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PubMed2005

Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn's disease.

BACKGROUND: The diagnosis of small-bowel Crohn's disease sometimes is difficult and may be missed by conventional imaging studies. Capsule endoscopy might identify small-bowel disease undetected by other investigations. METHODS: Patients with or without known Crohn's disease who were suspected to have small-bowel Crohn's disease were prospectively evaluated with push enteroscopy, enteroclysis, and capsule endoscopy. Each examiner was blinded to results of other investigations. Referring doctors were required to complete questionnaires before and after the investigations. RESULTS: Twenty-two patients were known to have Crohn's disease (Group 1), and 21 were suspected to have small-bowel Crohn's disease (Group 2). In Group 1, capsule endoscopy detected more erosions than the other two investigations (p < 0.001). In Group 2, a new diagnosis of Crohn's disease was made in two patients, but there was no significant difference in yield compared with the other two investigations. Referring physicians rated the usefulness of capsule endoscopy as 4.4 on a scale of 5. Capsule endoscopy changed management for 30 patients (70%). CONCLUSIONS: Capsule endoscopy has a higher yield than push enteroscopy and enteroclysis in patients with known Crohn's disease when small-bowel mucosal disease is suspected, and this leads to a change in management in the majority of these patients.

Adolescent↗
PubMed2004

Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel.

OBJECTIVE: The Given Capsule procedure is a new system designed to aid the gastroenterologist in diagnosing small-bowel disease. Capsule endoscopy has provided gastroenterologists with easy access to small-bowel mucosa for examination by direct visualisation. The aim of our prospective study was to determine the indication for capsule endoscopy and to describe the identified pathology within the gastrointestinal tract. METHODS: Patients with unexplained gastrointestinal bleeding from suspected small-bowel pathology of an undisclosed nature or with unexplained abdominal pain for more than 6 months were eligible to undergo capsule endoscopy. Patients with suspected intestinal obstruction or with a history of major abdominal surgery were excluded. RESULTS: One hundred and sixty patients (70 women, 90 men; mean age 49.0 +/- 19.8 years, range 13-91 years) ingested the capsule easily. They had undergone 6 +/- 2.9 investigative procedures before capsule endoscopy. Two (1.25%) patients who had non-natural excretions underwent surgery: one was found to have Meckel's diverticulum and the other had stricturing Crohn's disease. The mean haemoglobin in iron-deficiency anaemia patients was 9.1 +/- 2.2 g%. The diagnostic yield of capsule endoscopy was 57.7% in iron-deficiency anaemia and 52.4% in suspected Crohn's disease. CONCLUSIONS: Capsule endoscopy detected the more clinically significant intestinal lesions. It was of diagnostic value in patients with obscure bleeding, suspected Crohn's disease and malabsorption, but the diagnostic yield in patients with chronic pain or irritable bowel syndrome-type symptoms was low.

Adolescent↗
PubMed2003

Wireless capsule endoscopy.

Gastroscopy, small bowel endoscopy, and colonoscopy are uncomfortable because they require comparatively large diameter flexible cables to be pushed into the bowel, which carry light by fibreoptic bundles, power, and video signals. Small bowel endoscopy is currently especially limited by problems of discomfort and failure to advance enteroscopes far into the small bowel. There is a clinical need for better methods to examine the small bowel especially in patients with recurrent gastrointestinal bleeding from this site.

Endoscopes, Gastrointestinal↗
PubMed2005

A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding.

