Safety and efficacy of small-bowel capsule endoscopy examination in patients with Billroth II gastrojejunostomy.

BACKGROUND: Small-bowel capsule endoscopy (SBCE) has become an increasingly utilized imaging modality for patients suspected of having small intestinal diseases. However, data regarding the role of SBCE in patients with Billroth II gastrojejunostomy are limited. The objective is to evaluate the safety and efficacy of SBCE in Billroth II gastrojejunostomy patients. METHODS: We retrospectively studied patients with Billroth II gastrojejunostomy who underwent MiroCam capsule endoscopy between August 2013 and October 2019. Baseline patient characteristics; gastroscopic and SBCE findings; capsule transit time; and the occurrence of adverse events were collected and compared between groups with and without anastomotic lesions. RESULTS: In total, 30 patients were analyzed in the study. The median age was 59 years, and 26 patients (86.7%) were men. The majority of SBCE positive findings including ulcers (10.0%), angioectasias (6.7%) and polyps (6.7%). In patients with (n = 10) and without (n = 20) anastomotic lesions, the anastomotic lesion was significantly associated with a delayed gastric transit time (GTT) (P = 0.026), but the two groups showed no significant difference in completion (P > 0.05). All patients underwent successful SBCE examinations without adverse events, except device transit into the afferent loop, where it remained for nearly 2 h, occurred in one case with anastomotic ulcers. CONCLUSIONS: This retrospective study demonstrates that SBCE is a safe and effective diagnostic tool in patients with Billroth II gastrojejunostomy with a favorable gastroscopic evaluation within 7 days prior. The frequently real-time monitoring is suggested due to the risk of retention in the afferent loop, and a delayed food intake is required when a prolonged stay in the afferent loop occurred.

Photoexcitation-Based Supramolecular Access to Full-Scale Phase-Diagram Structures through in situ Phase-Volume Ratio Phototuning.

Controlling phase separation and transition plays a core role in establishing and maintaining the function of diverse self-assembled systems. However, it remains challenging to achieve wide-range continuous phase transition for dynamically producing a variety of assembled structures. Here, we developed a far-from-equilibrium system, upon the integration of photoexcitation-induced aggregation molecules and block copolymers, to establish an in situ phase-volume ratio photocontrol strategy. Thus, full-scale phase-diagram structures, from lamellar structure to gyroidal, cylindrical, and finally to a spherical one, can be accessed under different irradiation periods. Moreover, the phase transition was accompanied by considerable aggregation-induced phosphorescence and hydrophilicity/hydrophobicity change for building a functional surface. This strategy allows for a conceptual advance of accessing a wide range of distinct self-assembled structures and functions in real time.

Impact of capsule endoscopy on prevention of postoperative recurrence of Crohn's disease.

BACKGROUND AND AIMS: Capsule endoscopy (CE) can detect lesions outside the scope of ileocolonoscopy in postoperative patients with Crohn's disease (CD). However, the impact of such findings on patient outcomes remains unknown. This study is intended to evaluate the impact of CE findings on clinical management and outcomes in asymptomatic patients with CD without pharmacologic prophylaxis after ileocolonic resection. METHODS: In this retrospective cohort study, 37 patients (group 1) received ileocolonoscopy together with CE within 1 year after surgery, whereas 46 patients (group 2) only received ileocolonoscopy. Patients with endoscopic recurrence detected by either ileocolonoscopy or CE received pharmacologic therapy with azathioprine or infliximab. One year later, disease activity was re-evaluated. RESULTS: In group 1, all patients with ileocolonoscopy-identified recurrence also had CE-identified recurrence. In addition, CE detected endoscopic recurrence in 11 patients missed by ileocolonoscopy. Endoscopic remission identified by ileocolonoscopy was confirmed by CE in 13 patients. One year later, endoscopic remission identified by ileocolonoscopy was maintained in all 24 patients, and none had clinical recurrence. Conversely, in group 2, of those with ileocolonoscopy-identified remission, both ileocolonoscopy-identified recurrence and clinical recurrence occurred in 9 of 31 patients 1 year later. The total clinical recurrence rate was 2.7% (1/37) in group 1 versus 21.7% (10/46) in group 2 (P = .019). CONCLUSIONS: If endoscopic remission identified by ileocolonoscopy was confirmed by CE, patients could remain free of pharmacologic prophylaxis. If recurrence outside the scope of ileocolonoscopy was detected by CE, initiation of active pharmacologic therapy would be needed.

