Malignant peritoneal mesothelioma as a rare cause of ascites: a case report

<p>Abstract</p> <p>Introduction</p> <p>Peritoneal mesothelioma is a rare tumor with diagnostic and therapeutic problems. The peritoneum is the second most common site for development of mesothelioma, which in 30–45% of cases is associated with a synchronous pleural mesothelioma. Clinical symptoms and findings may be confusing and diagnosis can be easily overlooked especially in cases where there is no previous asbestos exposure.</p> <p>Case presentation</p> <p>We report a case of malignant peritoneal mesothelioma in a 75-year-old woman who presented with ascites which, in the absence of inhalational exposure to asbestos, caused diagnostic confusion, and evaded radiological detection.</p> <p>Conclusion</p> <p>We concluded from this case that Peritoneal Mesothelioma although rare but should be considered among the differential diagnosis of Ascites.</p

Use of small bowel capsule endoscopy in patients with chronic kidney disease:Experience from a university referral center

Abstract Background There are only few reports on the diagnostic yield (DY) of small bowel capsule endoscopy (SBCE) in patients with chronic kidney disease (CKD). We aim to report our SBCE experience in patients with CKD. Methods Retrospective study; case notes of patients with low estimated glomerular filtration rate (eGFR) who underwent SBCE (March 2005-August 2012) for anemia and/or obscure gastrointestinal bleeding (OGIB) were retrieved and abstracted. Severity of CKD was defined according to Renal Association recommendations as: stage 3 (eGFR: 30-59); stage 4 (eGFR: 15-29); and stage 5 (eGFR &lt;15 or on dialysis). Results In the aforementioned period, 69 patients with CKD [stage 3: 65/69 (92.8%), stage 4 or 5:4/69 (7.2%)] had SBCE. 51/65 (78.5%) patients with stage 3 CKD had SBCE due to unexplained anemia and/or OGIB [43 (66.1%) and 8 (12.3%), respectively]. In 25/51 (49%), the SBCE was normal and in 17/51 (33.3%) showed small-bowel angiectasias. Other findings were active bleeding (n=2), fold edema (n=2), ileal erosions (n=1), adenocarcinoma (n=1), and inconclusive/videos not available (n=3). All patients (n=4) with CKD grade 4 or 5 were referred due to unexplained anemia; 3/4 (75%) had angiectasias and 1 normal SBCE. Fecal calprotectin (FC) was measured in 12 patients with CKD stage 3 and unexplained anemia prior to their SBCE; no significant small-bowel inflammation was found in this subgroup. Conclusion SBCE has limited DY in CKD patients referred for unexplained anemia. Sinister SB pathology is rare, while the most common finding is angiectasias. Furthermore, FC measurement prior to SBCE-in this cohort of patients- is not associated with increased DY

Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos).

BACKGROUND AND AIMS: The first small-bowel video-capsule endoscopy (VCE) with 360° panoramic view has been recently developed. This new capsule has a wire-free technology, 4 high frame-rate cameras, and a long-lasting battery life. The present study was aimed at assessing performances and the safety profile of the 360° panoramic-view capsule in a large series of patients from a multicenter clinical practice setting. METHODS: Consecutive patients undergoing a 360° panoramic-view capsule procedure in 7 European Institutions between January 2011 and November 2015 were included. Both technical (ie, technical failures, completion rate) and clinical (ie, indication, findings, retention rate) data were collected by means of a structured questionnaire. VCE findings were classified according to the likelihood to explain reason for referral: P0-low, P1-intermediate and P2-high. RESULTS: Among 172 patients (94 men; median age: 68 years, IQR: 53-75), 142 underwent VCE for obscure (32 overt, 110 occult) GI bleeding (OGIB) and 28 for suspected (17) or established (2) Crohn's disease (CD). Overall, 560 findings were detected; 252 of them were P2. The overall diagnostic yield was 40.1%; 42.2% and 30.0% in patients with OGIB and CD, respectively. The rate of complete enteroscopy was 90.2%. All of the patients but one, who experienced capsule retention (1/172: 0.6%), excreted and retrieved the capsule. VCE failure occurred in 4 of 172 (2.3%) cases for technical problems. CONCLUSION: The present multicenter study, conducted in clinical practice setting and based on a large consecutive series of patients, showed that DY and safety profile of 360° panoramic-view capsule are similar to those of forward-view VCEs

