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Bourouail O, Bourabaa S, Halim EM, Njoumi N, Elhjouji A, Aitali A. Small intestinal metastasis of cutaneous melanoma in an elderly woman: Survival benefits of surgery and novel targeted therapies - A case report. Int J Surg Case Rep 2025; 127:110822. [PMID: 39823971 PMCID: PMC11786672 DOI: 10.1016/j.ijscr.2025.110822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 12/24/2024] [Accepted: 01/02/2025] [Indexed: 01/20/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE Cutaneous malignant melanoma, originating from melanocytes, is a highly metastatic cancer with an incidence rate of 0.9 per 100,000. The gastrointestinal tract is a common site of metastasis, with the small intestine being particularly affected. The aggressive nature and frequency of this condition emphasize the importance of prompt diagnosis and effective treatment. CASE PRESENTATION We report the case of an 82-year-old female with a history of left heel cutaneous melanoma, previously treated with excision and immunotherapy. Within six months of achieving disease-free status, an abdominal mass was detected during routine positron emission tomography-computed tomography. A radiological biopsy confirmed metastatic melanoma. Due to the localized nature of the disease, the patient underwent small bowel resection and was restarted on immunotherapy. Despite these interventions, brain and liver metastases developed within two months, highlighting the rapid progression and poor prognosis associated with this condition. CLINICAL DISCUSSION Melanoma frequently metastasizes to the gastrointestinal tract, with the small intestine being the most common site. These metastases present diagnostic challenges due to nonspecific symptoms such as abdominal pain or anemia. Multidisciplinary approaches combining surgical resection and systemic therapies, including immunotherapy and BRAF inhibitors, have dramatically improved survival rates in selected patients, even at advanced stages. CONCLUSION This case highlights the survival benefits of surgical resection in elderly patients with intestinal melanoma metastases, particularly when the disease-free interval from primary melanoma excision is under one year. While advancements in targeted therapies have transformed management, surgery remains vital for symptom relief and outcomes.
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Affiliation(s)
- Othmane Bourouail
- Visceral Surgery Department II, Mohammed V Military Hospital, Ibn Sina University Hospital, Rabat, Morocco.
| | | | - El Mustapha Halim
- Visceral Surgery Department II, Mohammed V Military Hospital, Ibn Sina University Hospital, Rabat, Morocco
| | - Noureddine Njoumi
- Visceral Surgery Department II, Mohammed V Military Hospital, Ibn Sina University Hospital, Rabat, Morocco
| | - Abderrahman Elhjouji
- Visceral Surgery Department II, Mohammed V Military Hospital, Ibn Sina University Hospital, Rabat, Morocco
| | - Abdelmounaim Aitali
- Visceral Surgery Department II, Mohammed V Military Hospital, Ibn Sina University Hospital, Rabat, Morocco
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Palm PH, Patrick MM, Cruz CA, Navaneethan U, Caycedo A, Ferrara M. Management of retained endoscopy capsule: a case series and literature review. J Surg Case Rep 2024; 2024:rjae749. [PMID: 39588215 PMCID: PMC11587894 DOI: 10.1093/jscr/rjae749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/09/2024] [Indexed: 11/27/2024] Open
Abstract
Video capsule endoscopy has become the gold standard for the evaluation of small bowel pathology. Capsular retention remains the most significant risk of this intervention. Here, we present two cases of retained capsules and our minimally invasive approach to retrieval. We also review the literature pertaining to retained endoscopy capsules and highlight a range of medical, surgical, and preventative strategies utilized in its management.
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Affiliation(s)
- Preston H Palm
- Orlando Health Colon and Rectal Institute, 110 W. Underwood St, Ste A, Orlando, FL 32806, United States
| | - Madison M Patrick
- Department of Clinical Sciences, Florida State University College of Medicine, 250 E. Colonial Dr. #200, Orlando, FL 32801, United States
| | - Claudia A Cruz
- Department of Clinical Sciences, Florida State University College of Medicine, 250 E. Colonial Dr. #200, Orlando, FL 32801, United States
| | - Udayakumar Navaneethan
- Orlando Health Colon and Rectal Institute, 110 W. Underwood St, Ste A, Orlando, FL 32806, United States
| | - Antonio Caycedo
- Orlando Health Colon and Rectal Institute, 110 W. Underwood St, Ste A, Orlando, FL 32806, United States
| | - Marco Ferrara
- Orlando Health Colon and Rectal Institute, 110 W. Underwood St, Ste A, Orlando, FL 32806, United States
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Thwaites PA, Gibson PR. Letter: The emerging role of novel capsule endoscopy systems in gastroenterology with specific reference to small bowel Crohn's disease. Authors' reply. Aliment Pharmacol Ther 2024; 59:1164-1165. [PMID: 38591805 DOI: 10.1111/apt.17970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
LINKED CONTENTThis article is linked to Thwaites et al papers. To view these articles, visit https://doi.org/10.1111/apt.17944 and https://doi.org/10.1111/apt.17946
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Affiliation(s)
- Phoebe A Thwaites
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
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Rosa B, Cotter J. Capsule endoscopy and panendoscopy: A journey to the future of gastrointestinal endoscopy. World J Gastroenterol 2024; 30:1270-1279. [PMID: 38596501 PMCID: PMC11000081 DOI: 10.3748/wjg.v30.i10.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
In 2000, the small bowel capsule revolutionized the management of patients with small bowel disorders. Currently, the technological development achieved by the new models of double-headed endoscopic capsules, as miniaturized devices to evaluate the small bowel and colon [pan-intestinal capsule endoscopy (PCE)], makes this non-invasive procedure a disruptive concept for the management of patients with digestive disorders. This technology is expected to identify which patients will require conventional invasive endoscopic procedures (colonoscopy or balloon-assisted enteroscopy), based on the lesions detected by the capsule, i.e., those with an indication for biopsies or endoscopic treatment. The use of PCE in patients with inflammatory bowel diseases, namely Crohn's disease, as well as in patients with iron deficiency anaemia and/or overt gastrointestinal (GI) bleeding, after a non-diagnostic upper endoscopy (esophagogastroduodenoscopy), enables an effective, safe and comfortable way to identify patients with relevant lesions, who should undergo subsequent invasive endoscopic procedures. The recent development of magnetically controlled capsule endoscopy to evaluate the upper GI tract, is a further step towards the possibility of an entirely non-invasive assessment of all the segments of the digestive tract, from mouth-to-anus, meeting the expectations of the early developers of capsule endoscopy.