BACKGROUND: Capsule endoscopy enables noninvasive diagnostic examination of the entire small intestine. However, sensitivity and specificity of capsule endoscopy have not been adequately defined. We, therefore, compared capsule endoscopy by using intraoperative enteroscopy as a criterion standard in patients with obscure GI bleeding. METHODS: Forty-seven consecutive patients with obscure GI bleeding (11 with ongoing overt bleeding, 24 with previous overt bleeding, and 12 with obscure-occult bleeding) from two German gastroenterologic centers were included. All patients who had a prior nondiagnostic evaluation, including upper endoscopy, colonoscopy with a retrograde examination of the distal ileum, and push enteroscopy, underwent capsule endoscopy followed by intraoperative enteroscopy. RESULTS: Capsule endoscopy identified lesions in 100% of the patients with ongoing overt bleeding, 67% of the patients with previous overt bleeding, and 67% of the patients with obscure-occult bleeding. Angiectasias were the most common source of bleeding (n = 22). Capsule endoscopy showed the source of bleeding in 74.4% of all patients. The method was more effective in patients with ongoing bleeding. Compared with intraoperative enteroscopy sensitivity, specificity, and positive and negative predictive values of capsule endoscopy were 95%, 75%, 95%, and 86%, respectively. CONCLUSIONS: Capsule endoscopy has high sensitivity and specificity to detect a bleeding source in patients with obscure GI bleeding. Thus, wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure GI bleeding.

Adolescent↗
PubMed2006

Arthroscopic psoas tenotomy.

Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months.

Arthroscopy↗
PubMedDate not supplied

Video wireless capsule endoscopy: a diagnostic tool for early Crohn's disease.

Crohn's disease is a chronic immune-mediated disease that affects any or all segments of the gastrointestinal tract, but is mainly found in the small intestines or colon. Crohn's disease in the early stages present with symptoms such as chronic diarrhea, abdominal pain, and weight loss that may mimic other conditions and cause a delay in diagnosis. Many patients experience emotional difficulties related to this debilitating disease. Current procedures used to visualize the small bowel for diagnosis of Crohn's disease include small-bowel follow through, enteroclysis, and computerized tomography, but do not provide definition of the mucosal surface. Clinical research shows us the diagnostic yield of these tests are not as high as once thought. A new diagnostic tool, the M2A Video Capsule, can be used to visualize the small bowel mucosa. With the detailed photo images provided by the capsule, the physician now has the ability to detect subtle changes in the mucosal lining that may be consistent with early Crohn's disease that were previously not available or identifiable. Earlier disease treatment and management may decrease the inflammatory changes that lead to bowel thickening and stricturing and have a positive impact on the patient's total quality of life.

Crohn Disease↗
PubMed2005

Diagnosis of small-bowel diseases in the era of capsule endoscopy.

Capsule endoscopy is a major breakthrough in gastrointestinal endoscopy and is a first-line tool to detect abnormalities of the small bowel, in up to 50% of patients, intestinal disorders are not associated with any physical findings or positive tests. Indications, yield and impact on patient management of this method of diagnosing small-bowel diseases are analyzed critically in light of current scientific knowledge.

Endoscopes, Gastrointestinal↗
PubMed1988

[Doxycycline esophagitis and esophageal ulcer].

Four cases of acute doxycycline injury of the esophageal mucosa--acute catarrhal doxycycline esophagitis and acute doxycycline ulcer are presented. The pathogenesis, clinical course, endoscopic pattern, prophylaxis and treatment of these complications of doxycycline treatment are discussed in detail. The gastroesophageal and duodenogastric reflux, which are most often the result of functional failure of the lower esophageal sphincter, are pointed out as the basic pathogenetic mechanism of the esophageal mucosa injury in oral doxycycline treatment.

Acute Disease↗
PubMed2005

Double-balloon endoscopy.

PURPOSE OF REVIEW: Our strategy for small intestinal diseases has dramatically been brushed up with a novel technique, double-balloon endoscopy, which exhibits extremely better insertability and maneuverability compared with conventional methods. Double-balloon endoscopy has a potential to change radically the approach for the small intestinal diseases in the future. In this article, the publications on double-balloon endoscope will be reviewed. RECENT FINDINGS: A double-balloon endoscope can be inserted into deeper portions of the small intestine via both oral and anal approaches, and allows endoscopic observation as well as treatment for the entire small intestine without general anesthesia. Reports have been made on this method's safety and low frequency of complication: it is very useful for diagnosis and treatment of small intestinal diseases, including small intestinal bleeding, small intestinal tumor, stenosis of small intestine, and polyposis syndrome. SUMMARY: The development of double-balloon endoscopy enabled observation and treatment in the entire small intestine. The double-balloon endoscopy has a potential to be a standard of enteroscopy by replacing conventional push enteroscopy and intraoperative enteroscopy. In the near future, the double-balloon endoscopy, together with the capsule endoscopy, will be essential modalities for the management of small intestinal diseases.

