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PubMed2006

Evolving diagnostic strategies for inflammatory bowel disease.

Advances in serologic markers, endoscopy, and radiology have led to rapid expansion of diagnosis and disease activity assessment of inflammatory bowel disease (IBD). Serologic markers may have diagnostic value in patients with an intermediate pretest probability of IBD, but these serology tests lack complete sensitivity, and a negative serology result does not exclude the possibility of IBD. Several recent studies have confirmed the utility of serologies in predicting intestinal complications and need for surgery in Crohn's disease. Serum C-reactive protein concentrations correlate with clinical, endoscopic, and radiologic measures of disease activity and appear to have prognostic value in acute severe colitis. Capsule and double balloon endoscopy allow visual inspection of previously inaccessible areas of the small intestine and are useful for patients with suspected small bowel involvement but negative results on conventional testing. CT enterography, which entails oral ingestion of a large volume of a neutral or negative contrast agent and scanning that highlights differences in contrast between the lumen and the bowel wall, appears to be more sensitive than small bowel follow-through for detecting small bowel Crohn's disease and provides extraluminal information. Magnetic resonance enterography uses principles similar to those for CT enterography, and early results are encouraging.

Capsule Endoscopy↗
PubMed2004

[Multiple angiodysplasia of the small intestine. A diagnostic and therapeutic challenge].

Small bowel bleeding is infrequent and presents a challenge to the clinician. Approximately 30-40% of gastrointestinal bleeding localized in the small bowel is due to angiodysplasia, a vascular malformation. We present the case of a patient with multiple angiodysplasia of the small bowel who required push enteroscopy and capsule endoscopy to establish the diagnosis. Treatment with subcutaneous octreotide was successful. In conclusion, in doubtful cases or in patients with persistent hemorrhage, capsule endoscopy can improve the diagnostic yield of enteroscopy in bleeding gastrointestinal vascular lesions such as angiodysplasia. Endoscopic treatment (laser coagulation) and drug therapy (somatostatin or analogs) are valid alternatives in inoperable or non-resectable cases.

Aged↗
PubMed2006

Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis.

PURPOSE: To prospectively evaluate the sensitivity and specificity of contrast material-enhanced and water-enhanced multidetector computed tomographic (CT) enteroclysis in depicting small-bowel neoplasms in symptomatic patients, with endoscopic, tissue, and follow-up findings as reference standards. MATERIALS AND METHODS: The study protocol was approved by the Human Research Committee of the institution, and all patients gave written informed consent. Two hundred nineteen patients (108 male, 111 female; age range, 17-98 years; mean, 53.1 years) with clinical suspicion of small-bowel neoplasm underwent contrast- and water-enhanced multidetector CT enteroclysis after normal findings of upper and lower gastrointestinal endoscopy. The prospective interpretations of CT enteroclysis results include evaluation of focal bowel wall thickening, small-bowel masses, small-bowel stenosis, mesenteric stranding, enlarged mesenteric lymph nodes, and visceral metastasis. Positive enteroclysis findings were compared with results of pathologic examination after surgical (n = 35) or endoscopic (n = 20) procedures. Negative results were compared with results of surgery (n = 8), enteroscopy (n = 15), capsule endoscopy (n = 14), and clinical follow-up (n = 127). Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated on a per-patient basis with 95% confidence intervals. RESULTS: Findings of CT enteroclysis were positive in 55 cases and negative in 164. The overall sensitivity and specificity in identifying patients with small-bowel lesions were 84.7% and 96.9%, respectively. The negative and positive predictive values were 94.5% and 90.9%, respectively. Findings of pathologic examination confirmed small-bowel tumor in 50 patients with carcinoid tumor (n = 19), adenocarcinoma (n = 7), lymphoma (n = 5), jejunal adenoma (n = 9), stromal tumor (n = 5), ectopic pancreas (n = 2), angiomatous mass (n = 2), or metastasis (n = 1). Five examinations resulted in false-positive findings. CONCLUSION: Contrast- and water-enhanced multidetector CT enteroclysis had an overall accuracy of 84.7% for depiction of small-bowel neoplasms.

Adolescent↗
PubMed1978

Jejunal biopsy with the Watson capsule and perforation in the elderly.

Details of jejunal biopsies using the Watson small intestinal biopsy capsule done from 1966 through 1976 at three centers in Liverpool were obtained. The only complications were jejunal perforation which occurred in 2 patients over 65 years of age, 1 of whom died. This increased risk in elderly does not appear to have been previously recognized and both cases are reported. Diagnostic yield in the age group over 65 is discussed. Stricter criteria in selection of these patients for biopsy are suggested. A period of in-patient observation after biopsy in those over the age of 65 may decrease the risks of perforation. In addition, the use of a pediatric capsule, ideally with controlled suction, may lessen the risk further. The use of duodenal biopsy via an endoscope may prove to be a useful additional technique in elderly patients.