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Affiliation(s)
- Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães 4835-044, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga 4710-057, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga 4710-057, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães 4835-044, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga 4710-057, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga 4710-057, Portugal
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Ionescu A, Glodeanu A, Ionescu M, Zaharie S, Ciurea A, Golli A, Mavritsakis N, Popa D, Vere C. Clinical impact of wireless capsule endoscopy for small bowel investigation (Review). Exp Ther Med 2022; 23:262. [PMID: 35251328 PMCID: PMC8892621 DOI: 10.3892/etm.2022.11188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 11/06/2022] Open
Abstract
Wireless capsule endoscopy is currently considered the gold standard in the investigation of the small bowel. It is both practical for physicians and easily accepted by patients. Prior to its development, two types of imaging investigations of the small bowel were available: radiologic and endoscopic. The first category is less invasive and comfortable for patients; it presents the ensemble of the small bowel, but it may imply radiation exposure. Images are constructed based on signals emitted by various equipment and require special interpretation. Endoscopic techniques provide real-time colored images acquired by miniature cameras from inside the small bowel, require interpretation only from a medical point of view, may allow the possibility to perform biopsies, but the investigation only covers a part of the small bowel and are more difficult to accept by patients. Wireless capsule endoscopy is the current solution that overcomes a part of the previous drawbacks: it covers the entire small bowel, it provides real-time images acquired by cameras, it is painless for patients, and it represents an abundant source of information for physicians. Yet, it lacks motion control and the possibility to perform biopsies or administer drugs. However, significant effort has been oriented in these directions by technical and medical teams, and more advanced capsules will surely be available in the following years.
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Affiliation(s)
- Alin Ionescu
- Department of Medical History, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Glodeanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sorin Zaharie
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana Ciurea
- Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andreea Golli
- Department of Public Health Management, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Nikolaos Mavritsakis
- Department of Physical Education and Sport, ‘1 Decembrie 1918’ University, 510009 Alba Iulia, Romania
| | - Didi Popa
- Department of Information and Communication Technology, University of Craiova, 200585 Craiova, Romania
| | - Cristin Vere
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Meltzer AC, Limkakeng AT, Gentile NT, Freeman JQ, Hall NC, Vargas NM, Fleischer DE, Malik Z, Kallus SJ, Borum ML, Ma Y, Kumar AB. Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial. J Am Coll Emerg Physicians Open 2021; 2:e12579. [PMID: 34723247 PMCID: PMC8544929 DOI: 10.1002/emp2.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for upper endoscopy (EGD). We conducted a clinical trial to determine if ED risk stratification with video capsule endoscopy (VCE) reduces hospitalization rates for low-risk to moderate-risk patients with suspected upper GI bleeding. METHODS We conducted a randomized controlled trial at 3 urban academic EDs. Inclusion criteria included signs of upper GI bleeding and a Glasgow Blatchford score <6. Patients were randomly assigned to 1 of the following 2 treatment arms: (1) an experimental arm that included VCE risk stratification and brief ED observation versus (2) a standard care arm that included admission for inpatient EGD. The primary outcome was hospital admission. Patients were followed for 7 and 30 days to assess for rebleeding events and revisits to the hospital. RESULTS The trial was terminated early as a result of low accrual. The trial was also terminated early because of a need to repurpose all staff to respond to the coronavirus disease 2019 pandemic. A total of 24 patients were enrolled in the study. In the experimental group, 2/11 (18.2%) patients were admitted to the hospital, and in the standard of care group, 10/13 (76.9%) patients were admitted to the hospital (P = 0.012). There was no difference in safety on day 7 and day 30 after the index ED visit. CONCLUSIONS VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended.
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Affiliation(s)
- Andrew C. Meltzer
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Nina T. Gentile
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Jincong Q. Freeman
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nicole C. Hall
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nataly Montano Vargas
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Zubair Malik
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Samuel J. Kallus
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Marie L. Borum
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Yan Ma
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Anita B. Kumar
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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Kneeland MK, Schilling MA, Aharonson BS. Exploring Uncharted Territory: Knowledge Search Processes in the Origination of Outlier Innovation. ORGANIZATION SCIENCE 2020. [DOI: 10.1287/orsc.2019.1328] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most innovation builds closely on existing knowledge and technology, delivering incremental advances on existing ideas, products, and processes. Sometimes, however, inventors make discoveries that seem very distant from what is known and well understood. How do individuals and firms explore such uncharted technological terrain? This paper extends research on knowledge networks and innovation to propose three main processes of knowledge creation that are more likely to result in discoveries that are distant from existing inventions: long search paths, scientific reasoning, and distant recombination. We explore these processes with a combination of a large and unique data set on outlier patents filed at the U.S. Patent and Trademark Office and interviews with inventors of outlier patents. Our exploratory analysis suggests that there are significant differences in the inventor teams, assignees, and search processes that result in outlier patents. These results have important implications for managers who wish to encourage a more exploratory search for breakthrough innovation.
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Affiliation(s)
| | | | - Barak S. Aharonson
- Strategic Management and Entrepreneurship, Xiamen School of Management, Xiamen University, 361005 Fujian, China
- Coller School of Management, Tel Aviv University, Tel Aviv 6997801, Israel
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Sun TJ, Cheng CS, Zhang HD. Optimizing the performance of magnet-controlled capsule endoscopy based on radiological and gastroscopic modeling. Exp Ther Med 2020; 19:248-254. [PMID: 31853296 PMCID: PMC6909664 DOI: 10.3892/etm.2019.8202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/09/2019] [Indexed: 12/16/2022] Open
Abstract
Routine use of magnet-controlled capsule endoscopy of the stomach has been limited by the inadequate views of specific stomach regions. In the present study, radiology and upper gastrointestinal endoscopy (UGIE) were used to determine optimal subject body positioning and suitable external control magnet placement for capsule endoscopy. Healthy adult volunteers were subjected to upper gastrointestinal X-ray radiography (n=5), spiral computed tomography with volume reconstruction (n=4) or UGIE (n=1). Stomach fundus-to-body (FB) and body-to-antrum (BA) angles were compared when subjects were supine, prone, lying on their left side and on their right side, and when they were standing upright. Vertical distances from the surface of the body to the distal points of the fundus and antrum were also compared in this range of subject positions. Obtuse angles were considered the most beneficial for capsule movement and short vertical distances were considered desirable for optimizing magnetic force. The FB angle was sharply acute in the supine position, relatively open where subjects were on their side, and almost 180° in the standing position. The BA angle was obtuse in the standing position but acute in all other positions. With the subject in any position, the left lower lateral chest had the shortest distance to the fundus, while the ventral wall was closest to the antrum. The present modeling analysis indicates that standing is superior to all decubitus positions for magnetic-capsule endoscopy, including the commonly used supine position. Both the abdominal anterior wall and left lateral lower chest appeared to be advantageous locations for external control magnet placement.
