute finding. Mortality during the study period was 12% while there was 1 documented incident of capsule retention. The rate of acute findings is greater than previously published international studies.ConclusionsThis project has established the feasibility of the creation of a regional capsule endoscopy registry. Further work to expand the patient pool as well as move to a prospective collection model are reasonable next steps to expand this project. We have also demonstrated significant differences regarding indications for VCE as well as the rate of significant findings of VCE of a our northern cohort compared to previously reported international sites. In particular the high rate of significant findings in anemia warrants further investigations.Funding AgenciesNone

Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis

BackgroundA full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades.MethodsSystematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses.ResultsIn total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI] 0.59–0.89%), 0.75% (95% CI 0.43–1.13%), 0.00% (95% CI 0.00–0.00%), 0.94% (95% CI 0.65–1.28%), 0.67% (95% CI 0.32–1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (− 0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time (P = .0006 and P < .0001)..ConclusionsVCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).

Clinical features of capsule endoscopy in 825 children: A single-center, retrospective cohort study.

Video capsule endoscopy (VCE) can detect mucosal lesions in the intestine, especially in the small bowel.Our study aims to evaluate the applications of VCE for pediatric gastrointestinal diseases.In this retrospective study, we included all patients who underwent VCE between December 2012 and December 2018. Clinical information and VCE data were analyzed.Among 828 patients, the completion rate was 99.6% (n = 825), with an average age of 10.2 ± 3.3 years old. A total of 459 VCE procedures showed abnormalities, and the overall diagnostic yield was 55.6%. The most common indications for VCE were abdominal pain among 505 (61.2%) patients and hematochezia (10.1%) among 83. Among the positive results of VCE, small bowel ulcers accounted for the highest percentage (57.7%), of which 164 cases were diagnosed as inflammatory bowel disease. For obscure gastrointestinal bleeding, 12 cases were diagnosed as Meckel's diverticulum. In terms of the small bowel transit time of VCE, compared with the negative group [288 (216.5, 390.3) min] and the enteritis group [277 (192.5, 374.8) min], a longer transit time was needed in the small bowel ulcer group [332.5 (240, 451.5) min, P < .01]. There were no correlations of positive VCE findings with anemia, the white blood cell count, the C-reactive protein level or the small bowel transit time according to Spearman rank analysis.VCE is relatively well tolerated and safe in children and has great value for the diagnosis and treatment of abdominal pain, especially inflammatory bowel disease and obscure gastrointestinal bleeding.

1952 Safety of Capsule Endoscopy During Pregnancy

INTRODUCTION: Currently there is limited literature on the safety of Video Capsule Endoscopy (VCE) during pregnancy. There is a theoretical risk of the growing uterus compressing the GI tract. Moreover the gastrointestinal transit is prolonged in the second and third trimester which may jeopardize VCE procedure. We hereby report a case of a pregnant patient who safely underwent a VCE without retention. CASE DESCRIPTION/METHODS: A 30 years old female who was 18 weeks pregnant with a history of myeloproliferative disorder and splenic vein thrombosis presented with hematemesis. She underwent an EGD that demonstrated type 1 isolated gastric varices without active bleeding that was doubted as the source. Colonoscopy found old blood in the terminal Ileum and the ascending colon. She was started on a beta-blocker for variceal bleeding prophylaxis. The patient was informed that there is limited literature on safety of VCE in pregnancy with a theoretical risk of capsule retention. As such pregnancy is deemed a relative contraindication to VCE. Therefore patient decided to pursue clinical monitoring. One week later the patient returned with similar symptoms. During this admission the manufacturer of the capsule was unable to provide any safety data as it had not been studied in pregnant patients. The Obstetrics (OB) service discussed the risks and benefits of VCE during pregnancy. The risk of a retained capsule is that it may require an x-ray of the abdomen and/or surgery. The patient was currently in the 2nd trimester which is the usual recommended trimester for any necessary surgery. Moreover the gestational age was beyond embryogenesis and per ACOG recommendations x-ray should be completed for maternal well-being. Since there were no safer alternatives and maternal wellbeing supersedes fetal health, VCE was performed. It found a small duodenal erosion but otherwise passed into the colon and was a normal examination of the small bowel. Hence recurrent bleeding was attributed to known gastric varices. She is now in her 30th week, following up with OB and per their review the fetus is doing well. She has had no more admissions for gastrointestinal bleeding. DISCUSSION: Elective VCE in pregnant patients should ideally be postponed until after delivery due to a lack of safety data. Nevertheless, VCE may be considered in indications related to maternal symptoms that put the mother or child at risk, such as small bowel bleeding. Accordingly, the FDA has assessed pregnancy as a relative contraindication to VCE.

