Feeding management before gastrointestinal studies in pigs.

Pigs are used to model humans in gastrointestinal (GI) studies because of their comparable size, physiology and behaviour: both are monogastric omnivores. A porcine surgical model for testing novel, tethered ultrasound capsule endoscopes (USCE) requires a clean, motile small intestine. Recommendations for human GI tract preparation before the mechanically similar process of video capsule endoscopy describe using oral purgatives, while high-carbohydrate drinks are recommended before colorectal surgery. Reports of the GI preparation of pigs exist but lack technical details, that is, administration, efficacy and side effects. This report details feeding a high-energy liquid diet to 11 female pigs undergoing surgery and USCE which was readily accepted and easily administered, and which produced a clean, motile small intestine and caused no detectable physiological/behavioural abnormalities.

El tiempo de tránsito intestinal de la cápsula endoscópica como factor para la detección de lesiones en hemorragia digestiva media / Small bowel transit time of capsule endoscopy as a factor for the detection of lesions in potential small bowel bleeding

Antecedentes: la relación entre el tiempo de tránsito intestinal (TTI) de la cápsula endoscópica (CE) y el diagnóstico de hemorragia digestiva media (HDM) es controvertida. Objetivo: evaluar la relación del TTI de la CE y la identificación de la HDM. Material y métodos: se dividieron las CE según el TTI en < 4 horas y ≥ 4 horas. Resultados: las CE con TTI ≥ 4 horas identificaron más angiodisplasias (p = 0.023), lesiones únicas (p = 0.029) y yeyunales (p = 0.001) con un OR de 3.13 (IC 95%, 1.61-6.10, p = 0.001) para identificar la causa de la HDM. Conclusiones: el TTI de la CE ≥ 4 horas incrementa el diagnóstico de HDM

Background: the relationship between small bowel transit time (SBTT) of the capsule endoscopy (CE) and the diagnosis of small bowel bleeding (SBB) is controversial. Objective: to evaluate the relationship between SBTT and CE and the identification of SBB. Material and methods: CE was divided according to SBTT into < 4 hours and ≥ 4 hours. Results: CE with SBTT ≥ 4 hours identified more angioectasias (p = 0.023), single lesions (p = 0.029) and jejunal lesions (p = 0.001) with an OR of 3.13 (95% CI, 1.61-6.10, p = 0.001) to identify the cause of SBB. Conclusions: CE SBTT of ≥ 4 hours increases the diagnosis of SBB

Clinical Use of Patency Capsule: A Comprehensive Review of the Literature.

The patency capsule is a radiopaque, dissolvable diagnostic tool, similar in shape and size to small bowel capsule endoscopes. It was developed to offer a simple, safe, efficient, and accurate evaluation of small bowel functional patency. Although unable to provide direct visual information regarding the presence and location of strictures, masses, or luminal narrowing of the small bowel, a successful patency test minimizes the risk of retention and allows the safe administration of a capsule endoscope. However, its use entails a low risk of potentially harmful adverse events, which in their majority are indolent and resolve spontaneously. Abdominal pain and symptomatic retention are accountable for the majority of reported adverse events, whereas a limited number of reports describe life-threatening complications, namely intestinal obstruction, perforation, and intestinal ischemia. Computed tomography is the modality of choice for the identification of the exact position of an impacted patency capsule, whilst the use of plain abdominal radiographs should be avoided for the evaluation of the patency capsule position, as they provide false information. Hereby, we present a comprehensive review of the available literature regarding the characteristics, indications, clinical use, effectiveness, and adverse events of the patency capsule.10.1093/ibd/izy152_video1izy152.video15777752348001.