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Affiliation(s)
- Ting-Ji Sun
- Department of Gastroenterology, Nanshan Hospital, Guangdong Medical University, Shenzhen, Guangdong 518052, P.R. China
| | - Chun-Sheng Cheng
- Department of Gastroenterology, Nanshan Hospital, Guangdong Medical University, Shenzhen, Guangdong 518052, P.R. China
| | - Hou-De Zhang
- Department of Gastroenterology, Nanshan Hospital, Guangdong Medical University, Shenzhen, Guangdong 518052, P.R. China
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Cheng CS, Sun TJ, Zhang HD. Human gastric magnet-controlled capsule endoscopy conducted in a standing position: the phase 1 study. BMC Gastroenterol 2019; 19:184. [PMID: 31718547 PMCID: PMC6852763 DOI: 10.1186/s12876-019-1101-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022] Open
Abstract
Background Current magnet-controlled capsule endoscopy (MCE) for the stomach is not yet satisfactory with respect to navigation control, especially in the gastric fundus and cardia. A newly developed MCE system conducted in a standing rather than supine position may improve capsule maneuverability within the stomach. The aim of this phase 1 study was to assess the feasibility and safety of this system for examining the human stomach in healthy volunteers. Methods A cohort of 31 healthy volunteers were enrolled. Each swallowed a capsule after drinking water and gas producing agents intended to produce distention. Under the newly developed standing MCE system, subjects were examined endoscopically while standing with external guide magnets placed on the abdominal wall and left lower chest. Safety, gastric preparation, maneuverability, visualization of anatomical landmarks and the gastric mucosa, and examination time were the primary parameters assessed. The gastric preparation and examination procedures were well accepted by the subjects and there were no adverse events. Results Gastric examination took 27.8 ± 8.3 min (12–45 min). Gastric cleanliness was good in 24 participants (77.4%) and moderate in 7 participants (22.6%). Gastric distention was good in all of 31 participants (100%). Capsule maneuverability was also graded as good in all 31 subjects (100%), and manipulation in the fundus and cardia regions was as easy as that in the antrum and body. Visualization of the gastric cardia, fundus, body, angulus, antrum and pylorus was assessed subjectively as complete in all 31 subjects (100%). Visualization of the gastric mucosa was also good (> 75%) in all 31 subjects (100%). In areas where the mucosa could not be visualized, the low visibility was due to opaque fluid or foam. Polyps and erosive lesions were found in 25 subjects. Conclusion MCE of the stomach conducted in a standing position is feasible and safe with satisfactory maneuverability.
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Affiliation(s)
- Chun-Sheng Cheng
- Department of Gastroenterology, Shenzhen Sixth People's Hospital, Guangdong Medical University, Nanshan District, Shenzhen, 518052, China
| | - Ting-Ji Sun
- Department of Gastroenterology, Shenzhen Sixth People's Hospital, Guangdong Medical University, Nanshan District, Shenzhen, 518052, China
| | - Hou-de Zhang
- Department of Gastroenterology, Shenzhen Sixth People's Hospital, Guangdong Medical University, Nanshan District, Shenzhen, 518052, China.
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Goldis A, Goldis R, Chirila TV. Biomaterials in Gastroenterology: A Critical Overview. ACTA ACUST UNITED AC 2019; 55:medicina55110734. [PMID: 31726779 PMCID: PMC6915447 DOI: 10.3390/medicina55110734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023]
Abstract
In spite of the large diversity of diagnostic and interventional devices associated with gastrointestinal endoscopic procedures, there is little information on the impact of the biomaterials (metals, polymers) contained in these devices upon body tissues and, indirectly, upon the treatment outcomes. Other biomaterials for gastroenterology, such as adhesives and certain hemostatic agents, have been investigated to a greater extent, but the information is fragmentary. Much of this situation is due to the paucity of details disclosed by the manufacturers of the devices. Moreover, for most of the applications in the gastrointestinal (GI) tract, there are no studies available on the biocompatibility of the device materials when in intimate contact with mucosae and other components of the GI tract. We have summarized the current situation with a focus on aspects of biomaterials and biocompatibility related to the device materials and other agents, with an emphasis on the GI endoscopic procedures. Procedures and devices used for the control of bleeding, for polypectomy, in bariatrics, and for stenting are discussed, particularly dwelling upon the biomaterial-related features of each application. There are indications that research is progressing steadily in this field, and the establishment of the subdiscipline of "gastroenterologic biomaterials" is not merely a remote projection. Upon the completion of this article, the gastroenterologist should be able to understand the nature of biomaterials and to achieve a suitable and beneficial perception of their significance in gastroenterology. Likewise, the biomaterialist should become aware of the specific tasks that the biomaterials must fulfil when placed within the GI tract, and regard such applications as both a challenge and an incentive for progressing the research in this field.
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Affiliation(s)
- Adrian Goldis
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | | | - Traian V. Chirila
- Queensland Eye Institute, South Brisbane, QL 4101, Australia;
- Science & Engineering Faculty, Queensland University of Technology, Brisbane, QL 4000, Australia
- Faculty of Medicine, University of Queensland, Herston, QL 4029, Australia
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia, 4072 QL, Australia
- Faculty of Science, University of Western Australia, Crawley, WA 6009, Australia
- University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
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Alam MW, Hasan MM, Mohammed SK, Deeba F, Wahid KA. Are Current Advances of Compression Algorithms for Capsule Endoscopy Enough? A Technical Review. IEEE Rev Biomed Eng 2017; 10:26-43. [PMID: 28961125 DOI: 10.1109/rbme.2017.2757013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The recent technological advances in capsule endoscopy system have revolutionized the healthcare system by introducing new techniques and functionalities to diagnose gastrointestinal tract. These techniques improve diagnostic accuracy and reduce the risk of hospitalization. Although many benefits of capsule endoscopy are known, there are still limitations including lower battery life, higher bandwidth, poor image quality and lower frame rate, which have restricted its wide use. In order to solve these limitations, the importance of a low-cost compression algorithm, that produces higher frame rate with better image quality and yet consumes lower bandwidth and transmission power, is paramount. While several review papers have been published describing the capability of capsule endoscope in terms of its functionality and emerging features, an extensive review on the compression algorithms from past and for future applications is still of great interest. Hence, in this review, we aim to address the issue by exploring the characteristics of endoscopic images, analyzing the strengths and weaknesses of useful compression techniques, and making suggestions for possible future adaptation.
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13
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The dawn of the small bowel expert cometh! Curr Opin Gastroenterol 2017; 33:171-172. [PMID: 28282322 DOI: 10.1097/mog.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Abstract
Capsule endoscopy was conceived by inventive minds of good people. In the beginning there was a will to do something for medicine. The idea fomented after a discourse between the talented engineer with his physician friend. It took years to develop the concept. Then excellent engineers created de novo the necessary components to turn the capsule into a viable reality. The story is a tribute to human ingenuity.