A survey of small bowel modelling and its applications for capsule endoscopy

This is the final version. Available on open access from Elsevier via the DOI in this recordThe small intestine, an anatomical site previously considered inaccessible to clinicians due to its small diameter and length, is the part of the gastrointestinal tract between the stomach and the colon. Since its introduction into clinical practice two decades ago, capsule endoscopy has become established as the primary modality for examining the surface lining of the small intestine. Today, researchers continue to develop ground-breaking technologies for novel miniature devices aiming for tissue biopsy, drug delivery and therapy. The purpose of this paper is to provide researchers and engineers in this area a comprehensive review of the progress in understanding the anatomy and physiology of the small intestine and how this understanding was translated to virtual and physical test platforms for assessing the performance of these intestinal devices. This review will cover both theoretical and practical studies on intestinal motor activities and the work on mathematical modelling and experimental investigation of capsule endoscope in the small intestine. In the end, the requirements for improving the current work are drawn, and the expectations on future research in this field are provided.Engineering and Physical Sciences Research Council (EPSRC)China Scholarship Counci

Morpho-functional evaluation of small bowel using wireless motility capsule and video capsule endoscopy in patients with known or suspected Crohn’s disease: pilot study

Background and study aims: SmartPill(®) (Given Imaging Corp.,Yoqneam,Israel) is an ingestible, non-imaging capsule that records physiological data including contractions and pH throughout the gastrointestinal tract. There are scarce data looking at SmartPill(®) assessment of patients with known/suspected small-bowel Crohn’s Disease (CD). This pilot study aims to investigate feasibility and safety of SmartPill(®) to assess gut motility in this group.  Patients and methods: Over 1 year, patients with known/suspected CD, referred for small-bowel capsule endoscopy (SBCE), were invited to participate and 12 were recruited (7 female, 5 male, mean age 44.2 ± 16.6 years). They underwent hydrogen breath test to exclude small-bowel bacterial overgrowth, patency capsule (Agile(®)), and provided stool samples for fecal calprotectin (FC). Patients ingested PillCam(®)SB2 and SmartPill(®) 4 hours apart. Using unpublished data, 33 healthy controls also were identified for the study. P < 0.05 was considered statistically significant. Results: Of the 12 patients enrolled, 10 underwent complete Smartpill(®) examination (1 stomach retention, 1 dropout). Pillcam(®) was complete in 10 (1 dropout, 1 stomach retention). Mean fecal calprotectin was 340 ± 307.71 mcg/g. The study group had longer transit times and lower gut motility index than did the controls. The difference in motility appears to be statistically significant (P < 0.05). Longer transit times for SmartPill(®) (not statistically significant) may have been due to different specifications between the capsules. Limitations included transient Smartpill(®) signal loss (5/10 studies). Conclusions: This is the first pilot to attempt combining SBCE and SmartPill(®) to assess small-bowel CD. Data on motility in CD are scarce. Multimodal information can provide a clearer clinical picture. Despite concerns about capsule retention in CD patients, SmartPill(®) seems safe for use if a patency capsule is employed beforehand

A. Training Simulators for Gastrointestinal Endoscopy: Current and Future Perspectives

Over the last decades, visual endoscopy has become a gold standard for the detection and treatment of gastrointestinal cancers. However, mastering endoscopic procedures is complex and requires long hours of practice. In this context, simulation-based training represents a valuable opportunity for acquiring technical and cognitive skills, suiting the different trainees’ learning pace and limiting the risks for the patients. In this regard, the present contribution aims to present a critical and comprehensive review of the current technology for gastrointestinal (GI) endoscopy training, including both commercial products and platforms at a research stage. Not limited to it, the recent revolution played by the technological advancements in the fields of robotics, artificial intelligence, virtual/augmented reality, and computational tools on simulation-based learning is documented and discussed. Finally, considerations on the future trend of this application field are drawn, highlighting the impact of the most recent pandemic and the current demographic trends