Endoscopic placement of the small-bowel video capsule by using a capsule endoscope delivery device.

BACKGROUND: Capsule endoscopy performed via the traditional peroral route is technically challenging in patients with dysphagia, gastroparesis, and/or abnormal upper-GI (UGI) anatomy. OBJECTIVE: To describe the indications and outcomes of cases in which the AdvanCE capsule endoscope delivery device, which has recently been cleared by the Food and Drug Administration, was used. DESIGN: Retrospective, descriptive, case series. SETTING: Tertiary care, university hospital. PATIENTS: We report a case series of 16 consecutive patients in whom the AdvanCE delivery device was used. The study period was May 2005 through July 2006. INTERVENTIONS: Endoscopic delivery of the video capsule to the proximal small bowel by using the AdvanCE delivery device. MAIN OUTCOME MEASUREMENTS: Indications, technique, and completeness of small bowel imaging in patients who underwent endoscopic video capsule delivery. RESULTS: The AdvanCE delivery device was used in 16 patients ranging in age from 3 to 74 years. The primary indications for endoscopic delivery included inability to swallow the capsule (10), altered UGI anatomy (4), and gastroparesis (2). Of the 4 patients with altered UGI anatomy, 3 had dual intestinal loop anatomy (ie, Bilroth-II procedure, Whipple surgery, Roux-en-Y gastric bypass) and 1 had a failed Nissen fundoplication. In all cases, the capsule was easily deployed without complication, and complete small intestinal imaging was achieved. LIMITATIONS: Small patient size. CONCLUSIONS: Endoscopic placement of the Given PillCam by use of the AdvanCE delivery device was safe and easily performed in patients for whom capsule endoscopy would otherwise have been contraindicated or technically challenging.

Liver transplantation for biliary atresia: 19-year, single-center experience.

OBJECTIVES: In this study, we describe our 19-year experience with liver transplantation as the definitive treatment for congenital biliary atresia. MATERIALS AND METHODS: We performed a retrospective study of 115 liver transplants from 1984 to 2003 in 85 patients with congenital biliary atresia. We determined the impact of era of transplantation (1984-1993 and 1994-2003), recipient age (< 1 and > 1), prior portoenterostomy, and type of surgery (whole-, reduced-, and split-liver transplant) on the outcome of the transplant. RESULTS: Overall long-term survival is 83%. Survival is greater in the more-recent era. No impact of age or prior portoenterostomy on survival was seen. Split-liver grafts showed superior graft survival, whereas reduced-liver transplants had the worst overall graft survival. CONCLUSIONS: Our results confirm that long-term patient survival after liver transplantation for congenital biliary atresia is excellent. When required, partial liver grafts provide excellent long-term outcome.

Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study.

OBJECTIVE: To define epidemiologic and clinical characteristics of newly diagnosed pediatric inflammatory bowel disease (IBD) in a large population-based model. STUDY DESIGN: All pediatric gastroenterologists providing care for Wisconsin children voluntarily identified all new cases of IBD during a 2-year period. Demographic and clinical data were sent to a central registry prospectively for analysis. RESULTS: The incidence of IBD in Wisconsin children was 7.05 per 100,000, whereas the incidence for Crohn's disease was 4.56, more than twice the rate of ulcerative colitis (2.14). An equal IBD incidence occurred among all ethnic groups, and children from sparsely and densely populated counties were equally affected. The majority (89%) of new IBD diagnoses were nonfamilial. CONCLUSIONS: This study provides novel, prospective, and comprehensive information on pediatric IBD incidence within the United States. The surprisingly high incidence of pediatric IBD, the predominance of Crohn's disease over ulcerative colitis, the low frequency of patients with a family history, the equal distribution of IBD among all racial and ethnic groups, and the lack of a modulatory effect of urbanization on IBD incidence collectively suggest that the clinical spectrum of IBD is still evolving and point to environmental factors contributing to the pathogenesis.