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Affiliation(s)
- Samuel N Adler
- Division of Gastroenterology, Bikur Holim Hospital, Jerusalem, Israel
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15
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Bar-Gil Shitrit A, Koslowsky B, Livovsky DM, Shitrit D, Paz K, Adar T, Adler SN, Goldin E. A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy. Scand J Gastroenterol 2017; 52:328-333. [PMID: 27841040 DOI: 10.1080/00365521.2016.1253769] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD). AIM The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings. PATIENTS AND METHODS Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD. RESULTS Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD. CONCLUSIONS Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE. ClinicalTrials.gov Identifier: NCT01266629.
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Affiliation(s)
| | - Benjamin Koslowsky
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Dan M Livovsky
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - David Shitrit
- b The Department of Pulmonology , Meir Medical Center , Kfar Saba , Israel
| | - Kalman Paz
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Tomer Adar
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Samuel N Adler
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
| | - Eran Goldin
- a Digestive Diseases Institute, Shaare Zedek Medical Center , Jerusalem , Israel
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Madani K, Khanmohammadi S, Azimirad V. Finding Optimal Actuation Configuration for Magnetically Driven Capsule Endoscopy Based on Genetic Algorithm. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0180-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Singeap AM, Stanciu C, Trifan A. Capsule endoscopy: The road ahead. World J Gastroenterol 2016; 22:369-378. [PMID: 26755883 PMCID: PMC4698499 DOI: 10.3748/wjg.v22.i1.369] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/04/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023] Open
Abstract
Since its introduction into clinical practice 15 years ago, capsule endoscopy (CE) has become the first-line investigation procedure in some small bowel pathologies, and more recently, dedicated esophageal and colon CE have expanded the fields of application to include the upper and lower gastrointestinal disorders. During this time, CE has become increasingly popular among gastroenterologists, with more than 2 million capsule examinations performed worldwide, and nearly 3000 PubMed-listed studies on its different aspects published. This huge interest in CE may be explained by its non-invasive nature, patient comfort, safety, and access to anatomical regions unattainable via conventional endoscopy. However, CE has several limitations which impede its wider clinical applications, including the lack of therapeutic capabilities, inability to obtain biopsies and control its locomotion. Several research groups are currently working to overcome these limitations, while novel devices able to control capsule movement, obtain high quality images, insufflate the gut lumen, perform chromoendoscopy, biopsy of suspect lesions, or even deliver targeted drugs directly to specific sites are under development. Overlooking current limitations, especially as some of them have already been successfully surmounted, and based on the tremendous progress in technology, it is expected that, by the end of next 15 years, CE able to perform both diagnostic and therapeutic procedures will remain the major form of digestive endoscopy. This review summarizes the literature that prognosticates about the future developments of CE.
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Maeda Y, Moribata K, Deguchi H, Inoue I, Maekita T, Iguchi M, Tamai H, Kato J, Ichinose M. Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy. BMC Gastroenterol 2015; 15:132. [PMID: 26467439 PMCID: PMC4605125 DOI: 10.1186/s12876-015-0362-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background Both double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) have similar diagnostic yields for patients with overt obscure gastrointestinal bleeding (OGIB). However, the choice of initial modality is still controversial. The aim of this study was to show the clinical outcome of the strategy of initial VCE, followed by DBE. Methods Eighty-nine consecutive overt OGIB patients who had undergone VCE as the initial examination were analyzed. The interpreters of VCE evaluated the necessity of performing DBE, and the antegrade or retrograde route was chosen, depending on the transit time of the capsule. Results Thirty-seven patients (42 %) underwent DBE depending on the findings of VCE. Of these, bleeding sites in the small bowel were identified in 29 patients with the initially selected route (21 antegrade and 8 retrograde). The remaining 8 later underwent DBE by the other route, but 7 had no bleeding lesion, which was confirmed by second-look VCE. One remaining patient had a jejunal varix found by VCE, but DBE from either side could not reach the lesion. The sensitivity and negative predictive value of VCE were 100 %, both for the presence of small bowel lesions and the requirement of hemostasis in the small bowel; this indicated that VCE never misses relevant findings in the small bowel, and that negative VCE findings correspond to the lack of necessity for further examination. Conclusions VCE as the initial examination can efficiently identify overt OGIB patients who require DBE. The strategy of initial VCE for overt OGIB appears to be reasonable.
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Affiliation(s)
- Yoshimasa Maeda
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Kosaku Moribata
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Hisanobu Deguchi
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Izumi Inoue
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Takao Maekita
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Hideyuki Tamai
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Jun Kato
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
| | - Masao Ichinose
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
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Goffredo R, Accoto D, Guglielmelli E. Swallowable smart pills for local drug delivery: present status and future perspectives. Expert Rev Med Devices 2015; 12:585-99. [DOI: 10.1586/17434440.2015.1061933] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Schlag C, Menzel C, Nennstiel S, Neu B, Phillip V, Schuster T, Schmid RM, von Delius S. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2015; 81:889-95. [PMID: 25432532 DOI: 10.1016/j.gie.2014.09.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND In mid-GI bleeding, video capsule endoscopy (VCE) shows the best diagnostic yield for ongoing overt bleeding. To date, the utility of VCE in acute severe GI bleeding has been analyzed rarely. OBJECTIVE To evaluate the impact of VCE when performed on patients with acute severe GI bleeding immediately after an initial negative upper endoscopy result. DESIGN Prospective study. SETTING Tertiary-care center. PATIENTS Patients with melena, dark-red or maroon stool, hemodynamic instability, drop of hemoglobin level ≥2 g/dL/day, and/or need of transfusion ≥2 units of packed red blood cells per day were included. INTERVENTIONS After a negative upper endoscopy result, emergency VCE was performed by immediate endoscopic placement of the video capsule into the duodenum. MAIN OUTCOME MEASUREMENTS Rate of patients in whom emergency VCE correctly guided further diagnostic and therapeutic procedures. RESULTS Upper endoscopy showed the source of bleeding in 68 of 88 patients (77%). In the remaining 20 patients (23%), emergency VCE was performed, which was feasible in 19 of 20 patients (95%; 95% confidence interval [CI], 75%-99%). Emergency VCE correctly guided further diagnostic and therapeutic procedures in 17 of 20 patients (85%; 95% CI, 62%-97%) and showed a diagnostic yield of 75% (95% CI, 51%-91%). LIMITATIONS Single-center study, small sample size. CONCLUSION In patients with acute severe GI bleeding and negative upper endoscopy results, emergency VCE can be useful for the immediate detection of the bleeding site and is able to guide further therapy. (Clinical trial registration number: NCT01584869.)