Pooled Analysis of the Efficacy and Safety of Video Capsule Endoscopy in Patients with Implantable Cardiac Devices.

Background To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing “capsule endoscopy” AND “pacemaker”, “defibrillator” OR “left ventricular assist device” as keywords, were selected. Studies performed in vitro, isolated case reports, and abstracts/posters were excluded. Results A total of 735 VCE procedures were performed in patients with cardiac devices in various clinical settings. Cardiac events were not seen in any case. Interference on capsule images transmission was noted in 5 cases (left ventricular assist device (LVAD)) where few images were lost when the capsule was closest to the device. Finally, interference between capsule and telemetry leads was noted in 6 cases (4 Permanent Pacemakers (PPM), 2 Implantable Cardioverter-Defibrillator (ICD)) leading to image artifacts. Discussion Adverse cardiac events were not seen in any study. Loss of images occurred when the VCE was in proximity to the device (only with LVAD) or after telemetry leads installation without affecting the completion rate and diagnostic yield of VCE. Conclusion VCE is safe and remains efficient in patients with cardiac devices. If cardiac monitoring is required, wired systems are preferable.

High Concordance between Trained Nurses and Gastroenterologists in Evaluating Recordings of Small Bowel Video Capsule Endoscopy (VCE)

Background &amp; Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming.A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations.Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded.Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients.There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference: -79.6%).Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure.

High concordance between trained nurses and gastroenterologists in evaluating recordings of small bowel video capsule endoscopy (VCE).

. The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming. A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations. This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as "thumbnails" and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded. A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 +/- 12 years, range: 27-86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference: -79.6%). Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure.

Initial experience of video capsule endoscopy at a tertiary center in Saudi Arabia.

Background/Aim:No prior experience with video capsule endoscopy (VCE) has been published from Saudi Arabia. In this study, we aim to report the first Saudi experience with VCE.Patients and Methods:A prospective study was conducted between March 2013 and September 2017 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Eligible patients underwent VCE and their data (age, sex, indication for VCE, type of obscure gastrointestinal bleeding [OGIB: overt vs occult], VCE findings, and complications) were recorded. Approval was obtained from the institutional ethics board before the study began and all patients provided verbal and signed consent for the procedure. The procedure was performed according to the established guidelines.Results:During the study period, a total 103 VCE procedures were performed on 96 patients. Overall, 60 participants (62.5%) were male (mean age, 58.8 years; range, 25–97 years) and 36 (37.5%) were female (mean age, 52.8 years; range, 18–78 years). The most frequent indication for VCE was OGIB (n = 91, 88.35%; overt, n = 46, 50.55%; occult, n = 45, 49.45%). Other indications were suspected Crohn's disease (n = 4, 3.88%), suspected complicated celiac disease (n = 4, 3.88%), and unexplained chronic abdominal pain (n = 4, 3.88%). The VCE results were categorized as incomplete (n = 2, 1.94%), poor-quality (n = 7; 6.8%), normal (n = 39, 37.86%), and abnormal (n = 55, 53.4%). The completion rate was 98.06% (n = 101), and the overall diagnostic yield was 53.4%. Of the 55 patients with abnormal VCE results, 43 (78.2%) had small bowel (SB) abnormalities and 12 (21.8%) had abnormalities in the proximal or distal gut. The most frequent SB abnormalities were angiodysplasia (n = 22, 40.0%) and tumors (n = 7, 12.7%).Conclusion:The diagnostic yield of VCE for Saudi patients with OGIB is comparable to that reported internationally; however, data for other VCE indications, including inflammatory bowel disease, are still lacking.

Incidence of small bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy.