Gastroduodenal lesions detected during small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact

Background: Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management. Patients and methods: This study is a retrospective analysis of data from 2,217 consecutive capsule endoscopy procedures performed at a single tertiary-care center between January 2008 and February 2016. Patient baseline characteristics, gastroduodenal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed. Results: Two thousands and two hundred seventeen patients were finally included in the analysis. One thousand and seventy patients were male (48.2%) and the mean age was 56.1 ± 19.5 years (range: 12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Gastroduodenal abnormalities were detected by capsule endoscopy in 696 (31.4%) of 2,217 patients. The most common types of missed gastric and duodenal lesions found were gastric erosions (35.4%), findings suggestive of chronic gastritis (22.9%), duodenal erosions (28.1%) and duodenal erythema (23.5%). This information had a clinical or diagnostic impact of 26.2% and a therapeutic impact of 15.5%. Conclusion: Capsule endoscopy detects not only small bowel lesions but also some gastroduodenal lesions that may be overlooked during an initial gastroscopy. Therefore, all gastroduodenal images should be read during small bowel capsule endoscopy as it may provide relevant information that result in changes in patient management (AU)

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Influencia de la experiencia acumulada del explorador en el valor predictivo negativo de la cápsula endoscópica / Impact of the endoscopist's experience on the negative predictive value of capsule endoscopy

INTRODUCCIÓN: La influencia de la experiencia acumulada del médico que interpreta cápsulas endoscópicas sobre su capacidad diagnóstica es discutida. OBJETIVO: Determinar si existen diferencias en el valor predictivo negativo de las cápsulas endoscópicas informadas por los mismos endoscopistas a lo largo del tiempo. MÉTODOS: Revisamos las 900 primeras cápsulas endoscópicas realizadas por tres gastroenterólogos expertos en endoscopia durante 8 años. Se dividieron en 3 grupos de 300 cápsulas cada uno. El grupo 1 fue la suma de las tres primeras centenas informadas por cada uno, el grupo 2 la suma de las tres segundas centenas y el grupo 3 la suma de las tres terceras centenas. Se hizo un seguimiento mínimo de 28 meses a los casos con exploración normal. RESULTADOS: Aunque se consideraron normales el 18% de las cápsulas del grupo 1, el 19,3% de las del grupo 2 y el 15,6% de las del grupo 3, solo fue posible seguir y finalmente analizar a 34 enfermos en el grupo 1, a 38 en el 2 y a 36 en el 3. Sobre estos casos, el valor predictivo negativo fue del 88,2% en el grupo 1, del 89,5% en el grupo 2 y del 97% en el grupo 3 (p > 0,05). CONCLUSIÓN: El valor predictivo negativo de la cápsula endoscópica, aunque con tendencia a aumentar, se mantiene alto y sin diferencias significativas desde las 100 primeras exploraciones si los médicos que la interpretan son expertos en endoscopia convencional y tienen formación específica previa

INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P > .05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training

High-resolution microendoscope imaging of inverted papilloma and normal sinonasal mucosa: evaluation of interobserver concordance.

BACKGROUND: High-resolution microendoscopy (HRME) enables real-time imaging of epithelial tissue. The utility of this novel imaging modality for inverted papilloma has not been previously described. This study examines the ability of otolaryngologists to differentiate between images of inverted papilloma and normal sinonasal mucosa obtained with a HRME. METHODS: Inverted papilloma and normal sinonasal mucosa specimens were stained with a contrast agent, proflavine. HRME images were subsequently captured. Histopathological diagnosis was obtained for each sample. Quality-controlled images were used to assemble a training set. After reviewing the training images, 6 otolaryngologists without prior HRME experience reviewed and classified test images. RESULTS: Five samples of inverted papilloma and 2 normal sinonasal mucosa samples were collected. Four representative images from each specimen were used for the 28-image test set. The mean accuracy among all reviewers was 89.9% (95% confidence interval [CI], 84.3% to 94.0%). The sensitivity to correctly identify inverted papilloma was 86.7% (95% CI, 79.2% to 92.2%), and the specificity was 92.9% (95% CI, 89.0% to 100.0%). The Fleiss kappa interrater reliability score was 0.80 (95% CI, 0.70 to 0.89). CONCLUSION: Inverted papilloma and normal sinonasal mucosa have distinct HRME imaging characteristics. Otolaryngologists can be successfully trained to distinguish between inverted papilloma and normal sinonasal mucosa. HRME is a feasible tool for identification of inverted papilloma. By conducting future in vivo trials, HRME potentially may enable real-time surgical margin determination during surgical excision of inverted papilloma.

[Capsule Endoscopy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators - Is the Formal Contraindication still Justified?]. / Kapselendoskopie bei Patienten mit Herzschrittmachern und implantierbaren Cardioverter-Defibrillatoren - Ist die formale Kontraindikation noch gerechtfertigt?

