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.

Sedation With Propofol Has No Effect on Capsule Endoscopy Completion Rates: A Prospective Single-Center Study.

Patients who need both capsule endoscopy (CE) and colonoscopy often undergo both examinations on the same day to avoid repeated bowel preparation and fasting. Sedation can relieve pain and is commonly used for colonoscopies but may influence the CE completion rate.To determine whether sedation with propofol influences the completion rate and small-bowel transit time (SBTT) of CE.From July 2014 to December 2014, patients (18-65 years old) who needed both CE and colonoscopy were assessed consecutively for enrollment in our study. Colonoscopies were performed with or without sedation based on patient preferences on the day of capsule ingestion. The completion rate, SBTT, and diagnostic yield of CEs were recorded. Patients' satisfaction and pain scores were also recorded.Sedation with propofol had no significant effect on CE completion rates (83.3% sedation group vs 81.8% nonsedation group, P = 0.86) but was associated with increased SBTT (403.6 ±â€Š160.3 sedation group vs 334.5 ±â€Š134.4 nonsedation group, P = 0.006). The diagnostic yields in the sedation and nonsedation groups were 69.4% and 65.9%, respectively (P = 0.74). The median satisfaction scores were 8.6 in the sedation group and 3.5 in the nonsedation group (P < 0.001). Median pain scores were 1.4 in the sedation group and 6.7 in the nonsedation group (P < 0.001).Sedation with propofol increased SBTT but had no effect on CE completion rates, suggesting that CE and colonoscopy with propofol can be performed on the same day (clinical trial registration number: ChiCTR-ONRC-14004866).

[Pit pattern and endoscopic mucosal resection in diagnosis and treatment of colorectal tumors].

OBJECTIVE: To explore the effective methods to diagnose and treat colorectal cancer in its early stage. METHODS: 1 205 patients were examined by colonoscopy and mucosa staining with indigocarmine. The pit patterns were observed with magnifying endoscope and stereomicroscope according to the Kudo classification. The pathological diagnoses of the lesions were compared with their pit patterns. Electrocoagulation resection was performed on the prominent lesions and endoscopic mucosal resection (EMR) or endoscopic partial mucosal resection (EPMR) was performed on the flat lesions. RESULTS: In the 282 patients 478 prominent and flat lesions were found. There were 16 cases of laterally spreading tumor (LST), including I case of pit pattern II, 6 of pit pattern IIIL, 8 of pit pattern IV, and 1 of pit pattern Va, with 2 cases of intramembrane cancer and 1 case of IIa + IIc lesions invading the superficial myometrium among them. EMR and EPMR were performed on 14 LST lesions, 22 IIa lesions, and 14 IIb lesions. CONCLUSION: The examination of pit pattern is very important in early diagnosis of colorectal cancer and differentiation tumorous from non-tumorous lesions. V type pit pattern is an indicator of colorectal cancer. EMR and EPMR are safe and effective for flat lesions.

[Comparison of curative effect for colon flat lesion between mucosa resection and fulguration with high frequency current after mucosa staining under magnifying endoscope].

OBJECTIVE: To observe the relationship between the pit patterns and pathology and compare the curative effect for colon flat lesion between endoscopic mucosa resection (EMR) and fulguration with high frequency current (FHFC). METHODS: They were divided to two groups. There were 37 cases for FHFC in group A, and 34 cases for EMR in Group B. The two groups were comparabal. Examining patients suffering with colon flat lesions with magnifying endoscope and observing the pit patterns of mucosa after staining with indicarmine. RESULTS: The pit patterns of inflammatory or hyperplastic lesions were mainly pit II, adenoma pit III and pit IV, and carcinomatous lesions pit IV and pit V. The worse the differentiation degree of lesions was, the higher the pit patterns were. There were no difference (P > 0.05) between group A and B in complication and quantity, classification and distribution of lesions. No canceration was detected in 21 cases with adenoma in group A, while 4 cases of canceration (all were adenocacinoma) was found in 20 cases whith adenoma in group B. There was significance in canceration between two groups (P < 0.05). CONCLUSIONS: The worse the differentiation degree of lesions was, the higher pit patterns were. EMR and FHFC share the same validity and security when treating the flat lesions, but by EMR, doctors could judge whether the lesions were resected completely, once the remained lesions were found, they could be resected immediately again lesion in case of omission of canceration.