Risk factors for surgery in patients with retention of endoscopic capsule.

OBJECTIVES: Surgery is still the main means for removing retained endoscopic capsules. This study intended to evaluate risk factors for surgery in patients with capsule retention. MATERIALS AND METHODS: The data of 5348 consecutive capsule endoscopy examinations were retrospectively analyzed. Cox regression analysis was used to evaluate risk factors. RESULTS: Seventy-seven patients (1.4%) had capsule retention. Spontaneous passage occurred in 16 patients, of which 14 were asymptomatic. Successful retrieval by double-balloon enteroscopy (DBE) was achieved in 14 patients, of which 11 did not need surgery during clinical follow-up. A total of 50 patients underwent surgery. The cumulative rates of surgery were 44.2%, 53.2%, 55.8%, 62.3% and 64.9% at 1, 3, 6, 12 and 60 months after capsule retention, respectively. Intestinal obstruction [hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.12-3.76; p = .020] and overt small bowel bleeding (HR 2.01, 95%CI 1.08-3.71; p = .027) during capsule retention were independently associated with an increased risk for surgery. Specific treatment for primary disease (HR 0.22, 95%CI 0.07-0.74, p = .014) and successful endoscopic retrieval (HR 0.20, 95%CI 0.06-0.66; p = .008) were independently associated with a decreased risk for surgery. CONCLUSIONS: For asymptomatic patients, specific medical treatment for primary disease can be maintained until the capsule spontaneously passes or symptoms appear. For patients with slight abdominal pain, DBE can be performed. For patients with intestinal obstruction or overt small bowel bleeding, early surgical consultation should be considered.

[Application of Quality Control Circle in Reducing Incidence of Leakage in Digestive Endoscopy].

To study the role of the activity in reducing the incidence of water leakage in digestive endoscopy, through the activity of the quality control circle (QCC), the reasons for water leakage and high maintenance cost are analyzed deeply. Then, the author formulated and implemented targeted measures to intervene in the non-standard aspects of daily management of endoscopy. Then targeted measures has been taken to improve the nonstandard daily management.Results demonstrate that the application of the quality control circle can significantly reduce the incidence of water leakage in the digestive endoscope and control the other faults caused by the leakage. This not only reduces the high maintenance cost of endoscopy, improves the utilization rate and turnover rate of endoscopy, but also fully explores personal potential, enhances team cohesion, and improves quality management awareness.

Dispersion characteristics of arc-axis waveguides.

Ultrasonic single mode excitation methods, mode separation algorithms and damage detection applications all require the calculation of the dispersion characteristics of the waveguide. However, existing dispersion calculation methods are mainly applicable to straight-axis waveguides. Therefore, in this paper, a novel semi-analytical finite element method in cylindrical coordinates (SAFEM-CC) is established and we focus on the dispersion characteristics of arc-axis waveguides. The cross-section of the waveguide can have arbitrary complex shapes, and the correctness of this method is verified by the finite element eigenfrequency method. At the same time, this paper takes the example of an arc-axis structure with a square cross-section and investigates the convergence of SAFEM-CC under different numbers of elements, element types, and element orders. This paper also establishes a finite element simulation model to study the waveform transmission law over a wide frequency range and the wave amplitude distribution law within the cross-section of arc-axis waveguides. The dispersion characteristics of arc-axis waveguides at different radii are also investigated. Finally, the correctness of the proposed method and the dispersion characteristics of arc-axis waveguides are verified by a large number of experiments. The main conclusions are as follows: the waveform transmission laws of the guided wave in arc-axis waveguides at each frequency agree with the dispersion curve; the theoretical wavestructure gives the distribution law of the amplitude within the cross-section; when the axis is arc, the displacement of the wavestructure on the inner and outer sides does not have symmetry, and the difference between the left and right sides gradually increases as the radius decreases.