Background and study aims Lynch syndrome (LS) patients have an increased risk of small bowel cancer. The question is whether surveillance will lead to early detection of (pre)malignant lesions. We recently reported on prevalence of small bowel neoplasia (SBN) in LS patients as assessed by video capsule endoscopy (VCE). The aim of this prospective study was to determine the incidence of SBN. Patients and methods Asymptomatic LS patients who underwent a VCE were invited to undergo a second VCE procedure 2 years later. If abnormalities or polypoid lesions larger than 1 cm were detected, subsequent endoscopic procedures were performed. Results A total of 155 (78 %) of the initial 200 patients underwent a second VCE procedure after a mean of 2.2 (range 1 – 6) years. In 17 of the 155 (11 %) patients possibly significant lesions were detected, which required further investigation by means of gastroduodenoscopy (n = 8) or balloon-assisted endoscopy (n = 9). These procedures revealed no SBN. Conclusion No SBN was found after 2 years. Surveillance of the small bowel by VCE does not seem to be warranted in asymptomatic LS patients.

Bowel preparation in "real-life" small bowel capsule endoscopy: a two-center experience

BackgroundVideo capsule endoscopy (VCE) is an established diagnostic tool for the investigation of small bowel (SB) pathology. Bowel preparation prior to VCE may improve visualization, transit time, and diagnostic yield. We aimed to evaluate the “real-life” experience comparing two different preparation protocols in patients undergoing SB VCE.MethodsWe performed a retrospective analysis of prospectively collected data from SB VCE procedures, performed in two tertiary care medical centers in Israel. VCE procedures performed at “Sheba Medical Center” used a 2-L polyethylene glycol (PEG) bowel preparation (n=360) while VCEs performed at “Rambam Health Care campus” used a clear liquid diet plus 12-h fast protocol (n=500). A dichotomous preparation scale (adequate, inadequate) was used to classify cleansing quality. Data collection included patient and procedural details. The proportion of VCE procedures with adequate bowel preparation and the overall positive SB findings in the two different bowel preparation protocols were evaluated.ResultsSB completion rates were higher in the PEG protocol (96% vs. 83%, P<0.001) and SB passage time was significantly faster in the PEG protocol (mean 217±73 vs. 238±77 min, P<0.001). Bowel preparation quality was similar between groups (8% vs. 7% inadequate preparation, P=0.591). Overall positive SB findings were similar between the two groups (57% clear liquid fasting only vs. 51% PEG protocol, P=0.119).ConclusionIn this large cohort, a 2-L PEG protocol had similar preparation quality and diagnostic yield compared with clear liquid fasting.

Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding.

To assess whether video capsule endoscopy (VCE) affects the outcomes of left ventricular assist devices (LVADs) recipients with gastrointestinal bleeding. This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding (OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study. Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients (n = 12). The most common finding was active small intestinal bleeding (50%) and small intestinal angiodysplasia (33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study (50.0% vs 55.6%, P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed (50% vs 50%, P = 1.00). VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.

Accuracy of trained nurses in finding small bowel lesions at video capsule endoscopy.

The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.

PTH-180 Small Bowel Ultrasound and Video Capsule Endoscopy: Complimentary Investigations to Diagnose Small Bowel Crohn’S Disease

IntroductionCrohn’s disease affecting the small intestine requires accurate localization, assessment and follow up, to direct and monitor therapy. Video capsule endoscopy (VCE) has an established role in small bowel Crohn’s...

Use and Misuse of Small Bowel Video Capsule Endoscopy in Clinical Practice

Video capsule endoscopy (VCE) was introduced into the United States in 2000 and has significantly advanced the ability to visualize the small intestinal mucosa by using noninvasive technology. Compared with traditional imaging with small bowel barium imaging, the use of VCE has demonstrated the ability to enhance diagnostic yield in patients with suspected small bowel pathology by approximately 25%‐50% in patients with suspected small bowel disorders. 1‐3 Although the use of VCE has been recommended as the next step in patients with obscure gastrointestinal hemorrhage after a negative upper and/or lower endoscopic examination, 4 its use in other clinical scenarios such as small bowel inflammatory disorders may not be associated with similar diagnostic yields. The major complication associated with the use of VCE remains small bowel retention. Although the risk of this event is virtually nil in patients with obscure bleeding, it can approach 10% in patients with known inflammatory bowel disease (IBD). 5 A critical appraisement of appropriate use of this technology may help physicians and third-party payers to determine which subset of patients with suspected or known small bowel disorders would benefit the most from undergoing a VCE procedure. To critically examine the use of VCE in clinical practice, an evidence-based approach was performed by using the GRADE system, 6,7 and a critical review of the literature on capsule endoscopy was performed by using PubMed, SCOPUS, and the Cochrane Database from 2000‐2012. The quality of evidence could range from high (implying that further research was unlikely to change the authors’ confidence in the estimate of the effect) to moderate (further research would be likely to have an impact on the confidence in the estimate of effect) or low (further research would be expected to have an important impact on the confidence in the estimate of the effect and would be likely to change the estimate). The strength of a recommendation was graded as strong when the desirable effects of an intervention clearly outweigh the undesirable effects and as conditional when there was uncertainty about the tradeoffs. The evidence-based statements generated from this review are shown in Table 1. Studies including more than 20 patients were included for each topic to increase data quality when metaanalyses or randomized controlled trials were not available.