[Serrated adenoma of large intestine: report of 7 cases].

From December 2000 to April 2001, 859 patients were examined with coloscopy in our endoscopy centre and 188 cases of adenoma were diagnosed. Among the 188 patients, 7 were found with serrated adenoma that had been confirmed pathologically, including 6 male and 1 female patients, aged 32 to 53 with an average of 44.7 years. All the 7 cases were identified as having single focal lesion, among which 3 were found in the rectum, 1 in the transverse colon, 2 in the ascending colon and 1 in the cecum. The diameter of the lesions ranged from 8 to 27 mm with an average of 15.4 mm.

[Endoscopic diagnosis and treatment of the early-stage malignant colorectal polyp and follow-up study].

In the past 20 years we have performed endoscopic removal of colorectal polyps in 4 000 cases, and thorough histological examination of the removed polyps identified 121 cases of early-stage malignant polyp. According to the depth of malignant invasion and whether malignant remnants were present after the initial surgical removal, conservative treatment or radical operation was implemented. During the follow-up study, endoscopy was performed once each year in all the patients with malignancies. No recurrence was found in the 33 patients with mucosa cancer or in the 27 patients with type I submucosa cancer who did not receive radical operation due to absence of malignant remnants or in the 38 patients with type II submucosa cancer who had the radical operation. Relapse occurred in 1 patient with malignant remnant and in another 3 cases of type II submucasa cancer without radical operation.

[Construction and application of colorectal polyp database].

OBJECTIVE: To study the construction and application of computerized database of colorectal polyp in the clinical management and research of this disease. METHOD: A colorectal polyp database and its management system was constructed on the basis of Microsoft Access 2000. Clinical, endoscopic and pathological data, which went through standardized and elemental processing, of 2 627 cases (4 850 records) of colorectal polyp collected from 1990 to 2000 in Nanfang Hospital was entered into this database. RESULTS: Using this new database, the information on the population and age distribution, location and clinical features of colorectal polyps were obtained. Comparative study of the clinical and pathological findings in the cases, evaluation of the therapeutic effects, statistical review of the identification of the polyp and its canceration in the previous years as well as the analysis of other relevant factors were successfully accomplished, which greatly facilitated the follow-up study of some chosen cases that may be of clinical significance. CONCLUSIONS: Applications of modern informatics and computer technology greatly facilitates case management and clinical research of colorectal polyps, and standardized and elemental processing of the clinical data offers a new possibility for easy case information management.

[The diagnosis and treatment of 25 cases of laterally spreading tumor of the large intestine].

Laterally spreading tumor (LST) originates from the large intestine mucosa with prominent lesions that mainly extend laterally other than vertically. The pathological morphology and evolvement of this disease distinguish itself from other adenomas, and its close association with colorectal cancer has been noted. Up till now, no report on LST involving the large intestine has been available in China, therefore we presently report our experience in the diagnoses and treatment of 25 LST patients (26 lesions) identified with conventional endoscopy and mucosa staining during the period from Nov, 2000 to Oct, 2001. Among the 26 lesions, 11 were classified into granular homogeneous type, 15 into nodular mixed type, and 3 patients were found to have intramucosa carcinoma and 2 serrated adenoma. The biggest lesion was 60 mmx70 mm, the smallest being 11 mmx12 mm, and 6 lesions were within the range of 11 to 20 mm, 9 within 21 to 30 mm with the rest 11 lesions exceeding 31 mm in diameter. Type IV pit pattern was predominant in the the 26 lesions, accounting for a proportion of 61.54% (16/26). Two lesions with V(A) pit pattern and 1 with IV pattern were pathologically diagnosed to be intramucosa carcinoma, and 8 with type III(L) pit pattern were tubulovillous adenoma. Immediate or elective endoscopic mucosa resection or partitioned mucosa resection was performed in the 25 cases without incidences of the complications as bleeding or perforation.

Double balloon enteroscopy in the old: experience from China.

AIM: To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases. METHODS: DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis. RESULTS: Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively. CONCLUSION: DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.