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Vigorita V, Ausania F, Bertucci Zoccali M, Alvarez CF, Nadal BDU, Nuñez JEC. Small bowel intussusception secondary to metastatic melanoma 15 years after complete excision of the primary tumor. Int J Surg Case Rep 2014; 6C:26-28. [PMID: 25506846 PMCID: PMC4334886 DOI: 10.1016/j.ijscr.2014.11.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary intestinal melanoma is a rare entity, however the gastrointestinal tract, and particularly the small bowel, is a common site of recurrence from cutaneous melanoma. PRESENTATION OF CASE We report the case of a 48 year old woman with small bowel intussusception secondary to metastatic cutaneous melanoma, 15 years after excision of the primary tumor. The patient underwent an emergency small bowel resection with negative margins on final pathology. DISCUSSION Surgical resection is a palliative, yet necessary, procedure in the setting of small bowel obstruction due to intussusception secondary to intestinal metastatic melanoma. In case of bowel metastasis, presenting symptoms are nonspecific and do not provide significant clues to the differential diagnosis of the underlying disease. In some patients, complete surgical resection of early diagnosed bowel metastases is associated with prolonged survival. Systemic chemotherapy in these patients does not provide survival benefit. CONCLUSION The occurrence of bowel relapse after very long disease free interval, while highly unlikely in most tumors, should always be considered in the differential diagnosis of patients with previous history of cutaneous malignant melanoma presenting with gastrointestinal symptoms.
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Affiliation(s)
- Vincenzo Vigorita
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain.
| | - Fabio Ausania
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Marco Bertucci Zoccali
- General Surgery Unit, Department of Surgery, Catholic University Med. School - "A. Gemelli" Gen. Hospital, Rome, Italy
| | - Cristina Facal Alvarez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Blanca De Urrutia Nadal
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Jose Enrique Casal Nuñez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
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Muhammad A, Vidyarthi G, Brady P. Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature. World J Gastroenterol 2014; 20:8416-8423. [PMID: 25024599 PMCID: PMC4093694 DOI: 10.3748/wjg.v20.i26.8416] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/30/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.
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Endoscopic evaluation of gastrointestinal tract in patients with hereditary hemorrhagic telangiectasia and correlation with their genotypes. Genet Med 2013; 16:3-10. [PMID: 23722869 DOI: 10.1038/gim.2013.62] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/09/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant vascular dysplasia characterized by telangiectases and arteriovenous malformations. Three causative genes are known: ENG (HHT-1), ACVRL1 (HHT-2), and SMAD4 (mutated in HHT in association with juvenile polyposis). Gastrointestinal bleeding is the most common symptom after epistaxis. The stomach and the duodenum are the main gastrointestinal sites of telangiectases. Our aim was to explore gastrointestinal tract of consecutive HHT patients to assess distribution, number, size, and type of telangiectases in relation to genotype. METHODS HHT patients underwent gastroduodenoscopy, video capsule endoscopy, and colonoscopy. Molecular analysis of ENG and ACVRL1 was performed to identify the disease-causing mutation. RESULTS Twenty-two patients (13 men; mean age: 59 ± 9 years) were analyzed: 7 with HHT-1, 13 with HHT-2, and 2 undefined. Gastrointestinal telangiectases were identified as follows: at gastroduodenoscopy in 86% of HHT-1 patients and in 77% of HHT-2 patients, at video capsule endoscopy in all HHT-1 patients and in 84% of HHT-2 patients, and at colonoscopy in 1 patient for each group. HHT-1 showed multiple telangiectases with a higher prevalence, more relevant in the duodenum. CONCLUSION Our data demonstrate extensive involvement of the gastrointestinal tract with a more severe association in HHT-1. Gastroduodenoscopy provides significant information on gastrointestinal involvement, and video capsule endoscopy may be added in selected patients. Colonic polyps/adenomas were identified as occasional findings.
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Ciuti G, Menciassi A, Dario P. Capsule endoscopy: from current achievements to open challenges. IEEE Rev Biomed Eng 2012; 4:59-72. [PMID: 22273791 DOI: 10.1109/rbme.2011.2171182] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Wireless capsule endoscopy (WCE) can be considered an example of disruptive technology since it represents an appealing alternative to traditional diagnostic techniques. This technology enables inspection of the digestive system without discomfort or need for sedation, thus preventing the risks of conventional endoscopy, and has the potential of encouraging patients to undergo gastrointestinal (GI) tract examinations. However, currently available clinical products are passive devices whose locomotion is driven by natural peristalsis, with the drawback of failing to capture the images of important GI tract regions, since the doctor is unable to control the capsule's motion and orientation. To address these limitations, many research groups are working to develop active locomotion devices that allow capsule endoscopy to be performed in a totally controlled manner. This would enable the doctor to steer the capsule towards interesting pathological areas and to accomplish medical tasks. This review presents a research update on WCE and describes the state of the art of the basic modules of current swallowable devices, together with a perspective on WCE potential for screening, diagnostic, and therapeutic endoscopic procedures.
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Affiliation(s)
- Gastone Ciuti
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy.
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Evaluating the role of small-bowel endoscopy in clinical practice: the largest single-centre experience. Eur J Gastroenterol Hepatol 2012; 24:513-9. [PMID: 22330235 DOI: 10.1097/meg.0b013e328350fb05] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There are few centres that offer all forms of small-bowel endoscopic modalities [capsule endoscopy (CE), push enteroscopy (PE), double-balloon enteroscopy (DBE) or single-balloon enteroscopy and intraoperative enteroscopy (IOE)]. Previous investigators have suggested that DBE may be more cost-effective as the first-line investigation. We evaluated the relationship among four modalities of small-bowel endoscopy in terms of demand, diagnostic yield, patient management and tolerability. METHODS Data were collected on patients who underwent PE and IOE since January 2002, CE since June 2002 and DBE since July 2006. These included age, sex, indication of referral, comorbidity, previous investigations and diagnosis obtained, including subsequent management change. RESULTS Demand for CE and DBE increased every year. A total of 1431 CEs, 247 PEs, 102 DBEs and 17 IOEs were performed over 93 months. The diagnostic yield was 88% for IOE compared with 34.6% for CE, 34.5% for PE and 43% for DBE (P<0.001). Management was altered by CE in 25%, by PE in 19% and by DBE in 33% of patients. However, 44% of patients who underwent DBE found the procedure difficult to tolerate. In 2009, for every 17 CEs performed, one patient underwent DBE locally. CONCLUSION This is the first series to report the clinical experience of four modalities of small-bowel endoscopy from a single centre. The use of CE as first-line investigation, followed by PE/DBE or IOE, is potentially both less invasive and tolerable.
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Training in Capsule Endoscopy: Are We Lagging behind? Gastroenterol Res Pract 2012; 2012:175248. [PMID: 22566997 PMCID: PMC3332190 DOI: 10.1155/2012/175248] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 01/30/2012] [Indexed: 12/15/2022] Open
Abstract
Capsule endoscopy (CE) is a new modality to investigate the small bowel. Since it was invented in 1999, CE has been adopted in the algorithm of small bowel investigations worldwide. Reporting a CE video requires identification of landmarks and interpretation of pathology to formulate a management plan. There is established training infrastructure in place for most endoscopic procedures in Europe; however despite its wide use, there is a lack of structured training for CE. This paper focuses on the current available evidence and makes recommendations to standardise training in CE.
