159 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
International core curriculum for capsule endoscopy training courses
Capsule endoscopy (CE) has become a first-line noninvasive tool for visualisation of the small bowel (SB) and is being increasingly used for investigation of the colon. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines have specified requirements for the clinical applications of CE. However, there are no standardized recommendations yet for CE training courses in Europe. The following suggestions in this curriculum are based on the experience of European CE training courses directors. It is suggested that 12 hours be dedicated for either a small bowel capsule endoscopy (SBCE) or a colon capsule endoscopy (CCE) course with 4 hours for an introductory CCE course delivered in conjunction with SBCE courses. SBCE courses should include state-of-the-art lectures on indications, contraindications, complications, patient management and hardware and software use. Procedural issues require approximately 2 hours. For CCE courses 2.5 hours for theoretical lessons and 3.5 hours for procedural issued are considered appropriate. Hands-on training on reading and interpretation of CE cases using a personal computer (PC) for 1 or 2 delegates is recommended for both SBCE and CCE courses. A total of 6 hours hands-on session- time should be allocated. Cases in a SBCE course should cover SB bleeding, inflammatory bowel diseases (IBD), tumors and variants of normal and cases with various types of polyps covered in CCE courses. Standardization of the description of findings and generation of high-quality reports should be essential parts of the training. Courses should be followed by an assessment of trainees' skills in order to certify readers' competency.info:eu-repo/semantics/publishedVersio
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
Panenteric capsule endoscopy identifies proximal small bowel disease guiding upstaging and treatment intensification in Crohn’s disease: A European multicentre observational cohort study
Background: Endoscopically defined mucosal healing in Crohn\u2019s disease is associated with improved outcomes. Panenteric capsule endoscopy enables a single non-invasive assessment of small and large bowel mucosal inflammation. Aims and methods: This multicentre observational study of patients with suspected and established Crohn\u2019s disease examined the feasibility, safety and impact on patient outcomes of panenteric capsule endoscopy in routine clinical practice. The potential role in assessment of disease severity and extent by a comparison with existing clinical and biochemical markers is examined. Results: Panenteric capsule endoscopy was performed on 93 patients (71 with established and 22 with suspected Crohn\u2019s disease). A complete examination occurred in 85% (79/93). Two cases (2.8%) of capsule retention occurred in patients with established Crohn\u2019s disease. Panenteric capsule resulted in management change in 38.7% (36/93) patients, including 64.6% (32/48) of those with an established diagnosis whose disease was active, and all three patients with newly diagnosed Crohn\u2019s disease. Montreal classification was upstaged in 33.8% of patients with established Crohn\u2019s disease and mucosal healing was demonstrated in 15.5%. Proximal small bowel disease upstaged disease in 12.7% and predicted escalation of therapy (odds ratio 40.3, 95% confidence interval 3.6\u2013450.2). Raised C-reactive protein and faecal calprotectin were poorly sensitive in detecting active disease (0.48 and 0.59 respectively). Conclusions: Panenteric capsule endoscopy was feasible in routine practice and the ability to detect proximal small bowel disease may allow better estimation of prognosis and guide treatment intensification. Panenteric capsule endoscopy may be a suitable non-invasive endoscopic investigation in determining disease activity and supporting management decisions
Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline â Update 2020
1. ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. Strong recommendation, high quality evidence. ESGE/ESGAR do not recommend barium enema in this setting. Strong recommendation, high quality evidence. 2. ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors. Strong recommendation, low quality evidence. ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete. Weak recommendation, low quality evidence. 3. When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms. Strong recommendation, high quality evidence. Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation. Very low quality evidence. ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms. Strong recommendation, high quality evidence. In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms. Weak recommendation, low quality evidence. 4. Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors. Strong recommendation, high quality evidence. ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer. Weak recommendation, low quality evidence. 5. ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs. Strong recommendation, moderate quality evidence. ESGE/ESGAR also suggest the use of CCE in this setting based on availability. Weak recommendation, moderate quality evidence. 6. ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasible. Weak recommendation, low quality evidence. There is insufficient evidence to recommend CCE in this setting. Very low quality evidence. 7. ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible. Weak recommendation, low quality evidence. There is insufficient evidence to recommend CCE in post-polypectomy surveillance. Very low quality evidence. 8. ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation. Strong recommendation, low quality evidence. 9. ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp â„6 mm detected at CTC or CCE. Follow-up CTC may be clinically considered for 6â9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia. Strong recommendation, moderate quality evidence.Source and scop
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
Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement
Background and study aims \u2002Nomenclature and descriptions of small bowel (SB) vascular lesions in capsule endoscopy (CE) are scarce in the medical literature. They are mostly based on the reader's opinion and thus differ between experts, with a potential negative impact on clinical care, teaching and research regarding SBCE. Our aim was to better define a nomenclature and to give a description of the most frequent vascular lesions in SBCE. Methods \u2002A panel of 18 European expert SBCE readers was formed during the UEGW 2016 meeting. Three experts constructed an Internet-based four-round Delphi consensus, but did not participate in the voting process. They built questionnaires that included various still frames of vascular lesions obtained with a third-generation SBCE system. The 15 remaining participants were asked to rate different proposals and description of the most common SB vascular lesions. A 6-point rating scale (varying from 'strongly disagree' to 'strongly agree') was used successive rounds. The consensus was reached when at least 80\u200a% voting members scored the statement within the 'agree' or 'strongly agree'. Results \u2002Consensual terms and descriptions were reached for angiectasia/angiodysplasia, erythematous patch, red spot/dot, and phlebectasia. A consensual description was reached for more subtle vascular lesions tentatively named "diminutive angiectasia" but no consensus was reached for this term. Conclusion \u2002An international group has reached a consensus on the nomenclature and descriptions of the most frequent and relevant SB vascular lesions in CE. These terms and descriptions are useful in daily practice, for teaching and for medical research purposes
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