BACKGROUND AND AIMS: Capsule endoscopy is an established tool for investigation of the small intestine. Because of limited clinical experience in patients with cardiac devices the US Food and Drug Administration and the manufacturers recommend not to use capsule endoscopy in these patients. METHODS: Studies investigating possible interference between small bowel capsule endoscopy and cardiac pacemakers and implanted cardioverters were analysed. For the review we considered studies published in English or German and indexed in PubMed (Medline) as well as relevant abstracts and technical data from the manufacturer. RESULTS: In vitro and in vivo studies applying real capsules revealed no clinically relevant interference with pacemakers and implanted cardioverters. This evidence already has had an impact on clinical practice and recommendations of scientific societies. On the other hand wireless telemetry can interfere with CE video. CONCLUSION: According to present evidence, small bowel capsule endoscopy can be used in patients with pacemakers and implanted cardioverters after obtaining informed consent concerning the formal existence of contraindication.

Capsule endoscopy in a network cooperation: assessment of the experience in 822 patients.

INTRODUCTION: Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of occult or obscure gastrointestinal bleeding and Crohn's disease. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages. METHODS: CE device was bought by a central hospital (CH). Requested equipment is transported to the network partner (NP) and the procedure performed at the spot in personal responsibility. Video reading is exclusively done in the CH. RESULTS: Within 10 years, 822 CE (438 m., 384 f.; 63 ± 17 (13-92) years) were performed by 18 cooperating gastroenterological departments. 587/822 (71%) CE were done at NP, 235/822 (29%) in the CH. Between 2002 (n = 39) and 2011 (n = 123) the annual number of CE increased threefold. 95% of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network. Leading indication for CE was suspected mid-GI-bleeding (80%). Mean latencies between requested date and actual examination were 0 and between equipment's return and report 2 days. 45/191(24%) flexible enteroscopies performed in the CH followed CE findings from NP. DISCUSSION: Our 10 years experience show that mobile use of CE is feasible providing quality parameters similar to a single center solution, increases the number of CE investigations, therefore, improves reading expertise and enables both an area-wide and economic offer for this technique. Additionally, patients with the need for invasive enteroscopy are identified and attracted to that NP who provides an invasive SB endocopy device.

The use of small bowel capsule endoscopy in iron deficiency anaemia: low impact on outcome in the medium term despite high diagnostic yield.

INTRODUCTION: Small bowel capsule endoscopy (SBCE) is a useful diagnostic modality in small bowel disorders. Iron deficiency anaemia (IDA) is one of the most common indications for SBCE. However, there are limited data on the diagnostic yield for IDA alone, and little is known about the clinical impact and long-term outcome of patients following SBCE. AIM: To determine the diagnostic yield of SBCE in IDA and to examine outcome. MATERIALS AND METHODS: A retrospective review of a tertiary referral centre's database over a 21-month time period was carried out. Information on follow-up and management was obtained through chart review. RESULTS: In all, 309 SBCEs were identified, 30% (n=93) for anaemia and in 70% (n=65), follow-up data were available. The small bowel diagnostic yield for IDA was 53% (n=35), including angiodysplasia 49% (n=17), nonspecific inflammation 34% (n=12), active bleeding 11% (n=4) and Crohn's disease 6% (n=2). In addition, 16% (n=10) had abnormalities (gastritis, gastric antral vascular ectasia, duodenitis) outside the small bowel. In all, 42% (n=27) were persistently anaemic after a mean follow-up of 9.3 months. Of these, 52% (n=14) and 48% (n=13) had positive and negative SBCEs, respectively. In total, SBCE led to a change in treatment in 28 patients (44%), of whom 17 (61%) remained anaemic. CONCLUSION: This study shows a high overall diagnostic yield for SBCE in IDA 71% (n=45). Despite the majority, 53% (n=24), of patients with positive tests receiving specific treatment, 61% (n=17) remained anaemic in the long term. SBCE results were not predictive of long-term outcome even when stratified for a change in management.

The optimization of wireless power transmission: design and realization.

