Small bowel capsule endoscopy : where are we after almost 15 years of use?

The development of capsule endoscopy (CE) in 2001 has given gastroenterologists the opportunity to investigate the small bowel in a non-invasive way. CE is most commonly performed for obscure gastrointestinal bleeding, but other indications include diagnosis or follow-up of Crohn's disease, suspicion of a small bowel tumor, diagnosis and surveillance of hereditary polyposis syndromes, Nonsteroidal anti-inflammatory drug-induced small bowel lesions and celiac disease. Almost fifteen years have passed since the release of the small bowel capsule. The purpose of this review is to offer the reader a brief but complete overview on small bowel CE anno 2014, including the technical and procedural aspects, the possible complications and the most important indications. We will end with some future perspectives of CE

The revival of unsedated colonoscopy through water infusion

Introduction : Unsedated colonoscopy using water infusion has been performed in a US veterans population, showing feasibility and even enhanced adenoma detection rate (Leung et al, J Interv Gastroenterol, 2011, 1, 8-13). Avoiding sedation or general anesthesia theoretically will avoid sedation related complications, could be time- and cost-saving, could improve patient satisfaction and reduce waiting lists for colonoscopy. Aim : To study the feasibility of unsedated colonoscopy by means of water infusion in a tertiary hospital setting. The primary endpoint of this trial is reaching the cecum without need for sedation. Methods : The water infusion technique for colonoscopy consists of using water at body temperature at insertion of the endoscope, instead of air insufflation. It is combined with removal of all residual colonic air by suction and residual feces by water exchange. Once the cecum is reached, air insufflation is used during withdrawal for mucosal inspection. All patients start the endoscopy unsedated but sedation and analgesia are administered if needed or asked for (midazolam 2,5 mg / pethidine 50 mg). When progression with water fails, switch to air insufflation is made. Pain scores are registred on a VAS (0=no pain, 10=maximal pain). Patient satisfaction and willing to repeat the procedure are also scored on a VAS (respectively: 0=very low, 10=high/ 0=not willing to repeat, 10=willing). Results : 38 patients (18F, 20M) with a mean age of 57 ± 11 yrs are included. Indications for colonoscopy are: cancer screening 24%, polyp surveillance 18%, diagnostic 58%. The primary endpoint, unsedated succesful cecal intubation, is reached in 27 patients (71,2%). The global cecal intubation rate is 94,7% (n=36). Mean insertion time was 14 ± 6 min. Mean length of the colonoscope at the cecum was 82 ± 10 cm. Mean volume of water infused upon arrival to the cecum is 332 ± 172 ml. In 11 patients (28,9%) temporary switch to air insufflation during insertion is needed (6 at the hepatic flexure, 5 in the sigmoid). Men reach the endpoint more readily than women (85% vs. 55,6%, p = 0,046). Age doesn’t make a difference (p = 0,62). Maximum mean pain score during insertion is 3,1 ± 2,7; pain at time of discharge is 1,5 ± 2,2. Patient satisfaction is 9,2 ± 1,2, willingness to repeat 9,7 ± 0,7. Mean withdrawal time is 8,8 + 4,6 min and the adenoma detection rate is 21%. Conclusions : Water-infused colonoscopy is a promising and simple technique to perform complete unsedated colonoscopy. This method may open perspectives for a new era in colonoscopy with high patient satisfaction and lower costs

Infliximab treatment in pediatric IBD patients: a single centre experience

C

The dust mass in Cassiopeia A from infrared and optical line flux differences

The large quantities of dust that have been found in a number of high redshift galaxies have led to suggestions that core-collapse supernovae (CCSNe) are the main sources of their dust and have motivated the measurement of the dust masses formed by local CCSNe. For Cassiopeia~A, an oxygen-rich remnant of a Type~IIb CCSN, a dust mass of 0.6-1.1~M$_\odot$ has already been determined by two different methods, namely (a) from its far-infrared spectral energy distribution and (b) from analysis of the red-blue emission line asymmetries in its integrated optical spectrum. We present a third, independent, method for determining the mass of dust contained within Cas~A. This compares the relative fluxes measured in similar apertures from [O~{\sc iii}] far-infrared and visual-region emission lines, taking into account foreground dust extinction, in order to determine internal dust optical depths, from which corresponding dust masses can be obtained. Using this method we determine a dust mass within Cas~A of at least 0.99$^{+0.10}_{-0.09}$~M$_\odot$.Comment: Accepted by MNRAS, 17 pages, 12 figures. Author accepted manuscript. Accepted on 21/03/2021. Deposited on 22/03/202

Assessment of faecal microbial transfer in irritable bowel syndrome with severe bloating

A

Impact of a decade of successful antiretroviral therapy initiated at HIV-1 seroconversion on blood and mucosal reservoirs

Persistent reservoirs remain the major obstacles to achieve an HIV-1 cure. Prolonged early antiretroviral therapy (ART) may reduce the extent of reservoirs and allow for virological control after ART discontinuation. We compared HIV-1 reservoirs in a cross-sectional study using polymerase chain reaction-based techniques in blood and tissue of early-treated seroconverters, late-treated patients, ART-naïve seroconverters, and long-term non-progressors (LTNPs) who have spontaneous virological control without treatment. A decade of early ART reduced the total and integrated HIV-1 DNA levels compared with later treatment initiation, but not reaching the low levels found in LTNPs. Total HIV-1 DNA in rectal biopsies did not differ between cohorts. Importantly, lower viral transcription (HIV-1 unspliced RNA) and enhanced immune preservation (CD4/CD8), reminiscent of LTNPs, were found in early compared to late-treated patients. This suggests that early treatment is associated with some immunovirological features of LTNPs that may improve the outcome of future interventions aimed at a functional cure