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HU CHAO, MENG MAXQH, MANDAL MRINAL. EFFICIENT MAGNETIC LOCALIZATION AND ORIENTATION TECHNIQUE FOR CAPSULE ENDOSCOPY. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0219878905000398] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To build a new wireless robotic capsule endoscope with external guidance for controllable and interactive GI tract examination, a sensing system is needed for tracking 3D location and 2D orientation of the capsule endoscope movement. An appropriate sensing method is to enclose a small permanent magnet in the capsule. The intensities of the magnetic field produced by the magnet in different spatial points can be measured by the magnetic sensors outside the patient's body. With the sensing data of magnetic sensor array, the 3D location and 2D orientation of the capsule can be calculated. Higher calculation accuracy can be obtained if more sensors and optimal algorithm are applied. In this paper, different nonlinear optimization algorithms were evaluated to solve the magnet's 5D parameters, e.g. Powell's, Downhill Simplex, DIRECT, Multilevel Coordinate Search, and Levenberg Marquardt method. We have found that Levenberg-Marquardt method provides satisfactory calculation accuracy and faster speed. Simulations were done for investigating the de-noise ability of this algorithm based on different sensor arrays. Also the real experiment shows that the results are satisfactory with high accuracy (average localization error is 5.6 mm).
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Affiliation(s)
- CHAO HU
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
- Department of Electrical Engineering & Automation, Ningbo University, Ningbo, P. R. China
| | - MAX Q.-H. MENG
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
| | - MRINAL MANDAL
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
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Abstract
Capsule endoscopy for the colon was introduced to allow an alternative screening method to the invasive classic colonoscopy. The results of initial studies have shown inferior detection rates of colonic polyps by the colon capsule. In this paper we aim to review and summarize the recent advances in wireless capsule endoscopy of the colon. Publications regarding the use of colon capsule with new technology, as well as personal experience, were reviewed. Since the introduction of the first generation of the colon capsule, many improvements have been made to create a better capsule endoscope. These include a wider angle of view, a faster adaptable frame rate and a new data recorder which is able to control the capsule activity during the transit through the bowel. Recent studies show these improvements had a direct effect on the colon capsule performance, leading to a better diagnostic yield. Recent advancements in the technology of the wireless colon capsule endoscope offer the option to screen patients for colonic polyps noninvasively. Colon capsule endoscopy may become relevant for assessment of extent of inflammatory bowel disease.
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Abstract
BACKGROUND AND AIM Data about small bowel capsule endoscopy (SBCE) come from studies involving small and highly selected populations. The study aim was to describe extent of use, indications, results, complications, and practical issues of SBCE in clinical practice in a Northern Italian Region (Lombardia). MATERIALS AND METHODS Twenty-three out of 29 invited centers fulfilled a specific questionnaire. RESULTS Between 2001 and 2008, 2921 procedures were performed and both the number of centers performing SBCE (from 5 to 29) and the number of SBCE (from 7.2 to 69.2 per month) increased steadily. The main indications for SBCE were: obscure gastrointestinal bleeding (OGIB) (43.4%), unexplained anemia (23.9%), suspected Crohn's disease (7.8%) and abdominal pain (5.3%). Overall, SBCE was positive in 50% of cases, negative in 36% and undefined in 14%. The highest diagnostic yields were observed in patients with OGIB (62.5%), polypoid syndromes (74.1%), known (54.8%) or suspected (47.3%) inflammatory bowel disease, while the yields were low in patients examined for chronic diarrhea (27.4%) and abdominal pain (14.9%), 61 patients (2.1%) experienced capsule retention. Thirty-two of them eventually excreted the capsule naturally while endoscopic or surgical retrieval was necessary in 29 (1%) (in two because of obstruction). CONCLUSION Over a period of 7 years the use of SBCE in Lombardia increased steadily confirming, in clinical practice, a high diagnostic yield and an acceptable safety profile.
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Soyer P, Boudiaf M, Fishman EK, Hoeffel C, Dray X, Manfredi R, Marteau P. Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 2010; 80:10-30. [PMID: 21035353 DOI: 10.1016/j.critrevonc.2010.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022] Open
Abstract
This article describes the recent advances in radiological imaging of malignant neoplasms of the mesenteric small bowel and provides an outline of new trends and perspectives that can be anticipated. The introduction of multidetector row technology, which allows the acquisition of submillimeter and isotropic voxels, has dramatically improved the capabilities of computed tomography in the investigation of the mesenteric small bowel. This technology combined with optimal filling of small bowel loops through the use of appropriate enteral contrast agents has markedly changed small bowel imaging. Computed tomography-enteroclysis, which is based on direct infusion of enteral contrast agent into the mesenteric small bowel through a naso-jejunal tube, provides optimal luminal distension. By contrast, computed tomography-enterography is based on oral administration of enteral contrast agent. These two techniques are now well-established ones for the detection and the characterization of small bowel neoplasms. During the same time, combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging has gained wide acceptance for the evaluation of patients with suspected small bowel neoplasms. Rapid magnetic resonance imaging sequences used in combination with specific enteral contrast agents generate superb images of the mesenteric small bowel so that magnetic resonance-enteroclysis and magnetic resonance-enterography are now considered as effective diagnostic tools for both the detection and the characterization of neoplasms of the mesenteric small bowel. Recent improvements in image post-processing capabilities help obtain realistic three-dimensional representations of tumors and virtual enteroscopic views of the small bowel that are useful for the surgeon and the gastroenteroenteologist to plan surgical or endoscopic interventions. Along with a better knowledge of the potential and limitations of wireless capsule endoscopy and new endoscopic techniques, these recent developments in radiological imaging reasonably suggest that substantial changes in the investigation of small bowel tumors may be anticipated in a near future, thus potentially create a new paradigm shift after standard small bowel follow-through study has been universally abandoned.
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Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP and Université Diderot-Paris, France.
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Guo X, Yan G, He W, Jiang P. Improved modeling of electromagnetic localization for implantable wireless capsules. Biomed Instrum Technol 2010; 44:354-359. [PMID: 20715967 DOI: 10.2345/0899-8205-44.4.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An electromagnetic localization method for implantable wireless capsules has been developed that employs a three-axial magnetic sensor embedded in the capsules and three energized coils attached on the abdomen. In order to further improve the localization accuracy, a novel localization model has been derived based on the Biot-Savart Law. For simplicity of the calculation without increasing the position error, the method of truncated series expansion has been used in modeling. The experiment showed that the improved model had higher precision than the original dipole model. Using the improved model, the localization error can be greatly reduced. The improved model is an elementary math function and suitable for resolving some inverse magnetic problems in engineering.