BACKGROUND: A wireless power transmission system is regarded as a practical way of solving power-shortage problems in multifunctional active capsule endoscopes. METHODS: The uniformity of magnetic flux density, frequency stability and orientation stability are used to evaluate power transmission stability, taking into consideration size and safety constraints. Magnetic field safety and temperature rise are also considered. Test benches are designed to measure the relevent parameters. Finally, a mathematical programming model in which these constraints are considered is proposed to improve transmission efficiency. To verify the feasibility of the proposed method, various systems for a wireless active capsule endoscope are designed and evaluated. RESULTS: The optimal power transmission system has the capability to supply continuously at least 500 mW of power with a transmission efficiency of 4.08%. CONCLUSIONS: The example validates the feasibility of the proposed method. Introduction of novel designs enables further improvement of this method.

A real-time tracking system for in vivo endofunctional capsule using magnetic sensors.

This paper presents a real-time magnetic tracking system to be used for tracking an endofunctional capsule intended to aid in the delivery of biomarkers to specific areas in the gastrointestinal (GI) tract. Magnetic technology is chosen due to its significant advantages over others like RF and Ultrasonics. The tracking system is designed to be used with eight magnetic sensors making it less complex than the other proposed systems. The paper describes a new mathematical model which is more accurate than the existing ones, a linear tracking algorithm and system's performance evaluation for three sensor configurations. The algorithm copes with the problem of magnetic field strength drop due to varying orientation of magnet. The minimum average error obtained is 1.37cm/6.85% in a 20×20×20 cm(3) volume for two dimensional sensor configuration.

In vivo microscopic imaging of the bronchial mucosa using an endo-cytoscopy system.

OBJECTIVES: We investigated the capabilities of an endo-cytoscopy system (ECS) that enables microscopic imaging of the tracheobronchial tree during bronchoscopy, including normal bronchial epithelium, dysplastic mucosa and squamous cell carcinoma. METHODS: The newly developed ECS has a 3.2 mm diameter that can be passed through the 4.2 mm working channel of a mother endoscope for insertion of the ECS. It has a high magnification of 570× on a 17 in. video monitor. Twenty-two patients (7 squamous cell carcinoma, 11 squamous dysplasia and 4 after PDT therapies) were underwent white light, NBI light and AFI bronchoscopy. Both abnormal areas of interest and normal bronchial mucosa were stained with 0.5% methylene blue and examined with ECS at high magnification (570×). Histological examinations using haematoxylin and eosin staining were made of biopsied specimens. Analyzed ECS images were compared with the corresponding histological examinations. RESULTS: In normal bronchial mucosa, ciliated columnar epithelial cells were visible. In bronchial squamous dysplasia, superficial cells with abundant cytoplasm were arranged regularly. In squamous cell carcinoma, large, polymorphic tumor cells showed increased cellular densities with irregular stratified patterns. These ECS images corresponded well with the light-microscopic examination of conventional histology. CONCLUSION: ECS was useful for the discrimination between normal bronchial epithelial cells and dysplastic cells or malignant cells during bronchoscopy in real time. This novel technology has an excellent potential to provide in vivo diagnosis during bronchoscopic examinations.

Safety, reliability and limitations of the given patency capsule in patients at risk of capsule retention: a 3-year technical review.

INTRODUCTION: The patency capsule may prevent capsule retention in high-risk patients. However data on its use in routine clinical practice is limited. METHODS: Patients referred to our institution between Feb-04 and Jan-07 were reviewed. The following data was collected: presenting symptoms; medical/surgical history; medication; radiology; patency/video capsule result; subsequent investigations; clinical outcomes. RESULTS: 373 patients were referred. In 315 (84%) 'low-risk' patients (no patency capsule): delayed transit occurred in three, with no cases of capsule retention. In 58 (16%) 'high risk' patients (patency capsule): asymptomatic retention occurred in eight, all with pathology despite normal prior barium studies in six; in four cases patency location was incorrectly assessed radiologically, leading to video capsule retention and surgery in one. DISCUSSION: Most patients can safely undergo capsule endoscopy without a patency capsule. The patency capsule appears safe and is indicative of pathology when retained. Assessment of patency capsule location post ingestion can be difficult, and if barium radiology is equivocal a limited abdominal computed tomography (CT) scan is suggested.