PTU-151 Small bowel ultrasound: diagnostic yield in established small bowel Crohn's disease

IntroductionCrohn's disease is an intestinal inflammatory disorder which frequently involves the small intestine. Accurate localisation of disease is important to direct targeted therapy. Video capsule endoscopy (VCE) has revolutionised clinical...

972 Small Bowel Ultrasound: Diagnostic Yield in Established Small Bowel Crohn's Disease

Introduction Crohn9s disease is an intestinal inflammatory disorder which frequently involves the small intestine. Accurate localisation of disease is important to direct targeted therapy. Video capsule endoscopy (VCE) has revolutionised clinical assessment of small intestinal Crohn9s disease. Small bowel ultrasound (SB USS) is a rapid, inexpensive, interactive and non-invasive alternative method for assessing small bowel Crohn9s disease, which is in routine use only at selected UK institutions. We evaluated the diagnostic yield of SB USS in VCE determined Crohn9s disease. Methods A retrospective assessment of patients who had undergone VCE in 2008–2010 was carried out. Patients investigated for suspected small bowel Crohn9s disease, or who had findings of small bowel Crohn9s on VCE were included, if they had also had a SB USS within 12 months. VCE findings were graded as mild (aphthous ulcers only), moderate (aphthous ulcers with mucosal distortion) or severe (aphthous ulcers with mucosal distortion and strictures/stenosis). SB USS was graded positive or negative for small bowel Crohn9s disease. Both assessments were single operator. Either investigation could predate the other. Results were expressed as sensitivity, specificity, positive and negative predictive value (PPV and NPV) of SB USS compared with VCE for detection of small bowel Crohn9s. Sub-analysis of SB USS findings for VCE-defined severity of small bowel Crohn9s disease was carried out. Results 196 VCE procedures were reviewed, of which 22 fulfilled the inclusion criteria. 10 patients had SB Crohn9s on VCE; this was detected in four patients by SB USS (sensitivity 40%). 12 patients had no evidence of SB Crohn9s on VCE; none of these had SB USS findings of Crohn9s disease (specificity 100%). Of 18 patients with no evidence of SB Crohn9s on SB USS, VCE findings of Crohn9s disease were apparent in 6 patients (negative predictive value 67%); however, all patients with positive findings of Crohn9s disease on SB USS had evidence of SB Crohn9s on VCE (positive predictive value 100%). Sub-analysis for severity of inflammation on VCE was carried out. Of four patients with positive findings at SB USS, 3 were severe and one moderate on VCE. One patient with severe Crohn9s on VCE was missed by SB USS; however, the patient9s body habitus was unfavourable. Conclusion SB USS has excellent positive predictive value (100%) and specificity (100%) for detection of SB Crohn9s disease, with only moderate negative predictive value (67%). In addition, all detected cases were moderate or severe, which may complicate VCE. It therefore seems a safe, quick, relatively cheap initial investigation in expert hands, which may obviate more costly, invasive investigations. A prospective evaluation of these diagnostic modalities should be carried out. Competing interests None declared.