In Situ Regulation of Microphase Separation-Recognized Circularly Polarized Luminescence via Photoexcitation-Induced Molecular Aggregation.

Circularly polarized luminescence (CPL) has attracted great interest owing to its extensive optical information and chiral structural dependence. However, rationally regulating solid-phase CPL signals remains difficult because of the close packing of molecules in solid-state materials and the lack of structural visualization. In this work, we proposed a microphase-separation-recognized CPL regulation strategy via coassembly of a hexathiobenzene-based luminophore and chiral block copolymer (cBCP) with in situ photocontrollability. As a consequence to the continuous increase in the luminophore-to-cBCP ratio, the CPL signal of the supramolecular system exhibited an increasing trend until a critical point. Then, further increasing the ratio stretched the helical pitch of cBCP, which led to CPL reduction. With the photoexcitation-induced molecular aggregation of the luminophore, which was implemented using in situ photoirradiation, the helical pitch was retracted along with the restoration of the CPL signal. These processes were fully recognized and monitored by the microphase-separated nanomorphological change of the coassembled system, which indicated that such a structural contrast could be an effective method for rationally regulating the supramolecular chiropticity of solid-state materials.

Relationships of capsule endoscopy Lewis score with clinical disease activity indices, C-reactive protein, and small bowel transit time in pediatric and adult patients with small bowel Crohn's disease.

Relationships between the capsule endoscopy Lewis score (LS) and clinical disease activity indices and C-reactive protein (CRP) are controversial in adult patients with Crohn's disease (CD). Also, data on pediatric patients are relatively less. However, correlation between LS and small bowel transit time (SBTT) remains investigational. The aim of the present study was to explore the correlations between LS and clinical disease activity indices, CRP, SBTT in pediatric, and adult patients with small bowel CD.Retrospective, single-center study on consecutive inpatients with established small bowel CD was conducted. The clinical disease activity index was determined using the abbreviated Pediatric Crohn's Disease Activity Index (aPCDAI) in patients aged <18 years and the Harvey-Bradshaw Simple Index (HBI) in adults. Spearman's rank correlation coefficient was used to assess the correlations of LS with aPCDAI, HBI, CRP, and SBTT, respectively.150 patients were enrolled (30 children and adolescents). In pediatric patients, correlations between LS and aPCDAI, CRP were moderate (r1 = 0.413; r2 = 0.379; P1 = .023; P2 = .044). There was no correlation between LS and SBTT (r = -0.029; P = .88). In adults, weak correlations were found between LS and HBI, SBTT (r1 = 0.213; r2 = 0.237; P1 = .019; P2 = .009). Correlation between LS and CRP was moderate (r = 0.326; P < .001). Strong correlations were found between CRP and HBI, aPCDAI (r1 = 0.522; r2 = 0.650; P < .001). The follow-up patients were all in clinical remission after treatment within 4 months, whereas only a minority reached mucosal healing. HBI, aPCDAI, CRP, and LS in all patients were reduced after treatment, whereas difference in CRP in pediatric patients and difference in LS in adults between baseline and follow-up were not found to be statistically significant. Also, the average SBTT at baseline was not found to be different from that at follow-up in all patients.The role of capsule endoscopy should be emphasized both in pediatric and adult patients with small bowel CD. Furthermore, the small bowel transit time may not be affected by the grade of small intestinal inflammation.