Endoscopy, Gastrointestinal↗
PubMed1989

[Experimental study of submucous vesical injections in rats. Teflon versus silicone].

Correction of vesicoureteric reflux by endoscopic subureteric injection of polytef paste is an expending procedure. But polytef past is thick, hard to inject and can migrate at distant sites of injection. We have tried a silicone paste on experimental studie observes tissue reaction at the site of injection (bladder) and in pelvic nodes, kidneys, liver, lungs, brain. 22 rats were injected: 8 with polytef paste, 14 with silicone paste. The study demonstrated that polytef paste sub mucosal injection is followed by migration nodes and local granulomatous reaction. The silicone paste is easier to inject; none particules of silicone were found in nodes nor in others visceria; granulomatous reaction and fibrous capsule around foreign body were smaller.

Administration, Intravesical↗
PubMed1998

A new guide system for posteromedial portal in arthroscopic knee surgery.

A view through the posteromedial portal is necessary to observe the posterior portion of the knee joint such as the tibial attachment of the posterior cruciate ligament (PCL) or the posterior horn of the medial meniscus, which is barely, visible through anterior portals. Especially in arthroscopic PCL reconstruction, the arthroscopic view through the posteromedial portal is indispensable for boring a tibial bone tunnel that is correctly sited. However, it is difficult to create this portal safely without cartilaginous or meniscal damage. We have produced new guidelines to facilitate the process of creating the posteromedial portal even by inexperienced hands. With a cannulated K-wire and a cannulated rod with sharp teeth, the joint capsule of the posteromedial corner can be penetrated safely with or without viewing the posteromedial corner through the anterolateral portal. Based on our experience of using this guide system, we believe it will be a great help to many orthopaedic surgeons in performing various types of arthroscopic surgery, not only for PCL reconstruction but also for arthroscopic synovectomy.

Arthroscopes↗
PubMed2006

Capsule endoscopy retention: is it a complication?

BACKGROUND: Capsule endoscopy has been found superior to barium x-rays and push enteroscopy in the investigation of obscure gastrointestinal bleeding and in the evaluation of suspected Crohn's disease. Currently, small bowel obstruction and strictures are considered by many physicians to be a contraindication to capsule endoscopy for fear of capsule retention or impaction. The goal of this study was to reassess this conventional wisdom that capsule endoscopy is contraindicated in small bowel obstruction and to determine the safety and efficacy of capsule endoscopy in the evaluation of patients with suspected stricture or small bowel obstruction. STUDY: A retrospective chart review was performed using a database of 568 capsule endoscopy cases performed between August 2001 and November 2003. Cases of suspected small bowel obstruction were selected and reviewed. RESULTS: Nineteen cases were identified in which capsule endoscopy was used in the setting of suspected small bowel obstruction. The diagnosis of suspected small bowel obstruction was based on symptoms alone in 8 cases and on symptoms plus abnormal radiographs in the remaining 11 cases. Capsule endoscopy made a definitive diagnosis in 5 of the 19 cases (26%): 2 Crohn's strictures, 1 radiation induced stricture, 1 nonsteroidal anti-inflammatory drug induced stricture, and 1 MALT lymphoma. The capsule was retained proximal to a stricture in 4 cases, in which the obstructing lesions were electively resected without complications. There was no case in which administration of the capsule led to an acute small bowel obstruction. CONCLUSIONS: Capsule endoscopy can be safely used to help identify the etiology and site of a small bowel obstruction. Retention of the capsule may indicate the presence of a lesion requiring surgery, but small bowel obstruction or strictures are not in themselves contraindications to the procedure. It is understood, however, that retention may lead to surgery in a patient who otherwise may have been treated medically without surgery for the same illness (eg, Crohn's disease and nonsteroidal anti-inflammatory drug enteropathy).

