Capsule endoscopy versus colonoscopy for the detection of polyps and cancer.

BACKGROUND: An ingestible capsule consisting of an endoscope equipped with a video camera at both ends was designed to explore the colon. This study compared capsule endoscopy with optical colonoscopy for the detection of colorectal polyps and cancer. METHODS: We performed a prospective, multicenter study comparing capsule endoscopy with optical colonoscopy (the standard for comparison) in a cohort of patients with known or suspected colonic disease for the detection of colorectal polyps or cancer. Patients underwent an adapted colon preparation, and colon cleanliness was graded from poor to excellent. We computed the sensitivity and specificity of capsule endoscopy for polyps, advanced adenoma, and cancer. RESULTS: A total of 328 patients (mean age, 58.6 years) were included in the study. The capsule was excreted within 10 hours after ingestion and before the end of the lifetime of the battery in 92.8% of the patients. The sensitivity and specificity of capsule endoscopy for detecting polyps that were 6 mm in size or bigger were 64% (95% confidence interval [CI], 59 to 72) and 84% (95% CI, 81 to 87), respectively, and for detecting advanced adenoma, the sensitivity and specificity were 73% (95% CI, 61 to 83) and 79% (95% CI, 77 to 81), respectively. Of 19 cancers detected by colonoscopy, 14 were detected by capsule endoscopy (sensitivity, 74%; 95% CI, 52 to 88). For all lesions, the sensitivity of capsule endoscopy was higher in patients with good or excellent colon cleanliness than in those with fair or poor colon cleanliness. Mild-to-moderate adverse events were reported in 26 patients (7.9%) and were mostly related to the colon preparation. CONCLUSIONS: The use of capsule endoscopy of the colon allows visualization of the colonic mucosa in most patients, but its sensitivity for detecting colonic lesions is low as compared with the use of optical colonoscopy. (ClinicalTrials.gov number, NCT00604162.)Clinical TrialComparative StudyJournal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Surface Modification, Characterization and Biofunctionality of Pegylated Titanate Films Obtained by the Sol-Gel Method

Pegylated titanates have been prepared as biomedical supports in the form of thin films. The independent preparation of a polyethylene glycol (PEG) and a ¿tetraisopropyl-orthotitanate (TIPT) precursorwas followed by mixing at different molar ratios and spin casting onto Si (100) substrates to form the films. Activation of the hybrid structure was induced by annealing at temperatures right below the PEG melting point. Structural and compositional changes during these steps were followed by Fourier transformed infrared (FTIR) spectroscopy, XPS) and water contact angle (CA) measurements. Biofunctionality of the pegylated titanates as antifouling ophthalmic films was tested on the one hand by determination of optical constants using genetic algorithms. On the other hand, indication of surface biocompatibility was provided by seeding mesenchymal stemcells. The results show that PEG-rich surfaces are less biocompatible than mild inorganic surfaces as derived from the inhibition of cytoskeleton polarization.JRC.I.4-Nanotechnology and Molecular Imagin

Wide area transepithelial sampling with computer assisted analysis (WATS3D) to detect high grade dysplasia and cancer in Barrett's esophagus: a multi-center, randomized study.

Background and aims Current surveillance for Barrett's esophagus (BE), consisting of 4-quadrant random forceps biopsy (FB), has an inherent risk of sampling error. Wide-Area Transepithelial Sampling (WATS) may increase detection of high-grade dysplasia (HGD) and adenocarcinoma (EAC). In this multicenter, randomized trial, we aimed to evaluate WATS as a substitute for FB. Methods Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice-versa. All WATs samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Laboratory. Similarly, all FBs were examined by two expert pathologists. The primary endpoint was concordance/disconcordance for detection of HGD/EAC between both techniques. Results 172 patients were included. Of these, 21 had HGD/EAC detected with both modalities, 18 other had HGD/EAC detected by WATS, but missed with FB and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (p=0.36). Utilizing WATS as an adjunct to FB significantly increased detection of HGD/EAC vs FB alone (absolute increase 10% [95%-CI: 6-16%]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95% CI:5.9-7.1), 4.9 (95% CI:4.1-5.4), and 11.2 (95%-CI:10.5-14.0) respectively. Conclusions Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for detection of HGD/EAC as single modality