Age Factors↗
PubMedDate not supplied

[Ileal carcinoid tumor manifesting as gastrointestinal hemorrhage and diagnosed with capsule endoscopy: Case report].

OBJECTIVE: To present a case of carcinoid tumor of the small bowel that produced hemorrhage and was identified by capsule endoscopy before surgery. INTRODUCTION: Carcinoid tumors of the small bowel are difficult to diagnose since most of them are asymptomatic and endoscopic examination by standard methods is not possible. Therefore they are rarely detected before a surgical procedure. METHOD: A review of the literature is done. Emphasis in the importance of early diagnosis due to its invasive tendency is also made. RESULTS: Male patient who had 3 episodes of malena along three years before hospitalisation. During this period three upper gastrointestinal endoscopies (EGD), three colonoscopies, two small bowel scintigraphies, one mesenteric angiography and one CAT scan were done before a capsule endoscopy was performed. This procedure revealed a tumor 0.8 cm diameter in the ileum, which was surgically resected. The pathological examination revealed carcinoid tumor invading the serosa. CONCLUSIONS: The carcinoid tumor is highly infiltrating, therefore early diagnose is mandatory. Since the capsule endoscopy makes possible the complete examination of the small bowel, it should be indicated in patients with gastrointestinal hemorrhage in whom EGD and colonoscopy are negative.

Capsules↗
PubMed2003

Endoscopic laser imaging of tissue perfusion: new instrumentation and technique.

BACKGROUND AND OBJECTIVES: New instrumentation, based on a previously established laser speckle perfusion imaging (LSI) technique is evaluated for its ability to capture and generate blood flow images during endoscopic surgery. STUDY DESIGN/MATERIALS AND METHODS: Investigations are detailed in an in-vitro blood flow model simulating physiological properties of vascularized tissue, and in-vivo in rabbit joint capsule tissue. RESULTS: In-vitro measurements showed a linear response of the instrument to blood flow in the range of 0-800 microl/minute, where data points were significantly correlated with an r(2) value of 0.96. In-vivo measurements showed a 58.7% decrease to the medial collateral ligament during occlusion of the femoral artery. CONCLUSIONS: Blood flow images demonstrate that the endoscopic LSI technique is capable of measuring relative tissue blood flow changes at high resolutions and rapid response times and incorporates well with endoscopic surgeries.

Animals↗
PubMed1989

Transurethral enucleation of benign prostatic hyperplasia.

A prostatic detaching blade for a new endoscopic method has been devised for transurethral resection of the prostate along the cleavage plane at the surgical capsule. After partial resection of the adenoma with the loop the remaining adenoma, except for a portion at the bladder neck, is detached from the surgical capsule under direct vision with the detaching blade. The remaining adenoma then is removed by the electric loop down to the detached surgical capsule. This method of resection has been performed in 200 patients with improvement of symptoms in all. Detachment of the adenoma along the surgical capsule always is possible, thereby defining the depth of resection and minimizing the risk of capsular perforation compared to standard transurethral prostatectomy.

Aged↗
PubMed2005

Capsule endoscopy: practical applications.

Few advances in the history of gastroenterology have made as dramatic an impact on the diagnosis of gastrointestinal disease as the development and rapid clinical implementation of wireless capsule endoscopy. Less than 4 years after the landmark publication, capsule endoscopy is widely considered an essential component of the diagnostic workup of obscure gastrointestinal bleeding, and its role is expanding in the diagnosis of small bowel diseases such as Crohn's disease. This review appraises the available literature and highlights practical aspects of capsule endoscopy of interest to the clinician. We discuss safety concerns, optimal preparation for the procedure, diagnostic utility as compared to conventional methods, indications for capsule endoscopy, and outcomes.

Abdominal Pain↗
PubMed2002

Wireless capsule endoscopy in a patient with obscure occult bleeding.

A case of obscure/occult bleeding in a 39-year old man with a 7-year history of chronic fatigue and iron-deficiency anemia is presented here. Esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and a magnetic resonance imaging small-bowel follow-through did not reveal any abnormalities. Multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the area of the lower jejunum and ileum were diagnosed only with capsule endoscopy. One ulcer located near the ileocecal valve was then biopsied during a repeat ileocolonoscopy, and the histology showed signs of Crohn's enteritis. The further treatment approach was changed, with medical treatment being initiated and intraoperative enteroscopy being averted. Wireless capsule endoscopy clarified the cause of the obscure/occult bleeding in this patient and contributed to the diagnosis and endoscopic imaging of an isolated Crohn's enteritis, which is the cause of bleeding in approximately 10 - 20 % of cases of occult bleeding.