Adult↗
PubMed1994

Depth of penetration of the neodymium:yttrium-aluminum-garnet laser in the human prostate at various dosimetry.

OBJECTIVE: To determine depth of thermal penetration by the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser at various dosimetry in the human prostate and to compare results of two techniques of laser application, single spot versus whole tissue photoirradiation. METHODS: Twelve men with Stage T2 (B) cancer of the prostate consented to laser prostatectomy immediately prior to a planned radical prostatectomy. In the first 3 patients (group I) the prostate was treated with the Nd:YAG laser in one spot area of each lobe. The next 9 patients underwent photoirradiation of all endoscopically visible tissues on one side of the prostate at different dosimetries: 60 W at sixty seconds (group II), 50 W at sixty seconds (group III), and 40 W at ninety seconds (group IV). Depth of laser penetration was measured from both histologic and gross evaluations of removed specimens within twenty-four hours. RESULTS: Thermal necrosis in group I showed an inconsistent depth of penetration even with the same amount of laser energy. Groups II, III, and IV all demonstrated clearly demarcated areas of thermal necrosis. Group II showed the greatest depth of laser effect among all groups, with a mean depth of 1.75 cm. No laser effect is detected near the true capsule of the prostate on any specimen. CONCLUSIONS: High dosage laser energy application at 60 W and sixty seconds of pulse duration with the whole tissue treatment provide the greatest depth of penetration in the human prostate while maintaining safety for the capsular area.

Burns↗
PubMed2006

Endoscopic placement of radiopaque markers for focused evaluation of intestinal motility.

Using traditional techniques in novel ways often can improve management of common surgical problems. Additionally, established products may find new utility when deployed in a slightly different fashion to enhance patient care in a clinically relevant way. This article describes endoscopic placement of radiopaque markers into the proximal small intestine as a means to evaluate motility in a focused fashion. A method to delineate the location of dysmotility in a patient with several potential sites is described. This technique is safe, feasible, reasonably inexpensive, and is easily performed by a skilled endoscopist. Moreover, this technique has the added benefit of providing functional data in a timely fashion.

Capsules↗
PubMed1984

[A case of papillary adenocarcinoma of the prostate].

A relatively rare case of papillary adenocarcinoma of prostate is reported. The patient was a 49-year-old male. He presented with the chief complaints of micturition frequency, a feeling of residual urine and a burning sensation in urethra. There was no palpable abnormality in the prostate. Endoscopic examination revealed papillary tumors in the prostatic urethra and the anterior urethra, but no evidence of abnormality in the utricle. Both hematological examination and blood chemistry revealed no abnormalities; ACP, PACP and PAP were normal. The tumors were resected by TUR on March 8, 1982. Histopathological findings indicated papillary proliferation of single layer of columnar epithelium, with clear cytoplasm and nuclei with atypism distributed in the base. The tumors in the anterior urethra gave the same findings, and the diagnosis made was papillary adenocarcinoma which seemed to have originated from the prostatic duct. After operation, hormone therapy and chemotherapy with peplomycin were conducted. Eleven months after the operation, the remaining prostatic tissues including surgical capsule were resected as completely as possible. Histopathological findings revealed only atrophic prostatic tissues without any remaining tumor. The hormone therapy was discontinued. Presently, 19 months has elapsed since the first TUR. His micturition condition is good without evidence of recurrence or metastasis.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

Epiglottic augmentation in the horse.

