Multicenter prospective evaluation of the express view reading mode for small-bowel capsule endoscopy studies.

BACKGROUND: Reducing the reading time of capsule endoscopy films is of high priority for gastroenterologists. We report a prospective multicenter evaluation of an "express view" reading mode (Intromedic capsule system). METHODS: Eighty-three patients with obscure gastrointestinal bleeding were prospectively included in 10 centers. All patients underwent small-bowel capsule endoscopy (Intromedic, Seoul, Republic of Korea). Films were read in standard mode, then a second reading was performed in express view mode at a second center. For each lesion, the precise location, nature, and relevance were collected. A consensus reading and review were done by three experts, and considered to be the gold standard. RESULTS: The mean reading time of capsule films was 39.7 minutes (11 - 180 minutes) and 19.7 minutes (4 - 40 minutes) by standard and express view mode, respectively ( P  < 1 × 10  - 4 ). The consensus review identified a significant lesion in 44/83 patients (53.0 %). Standard reading and express view reading had a 93.3 % and 82.2 % sensitivity, respectively (NS). Consensus review identified 70 significant images from which standard reading and express view reading detected 58 (82.9 %) and 55 (78.6 %), respectively. The informatics algorithm detected 66/70 images (94.3 %) thus missing four small-bowel angiodysplasia. CONCLUSION: The express view algorithm allows an important shortening of Intromedic capsule film reading time with a high sensitivity.

Could the colonic capsule PillCam Colon be clinically useful for selecting patients who deserve a complete colonoscopy?: results of clinical comparison with colonoscopy in the perspective of colorectal cancer screening.

OBJECTIVES: Preliminary studies have shown the possibility of detecting colonic polyps and tumors using the PillCam Colon capsule endoscope (CCE) (Given Imaging, Yoqneam, Israel). The aim of this study was to evaluate the ability of CCE to detect clinically relevant colonic findings as compared with colonoscopy, and further, to test the assumption that CCE used in the frame of colorectal cancer (CRC) screening could accurately discriminate patients deserving a complete colonoscopy. METHODS: A total of 128 patients (67 men, 55+/-14 years) with an indication of colonoscopy were investigated by CCE, followed by colonoscopy under general anesthesia on the next day. Bowel cleansing was carried out according to a previously published protocol (3 l polyethylene glycol+2 doses of sodium phosphate solution). All CCE recordings were read by the same physician and all colonoscopies, performed by the same operator, were blinded to each other's results. The primary outcome of the study was the decision made by the CCE reader to indicate a colonoscopy, compared with the final result of the colonoscopy. Secondary outcomes were the agreement between CCE and colonoscopy for making a diagnosis of colorectal disease, as well as detection rate, number, and size of polyps. RESULTS: Two patients were excluded: one did not swallow the capsule and the other was diagnosed with a jejunal stenosis by the CCE. The CCE found at least one clinically relevant colonic finding in 71 patients (56.3%), and the colonoscopy results confirmed this finding in 56 patients, showing a sensitivity of CCE of 87.5% (confidence interval (CI) 79.4-95.6%) and a specificity of 75.8% (CI 65.4-86.2%). With a prevalence of 50.8% of clinically relevant findings at colonoscopy, the positive predictive value of CCE was 78.9%, and the negative predictive value (NPV) was 85.4%. The agreement between CCE and colonoscopy was significant for the detection of any colonic lesion (P<0.0001), polyps (P<0.001), as well as for the detection of the number (P<0.0001) and size (P=0.0083) of polyps. Tolerance of the procedure was excellent, and no complication was reported. CONCLUSIONS: In the setting of this study, CCE seemed to be effective in detecting clinically significant colonic findings in patients with an indication of colonoscopy. The high NPV and excellent tolerance of CCE suggest that it could be evaluated in large CRC-screening programs and further studies in screening conditions should also evaluate its cost-efficacy ratio.

Laparoscopia diagnóstica en el Hospital General Universitario de la Samaritana

Se presenta la experiencia laparoscópica en 300 pacientes, entre enero de 1986 y enero de 1996, 149 hombres (49.6 por ciento) y 151 mujeres (50.3 por ciento) con edad promedio de 48.8 años. Las indicaciones fueron 1. Hipertensión portal y hepatopatía crónica (n 124, 41.3 por ciento). 2. Ascitis (n 27,9.0 por ciento) 3. Masas hepáticas (n 46, 15.3 por ciento) 4. Hepatoesplenomegalia (n 14,4.7 por ciento), 5. TBC (n 10,3.3 por ciento), 6. Hepatoxicidad (n 2, 0.6 por ciento), 7. Grupo de marcadores para hepatitis C (n 10,3.3 por ciento), y 8. Otros: Cáncer gastrointestinal, y dolor abdominal (n 67, 22.3 po rciento). Los hallazgos macroscópicos fueron: 1. Cirrosis e hipertensión portal (41.6 por ciento), 2. Carcinomatosis peritoneal (8.0 por ciento), 3. Hepatoesplenomegalia (8.3 por ciento), 4 Masas hepáticas (primarias y metastásicas) (12.3 por ciento), 5. Tuberculosis (4.0 porciento), 6. Hígado macroscópicamente sano (6.0 por ciento), y 7. Otros: abdomen congelado por carcinomatosis, plastrón y apendicitis retrocecal, adherencias peritoneales (19.6 por ciento). Se realizaron 211 biopsias (187 hepáticas, 18 peritoneales, 1 masa abdominal, 5 etiologías de ascitis). La correlación diagnóstica global macro y microscópica fue de 88 por ciento. Se presentaron 10 complicaciones: diez y seis leves (5.3 por ciento), y tres severas (1.0 por ciento). La mortalidad fue de 1.0 por ciento. Conclusiones: 1. La laparoscopia diagnóstica es un procedimiento simple, seguro y no dispensios. 2. Hay buena correlación entre los hallazgos macroscópicos e histológicos. 3. La morbimortalidad del procedimiento es baja cuando es realizada con las indicaciones apropiadas y por personal entrenado

Tratamiento de la acalasia primaria con estimulación eléctrica nerviosa transcutánea (TENS)

Se presenta la experiencia en el manejo de pacientes con acalasia primaria mediante la aplicación de estimulación eléctrica nerviosa transcutánea (TENS). Se observó una aceptable respuesta reflejada en el score de síntomas y un incremento de peso en la mayoría de los pacientes. Se considera esta modalidad terapéutica como una alternativa para el manejo de algunos pacientes con acalasia primaria