Retention of Capsule Endoscopes in a Patient after Roux-en-Y Gastric Bypass: A Case Report

Purpose: Video Capsule Endoscopy (VCE) is an important tool for minimally invasive evaluation of the small bowel (SB). Complication rates remain relatively low and few major contraindications have been identified. Currently the main complication of VCE is capsule retention, and retention at all levels of the gastrointestinal tract has been reported. Methods: Here we present the first case of capsule endoscope retention in a patient status post Roux-en-Y gastric bypass. Results: Case Presentation: A 50-year-old woman with a history of morbid obesity, status post Roux-en-Y gastric bypass, who presented to GI clinic for evaluation of iron deficiency anemia. Upper endoscopy and colonoscopy were performed without detection of significant pathological findings, and she was subsequently referred for VCE. The first study was incomplete as the capsule remained at the gastro-jejunal anastamosis. The patient underwent a repeat VCE procedure 2 weeks later. This study too was incomplete as the second capsule remained at the anastamotic site. Approximately 45 days post-procedure the patient successfully underwent upper endoscopy for retrieval of both capsule endoscopes. Upper endoscopic examination additionally showed a gastric pouch of about 4 to 5 cm, with significant narrowing of the outlet into the SB. The patient tolerated the procedure well without further complications. Conclusion: Video capsule endoscopy remains the preferred endoscopic imaging method of the SB with overall low complication rates. This case illustrates the importance of appropriate patient selection and evaluation of the functional patency of the gastrointestinal tract in patients with previous gastric bypass surgery. Utilization of radiographic imaging modalities such as SB follow-through to delineate the anatomy of the GI tract, or patency capsule to assess functional patency prior to VCE may be beneficial in this setting. Endoscopic deployment of the capsule endoscope should be more aggressively utilized in those patients with significant distal narrowing. Such interventions will become especially important in bariatric surgery patients as gastric bypass gains popularity among a growing population suffering from morbid obesity.

Enhancing Video Capsule Endoscopy: Location and Bleeding Detection

Video capsule endoscopy (VCE) is a method used to wirelessly scan the gastrointestinal (GI) tract lumen. Despite the effectiveness of VCE in GI endoscopic procedures, VCE is limited because it lacks the capability to exactly locate itself as well as accurately detect bleeding or clotting within the GI tract. The unreliability of localization combined with inaccurate blood detection in VCE ultimately leads to wired endoscopy for additional diagnosis. In this paper, a method to address localization of the VCE device, also known as a pill camera or capsule, in conjunction with an accurate detection of active bleeding and clotting inside the small intestine, is introduced. The Texas Instruments, ZigBee® kit, which uses a 3D trilateration method will be used for accurate location detection and image transmission throughout the VCE procedure. The system will be interfaced with software providing end users with the path and total distance traveled by the pill capsule within the small intestine. The blood detection system is enhanced by using a minilow energy wireless Raman spectrometry to scan for active bleeding or clots along the small intestinal wall. The employed spectrometry method scans for wavelengths based on blood’s optical characteristics and records any image fitting the exact spectrum. Blood detection and localization data are coupled together and then transferred to an external receiver. These two improvements together will enhance capsule endoscopy procedures and fill the gap created by the existing capsule endoscopy technologies, therefore, meeting the needs of physicians and patients.

USEFULNESS OF DOUBLE BALLOON ENTEROSCOPY AND VIDEO CAPSULE ENDOSCOPY FOR THE DIAGNOSIS AND MANAGEMENT OF PRIMARY FOLLICULAR LYMPHOMA OF THE GASTROINTESTINAL TRACT IN ITS EARLY STAGES

The aim of this study is to evaluate the usefulness of double balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in patients with primary follicular lymphoma (FL) of the gastrointestinal (GI) tract. Furthermore, we estimate the effectiveness of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) including rituximab for them. Thirteen consecutive patients who were diagnosed of having FL in the duodenum between July 2005 and September 2008 were studied. All patients were given the conventional staging examinations, including total enteroscopy using DBE and/or VCE procedures. Chemotherapy was performed after written informed consent. Response assessment was performed every 6-12 months. The median follow-up period was 30.2 months. FL was diagnosed in each patient as low grade (grade 1, n = 7; 2, n = 6) and, in all but 4 patients, localized lymphoma (stage I, n = 8; II(1), n = 1; II(2), n = 4). DBE revealed multifocal lesions in the jejunum in 10 of the patients, and in the ileum in 6. VCE showed similar findings in the jejunum in the recent 2 patients. Eleven of 13 patients finally received chemotherapy, and all of them achieved complete regression. They showed no evidence of recurrence after that. Total examination of the small intestine using DBE should be performed before treatment to choose a suitable treatment procedure for primary FL of the GI tract. On the other hand, VCE is useful for screening and following the small intestine in the patients with it. Chemotherapy is effective to achieve complete regression of primary FL of the GI tract.