37 research outputs found
Nuevas aplicaciones de la cĂĄpsula endoscĂłpica: PILLCAMâą ESO
ABSTRACT
Capsule endoscopy has opened a new era in
small bowel examination. Its indications are now welldefined
and currently, wireless capsule endoscopy is
considered as the first-line imaging tool for the
diagnosis of small bowel diseases. ECE has been
shown to be feasible, safe and a good alternative
technique in patients refusing conventional
endoscopy. Although results reported in both GERD
and cirrhotic patients are encouraging, great
differences in terms of accuracy (particularly in GERD
patients) have been found in published studies. These
differences have been attributed to study designs, the
lack of adequate experience and inconvenience of
ingestion protocols. In summary, more large-scale
studies evaluating the new 14-fps capsule, adequate
ECE-experience and new modified ingestion protocols
are still needed
Capsule endoscopy interpretation: the role of physician extenders
Background and aims: capsule endoscopy (CE) allows for a
new era in small-bowel examination. Nevertheless, physiciansâ
time for CE-interpretation remains longer than desirable. Alternative
strategies to physicians have not been widely investigated.
The aim of this study was to evaluate the accuracy of physician
extenders in CE-interpretation.
Material and methods: one CE-experienced gastroenterologist
and two physician extenders reviewed independently 20 CEprocedures.
Each reader was blinded to the findings of their colleagues.
A consensus formed by the readers and a second
CE-experienced gastroenterologist was used as gold standard.
Number, type and location of images selected, character of CEexams
and their relationship with indications were recorded. Gastric
emptying time (GEt), small-bowel transit time (SBTt) and time
spent by readers were also noted.
Results: sensitivity and specificity for âoverallâ lesions was 79
and 99% for the gastroenterologist; 86 and 43% for the nurse;
and 80 and 57% for the resident. All 34 âmajorâ lesions considered
by consensus were found by the readers. Agreement between
consensus and readers for images classification and procedures
interpretation was good to excellent (Îș from 0.55 to 1). No
significant differences were found in the GEt and SBTt obtained
by consensus and readers. The gastroenterologist was faster than
physician extenders (mean time spent was 51.9 ± 13.5 minutes
versus 62.2 ± 19 and 60.9 ± 17.1 for nurse and resident, respectively;
p < 0.05).
Conclusions: physician extenders could be the perfect complement
to gastroenterologists for CE-interpretation but gastroenterologists
should supervise their findings. Future cost-efficacy
analyses are required to assess the benefits of this alternative
Gastroduodenal injury after radioembolization of hepatic tumors
Radioembolization is a new tool for the treatment of hepatic tumors
that consists in the injection of biocompatible microspheres carrying
radioisotopes into the hepatic artery or its branches. METHODS: We have performed
radioembolization in 78 patients with hepatic tumors using resin-based
microspheres loaded with yttrium-90. All patients were previously evaluated to
minimize the risk of hazardous irradiation to nontarget organs and to obtain the
data needed for dose calculation. RESULTS: We report a complication found in
three cases (3.8%) that consists of abdominal pain resulting from gastroduodenal
lesions and that had a chronic, insidious course. Microscopically, microspheres
were detected in the specimens obtained from all affected gastric areas. Since
these gastroduodenal lesions do not appear when nonradiating microspheres are
injected in animals, lesions are likely to be due to radiation and not to an
ischemic effect of vascular occlusion by spheres. CONCLUSIONS: We believe that a
pretreatment evaluation that includes a more thorough scrutiny of the hepatic
vascularization in search of small collaterals connecting to the gastroduodenal
tract can help prevent this awkward complicatio
Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study
To obtain an adequate view of the whole small
intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting
is recommended. However, intestinal content can hamper vision in spite of these
measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness
during CE following three types of bowel preparation. PATIENTS AND METHODS: This
was a prospective, multicenter, randomized, controlled study. Two-hundred
ninety-one patients underwent one of the following preparations: 4 L of clear
liquids (CL) (group A; 92 patients); 90 mL of aqueous sodium phosphate (group B;
89 patients); or 4 L of a polyethylene glycol electrolyte solution (group C; 92
patients). The degree of cleanliness of the small bowel was classified by blinded
examiners according to four categories (excellent, good, fair or poor). The
degree of patient satisfaction, gastric and small bowel transit times, and
diagnostic yield were measured. RESULTS: The degree of cleanliness did not differ
significantly between the groups (P = 0.496). Interobserver concordance was fair
(k = 0.38). No significant differences were detected between the diagnostic
yields of the CE (P = 0.601). Gastric transit time was 35.7 +/- 3.7 min (group
A), 46.1 +/- 8.6 min (group B) and 34.6 +/- 5.0 min (group C) (P = 0.417).
Small-intestinal transit time was 276.9 +/- 10.7 min (group A), 249.7 +/- 13.1
min (group B) and 245.6 +/- 11.6 min (group C) (P = 0.120). CL was the best
tolerated preparation. Compliance with the bowel preparation regimen was lowest
in group C (P = 0.008). CONCLUSIONS: A clear liquid diet and overnight fasting is
sufficient to achieve an adequate level of cleanliness and is better tolerated by
patients than other forms of preparation
Accuracy of Capsule Colonoscopy in Detecting Colorectal Polyps in a Screening Population
BACKGROUND & AIMS: Capsule colonoscopy is a minimally invasive imaging method. We measured the accuracy of this technology in detecting polyps 6 mm or larger in an average-risk screening population.
METHODS: In a prospective study, asymptomatic subjects (n = 884) underwent capsule colonoscopy followed by conventional colonoscopy (the reference) several weeks later, with an endoscopist blinded to capsule results, at 10 centers in the United States and 6 centers in Israel from June 2011 through April 2012. An unblinded colonoscopy was performed on subjects found to have lesions 6 mm or larger by capsule but not conventional colonoscopy.
RESULTS: Among the 884 subjects enrolled, 695 (79%) were included in the analysis of capsule performance for all polyps. There were 77 exclusions (9%) for inadequate cleansing and whole-colon capsule transit time fewer than 40 minutes, 45 exclusions (5%) before capsule ingestion, 15 exclusions (2%) after ingestion and before colonoscopy, and 15 exclusions (2%) for site termination. Capsule colonoscopy identified subjects with 1 or more polyps 6 mm or larger with 81% sensitivity (95% confidence interval [CI], 77%-84%) and 93% specificity (95% CI, 91%-95%), and polyps 10 mm or larger with 80% sensitivity (95% CI, 74%-86%) and 97% specificity (95% CI, 96%-98%). Capsule colonoscopy identified subjects with 1 or more conventional adenomas 6 mm or larger with 88% sensitivity (95% CI, 82%-93) and 82% specificity (95% CI, 80%-83%), and 10 mm or larger with 92% sensitivity (95% CI, 82%-97%) and 95% specificity (95% CI, 94%-95%). Sessile serrated polyps and hyperplastic polyps accounted for 26% and 37%, respectively, of false-negative findings from capsule analyses.
CONCLUSIONS: In an average-risk screening population, technically adequate capsule colonoscopy identified individuals with 1 or more conventional adenomas 6 mm or larger with 88% sensitivity and 82% specificity. Capsule performance seems adequate for patients who cannot undergo colonoscopy or who had incomplete colonoscopies. Additional studies are needed to improve capsule detection of serrated lesions. Clinicaltrials.gov number: NCT01372878
Esophageal capsule endoscopy
Capsule endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe, and could be also an alternative procedure in those patients refusing upper endoscopy. Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients, current results are encouraging and open a new era in esophageal examination