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Affiliation(s)
- Xudong Guo
- Institute of Medical Device Engineering, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
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Rondonotti E, Villa F, Dell' Era A, Tontini GE, de Franchis R. Capsule endoscopy in portal hypertension. Clin Liver Dis 2010; 14:209-20. [PMID: 20682230 DOI: 10.1016/j.cld.2010.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the introduction of small bowel capsule endoscopy, and more recently of esophageal capsule endoscopy, these diagnostic tools have become available for the evaluation of the consequences of portal hypertension in the esophagus, stomach, and small intestine. The main advantage of the esophageal and the small bowel capsule is the relatively less invasiveness that could potentially increase patients' adherence to endoscopic screening/surveillance programs. When esophageal capsule endoscopy was compared with traditional gastroscopy, it showed good sensitivity and specificity in recognizing the presence and the size of esophageal varices. However, the results are not consistent among studies, and more data are needed.
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Affiliation(s)
- Emanuele Rondonotti
- Università degli Studi di Milano, IRCCS Ca' Granda Ospedale Policlinico Foundation, Italy
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Carpi F, Pappone C. Stereotaxis Niobe magnetic navigation system for endocardial catheter ablation and gastrointestinal capsule endoscopy. Expert Rev Med Devices 2009; 6:487-98. [PMID: 19751121 DOI: 10.1586/erd.09.32] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of robotic instruments capable of assisting medical staff during interventional or diagnostic procedures is growing rapidly today. Recently, a robotic system (Niobe, Stereotaxis Inc., USA) has been developed for navigating magnetically enabled tools inside the human body by controlling a magnetic field. This paper reports the fundamentals of this technology and reviews its application in two specific medical fields, cardiology and gastroenterology, in which its uses are different and are at dissimilar stages of development. In the first case, the system is already approved and employed for clinical treatments, such as magnetic steering of endocardial catheters for atrial fibrillation ablation, which is specifically considered in this article. In the second case, initial investigations are being performed today to study the potential magnetic maneuverability of ingestible video capsules adopted for endoscopic explorations of the digestive tract. This paper reviews current achievements and highlights future challenges related to each of these applications.
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Affiliation(s)
- Federico Carpi
- University of Pisa, Interdepartmental Research Centre E. Piaggio, School of Engineering, via Diotisalvi, 2 - 56100 Pisa, Italy.
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Rajesh A, Sandrasegaran K, Jennings SG, Maglinte DDT, McHenry L, Lappas JC, Rex D. Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease. ACTA ACUST UNITED AC 2009; 34:459-66. [PMID: 18546034 DOI: 10.1007/s00261-008-9427-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare results of capsule endoscopy with those of barium enteroclysis or CT enteroclysis. METHODS Retrospective review of hospital records revealed 65 patients who had an enteroclysis and small bowel capsule endoscopy. The diagnostic yield of capsule endoscopy was compared with the enteroclysis using Fisher's exact test. RESULTS The main indications were obscure gastrointestinal bleeding (n = 37) and suspected Crohn disease (n = 17). Radiologic studies included CT enteroclysis (n = 30), and fluoroscopic barium enteroclysis with carbon dioxide (n = 18) or with methylcellulose (n = 17). Capsule endoscopy had a higher diagnostic yield (8/17) compared to barium-methylcellulose cellulose enteroclysis (1/17) (P = 0.02). The diagnostic yield of capsule endoscopy was not significantly different compared with barium-carbon dioxide (12/18 vs. 10/18) enteroclysis or with CT enteroclysis (9/30 vs. 8/30). Vascular lesions were better assessed with capsule endoscopy. However, the CT enteroclysis found more lesions in patients with chronic abdominal pain. CONCLUSION Barium-carbon dioxide enteroclysis and CT enteroclysis have similar diagnostic yields for small bowel disease compared to capsule endoscopy. Barium methylcellulose has an inferior diagnostic yield.
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Affiliation(s)
- Arumugam Rajesh
- Department of Radiology, Indiana University School of Medicine, Indiana University Medical Center, Indianapolis, IN 46202, USA
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36
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Robotic magnetic steering and locomotion of capsule endoscope for diagnostic and surgical endoluminal procedures. ROBOTICA 2009. [DOI: 10.1017/s0263574709990361] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
SUMMARYThis paper describes a novel approach to capsular endoscopy that takes advantage of active magnetic locomotion in the gastrointestinal tract guided by an anthropomorphic robotic arm. Simulations were performed to select the design parameters allowing an effective and reliable magnetic link between the robot end-effector (endowed with a permanent magnet) and the capsular device (endowed with small permanent magnets). In order to actively monitor the robotic endoluminal system and to efficiently perform diagnostic and surgical medical procedures, a feedback control based on inertial sensing was also implemented. The proposed platform demonstrated to be a reliable solution to move and steer a capsular device in a slightly insufflated gastrointestinal lumen.
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Kelley SR, Lohr JM. Retained wireless video enteroscopy capsule: a case report and review of the literature. JOURNAL OF SURGICAL EDUCATION 2009; 66:296-300. [PMID: 20005505 DOI: 10.1016/j.jsurg.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 10/08/2009] [Accepted: 10/10/2009] [Indexed: 05/28/2023]
Abstract
Capsule enteroscopy, which is a wireless noninvasive approach to evaluation of the small intestine, consists of an 11 x 26-mm capsule containing a miniature video camera, batteries, illuminating light-emitting diodes, a transmitter, and an antenna. The components inside the capsule are encased by a slippery, nonbiodegradable, plastic housing, which weighs less than 4 g. Information obtained from the imager, approximately 2 frames per second, is transmitted by way of radiotelemetry to an array of sensors taped to the abdomen, which connect to a data recorder worn on a belt around the waist. The batteries are designed to last roughly 7-8 hours, providing enough energy to generate approximately 50,000 to 60,000 detailed images. The clinical review of the imagery is made available after completion of the study when images are downloaded from the data recorder to a computer with dedicated software.
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Affiliation(s)
- Scott R Kelley
- Department of Surgery, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH 45220, USA.
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Abstract
Intestinal melanomas can be primary tumours or metastases of cutaneous, ocular, or anal melanomas. Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common because of the tendency for cutaneous melanoma to metastasise to the gastrointestinal tract. Because distinguishing between primary and metastatic intestinal melanoma can be difficult, the main features of each are discussed, and the diagnostic images used to detect intestinal melanoma are assessed. Routine barium examinations and CT have limited sensitivity, but PET imaging can improve detection of melanoma metastases to the small bowel. Although various treatment strategies have been tried in patients with intestinal melanoma, surgical removal of intestinal metastases is the treatment of choice in patients with resectable tumours. No systemic therapy improves survival in patients with melanoma metastatic to the intestines; thus, the prognosis for these patients is poor. Patients with primary melanoma of the small intestine have a worse prognosis than do patients with metastases of cutaneous melanoma.