Epiglottic augmentation with injectable bovine collagen or an autogenous or allogenous auricular cartilage graft was performed in 12 horses with endoscopically and radiographically normal epiglottises. The grafting procedures were easy to perform and did not cause apparent discomfort. Cartilage graft extrusion or resorption may have occurred, but was not seen by endoscopy and lateral laryngeal radiography. Only collagen implants remained evident endoscopically, as smooth round submucosal bulges ventral to the epiglottic cartilage. Two horses with collagen implants, and all horses with cartilage autografts and allografts, were euthanatized at week 16. One horse with a collagen implant was euthanatized at week 4 and one at week 6. The epiglottis appeared thickened in three horses with collagen implants, two horses with autogenous grafts, and three horses with allogenous grafts. Pharyngeal lymphoid tissue was hyperplastic in two horses with autografts and three horses with allografts, but not in horses with collagen implants. Collagen grafts persisted as one or two smooth bulges 8 mm in diameter. Collagen incited a brisk foreign body reaction that was surrounded by a fibrous connective tissue capsule. Epiglottises of the horses with collagen implants were significantly thicker 20 mm from the tip than those of normal horses and horses with allografts. Cartilage graft incorporation was not evident grossly and was seen on microscopic examination in only one autograft. Thickening was caused by submucosal fibrosis.

Animals↗
PubMed2004

[Video capsule endoscopy in a group of networked users: effective and cost saving].

BACKGROUND: At present extensive application of video capsule endoscopy (VCE) as the most innovative diagnostic tool for small bowel diseases is limited by its high costs. The present study describes the first experience in the mobile use of VCE in a cooperation of associated gastroenterology departments in different hospitals. METHODS: The VCE device was bought by a centrally located hospital. In the case of a need for VCE elsewhere the mobile equipment was brought to the respective hospital. The examination was done on site by local physicians, who additionally were responsible for the procedure itself. The evaluation of the VCE pictures was carried out exclusively by the Ophysicians of the central hospital. RESULTS: Within 15 months VCE was performed in 40 patients (19 male, 21 female; age 61 +/- 14 years). Ten examinations were performed in the central hospital, 30 in the associated gastroenterology departments of other hospitals. Indications for VCE were obscure GI bleeding (65 %), chronic diarrhea and Crohn's disease (17.5 %) or suspected small bowel neoplasms (17.5 %). Clinically relevant pathological abnormalities were detected in 62.5 % of the patients, mainly ulcerations and erosions. Complications were non-spontaneous capsule passage in one patient. Compared to a single hospital, the multicenter use of VCE increased the frequency of investigations four times and reduced expenses to almost 30 %. CONCLUSIONS: The mobile use of VCE makes this innovative technique available for every patient while remaining in his local gastroenterology department. Additionally, this concept accelerates amortization and improves the quality of evaluation by focusing experience.

Cooperative Behavior↗
PubMed2006

Double-balloon enteroscopy in patients with GI bleeding of obscure origin.

BACKGROUND: Small-bowel bleeding is difficult to treat and diagnose. The recent introduction of wireless capsule endoscopy permits examination of the entire small intestine, but this method lacks tissue sampling and therapeutic capabilities. Recently, Yamamoto et al established a double-balloon insertion method for enteroscopy that allows examination of the entire small bowel and interventional options. OBJECTIVE: To evaluate double-balloon enteroscopy in patients with obscure GI bleeding. SETTING: Single-center prospective study. PATIENTS: Thirty-one consecutive patients with obscure GI bleeding (13 females, 18 males; mean age 56.4 +/- 3.2 years). Criteria for inclusion in the study were documented iron deficiency anemia (hemoglobin level <10 g/dL or a decrease of >2 g/dL over > or =2 months); upper endoscopy not revealing a site/cause of blood loss; and similarly uninformative lower endoscopy including examination of the terminal ileum. INTERVENTIONS: Endoscopic biopsy or therapy was performed as clinically indicated. MAIN OUTCOME MEASUREMENTS: Diagnostic yield for patients with obscure GI bleeding and patient follow-up. RESULTS: Double-balloon enteroscopy was completed without complications in all patients. Bleeding points were identified in 23 patients (74.2%). In 21 (91.3%) of these 23 patients the cause of blood loss was identified and treated with no further bleeding at 8.5 +/- 0.6 months of follow-up. LIMITATIONS: Small number of patients. CONCLUSIONS: These data suggest that double-balloon enteroscopy is useful for evaluation and treatment of patients with GI bleeding of obscure origin.

Adolescent↗