Adult↗
PubMed2005

Capsule endoscopy findings in celiac disease associated enteropathy-type intestinal T-cell lymphoma.

Capsule endoscopy is a new technology developed to investigate diseases of the small intestine. It has been shown to be superior to current modalities such as small-bowel radiography and enteroscopy. We describe a patient with long-standing celiac disease who presented with abdominal pain, diarrhea, and weight loss, after many years on a gluten-free diet. The symptom complex and results from small-bowel radiography and computerized tomography raised concern about progression to lymphoma, and ultimately a laparoscopy and small-bowel resection were done for diagnosis. A capsule endoscopy was performed to assess the extent of the patient's enteropathy-type intestinal T-cell lymphoma after three cycles of chemotherapy. We report the first use of capsule endoscopy in the setting of celiac disease associated enteropathy-type intestinal T-cell lymphoma. These endoscopic findings are correlated with those from gross and microscopic pathology and barium small-bowel radiography.

Biopsy↗
PubMed2007

Value of wireless capsule endoscopy in patients with indeterminate colitis (inflammatory bowel disease type unclassified).

BACKGROUND: Wireless capsule endoscopy (WCE) can identify small bowel mucosal lesions not seen with other imaging modalities. This technique can therefore play an important diagnostic role in the evaluation of patients with inflammatory bowel disease type unclassified (IBDU). We report on a multicentric study whose objective was to evaluate the value of WCE to increase diagnostic accuracy in categorizing IBDU. METHODS: Thirty patients with IBDU and negative serology were included. WCE was performed with a standard Pillcam capsule. Outcome measures were classified as suggestive of Crohn's disease (CD) when -3 ulcerations were present. RESULTS: WCE displayed endoscopic features suggestive for CD in 5 patients. In 6 other patients, WCE was negative, but repeated ileocolonoscopy with biopsies performed during follow-up evaluation revealed CD in 5 and ulcerative colitis (UC) in 1 patient. UC was found in a seventh case at colectomy performed just after WCE. Eighteen patients remained with a diagnosis of IBDU 16 months on average after WCE. CONCLUSIONS: WCE is a potentially clinically useful technique for categorizing a subgroup of patients with IBDU, although negative WCE does not exclude further diagnosis of CD. Patients with negative WCE who remain IBDU at follow-up evaluation may belong to an original subgroup of IBD.

Adolescent↗
PubMed1998

Neuroendoscopic approach to intraventricular lesions.

OBJECT: The purpose of this study was to determine the efficacy of endoscopic treatment in patients with intraventricular tumors. METHODS: A series of 30 patients with endoscopically treated intraventricular lesions is reported. The lesions included seven colloid cysts, six astrocytomas, three subependymomas, two ependymomas, and one each of the following: pineoblastoma, pineocytoma/pineoblastoma (intermediate type), epidermoid cyst, pineal cyst, medulloblastoma, arteriovenous hemangioma, cavernoma, choroid plexus papilloma, pituitary adenoma, craniopharyngioma, melanoma, and germinoma. Total tumor resections, partial resections, biopsies, stent implantations, septostomies, and third ventriculostomies were performed. In two cases (two subependymomas > 2 cm in diameter), piecemeal endoscopic resection was ineffective because of the very firm consistency of the tumors. Therefore the endoscopic procedure was discontinued and the tumors were removed microsurgically. In the remaining cases the procedures were completed as planned. Even in the presence of difficulties such as poor orientation or significant bleeding, there was no need to abandon the endoscopic procedure. A total of 28 strictly endoscopic interventions were performed, in which the average duration was 85 minutes (range 35-170 minutes). All colloid cysts and the epidermoid lesion were completely evacuated and the capsules were widely resected. Total extirpation of solid tumors was achieved in five cases, whereas most astrocytomas were partially resected. The hydrocephalus-related symptoms resolved in all of the 22 patients with cerebrospinal fluid pathway obstruction. There were no endoscopy-related deaths. In two cases, major bleeding occurred and was controlled endoscopically. The authors observed one case of meningitis, one of mutism, two of memory loss attributed to forniceal injury, one of transient trochlear palsy after a biopsy specimen of an aqueductal tumor was obtained, and one of transient confusion after a biopsy specimen of a germinoma was obtained. CONCLUSIONS: In the authors' preliminary experience, the endoscopic approach was found to be safe and effective. In this series, it was possible to achieve relief of noncommunicating hydrocephalus, tumor resections, and even complete tumor removals by using endoscopic techniques. Based on the results, the authors believe that endoscopic techniques should be considered in the treatment of selected intraventricular lesions.

Adenoma↗