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Affiliation(s)
- Marko Lens
- King's College, Genetic Epidemiology Unit, St Thomas's Hospital, London, UK.
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Sidhu R, Sanders DS, Thomson M, McAlindon ME. Is this the end of an era for conventional diagnostic endoscopy? Clin Med (Lond) 2009; 9:39-41. [PMID: 19271599 PMCID: PMC5922630 DOI: 10.7861/clinmedicine.9-1-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- R Sidhu
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield.
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40
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Carpi F, Pappone C. Magnetic maneuvering of endoscopic capsules by means of a robotic navigation system. IEEE Trans Biomed Eng 2009; 56:1482-90. [PMID: 19174328 DOI: 10.1109/tbme.2009.2013336] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The use of video capsules for noninvasive explorations of the digestive tube is progressively increasing today. At present, the motion of these wireless endoscopic devices cannot be controlled and they proceed by means of visceral peristalsis and gravity. Aimed at enabling a motion control, the technique described here uses an external magnetic field applied to the video capsule, previously coated with a magnetic shell. As a source of controlled magnetic field, a robotic magnetic navigation system, recently introduced in the clinical practice to magnetically steer cardiovascular interventional devices, was suggested in a previous study to be deserving of investigation. The attractive potentialities of this system, along with its current limitations, in order to maneuver endoscopic capsules were studied in this work for the first time, both from a theoretical and an experimental point of view. The actual capabilities were experimentally assessed with preliminary motion control tests on a conventional video capsule inside a human-sized plastic phantom. Results demonstrated the possibility of achieving controlled magnetic maneuvers within the considered environment.
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Affiliation(s)
- Federico Carpi
- Interdepartmental Research Centre E. Piaggio, School of Engineering, University of Pisa, Pisa 56100, Italy.
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41
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Carpi F, Pappone C. Magnetic robotic manoeuvring of gastrointestinal video capsules: preliminary phantom tests. Biomed Pharmacother 2008; 62:546-9. [DOI: 10.1016/j.biopha.2008.07.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 07/01/2008] [Indexed: 12/22/2022] Open
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42
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Wireless endoscopy capsule remaining safely for a long time. Dig Dis Sci 2008; 53:1422-3. [PMID: 18343997 DOI: 10.1007/s10620-008-0245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 05/19/2005] [Indexed: 12/09/2022]
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43
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Gastrointestinal Endoscopy. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Computed tomographic (CT) enteroclysis is a hybrid technique that combines the methods of fluoroscopic intubation-infusion small-bowel examinations with that of abdominal CT. The use of multidetector CT technology has made this a versatile examination that has evolved into two distinct technical modifications. CT enteroclysis can be performed by using positive enteral contrast material without intravenous contrast material and neutral enteral contrast material with intravenous contrast material. CT enteroclysis has been shown to be superior to other imaging tests such as peroral small-bowel examinations, conventional CT, and barium enteroclysis, except in the demonstration of early apthous ulcers of Crohn disease. CT enteroclysis is complementary to capsule endoscopy in the elective investigation of small-bowel disease, with a specific role in the investigation of Crohn disease, small-bowel obstruction, and unexplained gastrointestinal bleeding.
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, OU 15, Indianapolis, IN 46202-5253, USA.
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45
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Carpi F, Galbiati S, Carpi A. Controlled navigation of endoscopic capsules: concept and preliminary experimental investigations. IEEE Trans Biomed Eng 2007; 54:2028-36. [PMID: 18018698 DOI: 10.1109/tbme.2007.894729] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper describes a technique to control the navigation of traditional wireless endoscopic capsules and reports preliminary proof-of-concept investigations. These capsules are used for noninvasive explorations of the digestive tube. At present, their motion cannot be controlled and they proceed by means of the visceral peristalsis. In order to enable motion controls, the technique proposed here adopts magnetic shells which are to be applied to available capsules, immediately before their use. The shells are used to control the capsule movement by means of external magnetic fields. This solution is readily applicable to any endoscopic capsule, avoiding internal modifications. Prototype elastic shells made of silicone elastomers mixed with magnetic particles were fabricated. They were tested with the most diffused capsule (model M2A, Given Imaging Ltd., Yoqneam, Israel), by studying the performance of the capsule/shell complex in simplified experimental conditions. Bench tests permitted to demonstrate controlled translations, rotations, and rototranslations of the capsule/shell complex within tubular structures coated with pieces of bovine tissues. The use of a new instrumentation, recently developed for cardiovascular treatments, is proposed as a potential means enabling the application of controlled magnetic fields for intrabody navigations.
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Affiliation(s)
- Federico Carpi
- Interdepartmental Research Centre E. Piaggio, School of Engineering, University of Pisa, via Diotisalvi, 2, 56100 Pisa, Italy.
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Abstract
PURPOSE OF REVIEW The small bowel has been a technically difficult area to examine. Indirect modalities such as barium follow-through have the disadvantage of attendant radiation exposure. Capsule endoscopy, a novel wireless method of investigation of the small bowel, has acquired an important role in both adult and paediatric medicine. RECENT FINDINGS The clinical utility of capsule endoscopy has rapidly expanded since its approval by the Food & Drug Administration in the USA in 2001. It has developed an established role in adults, in the investigation of obscure gastrointestinal bleeding, small bowel Crohn's disease, complications of coeliac disease and surveillance of polyposis syndromes. Despite a lag in its use in paediatrics, capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. It has opened up new horizons and permitted a noninvasive approach to identifying occult lesions in the small bowel of children when conventional imaging has been unhelpful. SUMMARY This review appraises the current literature to define the clinical indications and practical aspects of capsule endoscopy that are of interest to the paediatrician.
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Affiliation(s)
- Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
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47
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Albert JG, Gimm O, Stock K, Bilkenroth U, Marsch WCH, Helmbold P. Small-bowel endoscopy is crucial for diagnosis of melanoma metastases to the small bowel: a case of metachronous small-bowel metastases and review of the literature. Melanoma Res 2007; 17:335-8. [PMID: 17885591 DOI: 10.1097/cmr.0b013e3282c3a706] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jörg G Albert
- First Department of Medicine, Martin-Luther-University Halle-Wittenberg, University of Heidelberg, Germany.
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48
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Fork FT, Aabakken L. Capsule enteroscopy and radiology of the small intestine. Eur Radiol 2007; 17:3103-11. [PMID: 17876583 DOI: 10.1007/s00330-007-0718-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/12/2007] [Accepted: 06/22/2007] [Indexed: 12/16/2022]
Abstract
In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first-line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localising mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn's disease are evaluated by MRI- enterography and CT-enterography.
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Affiliation(s)
- Frans-Thomas Fork
- Department of Diagnostic Radiology, Malmö University Hospital, Se-205 02, Malmoe, Sweden
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Maglinte DDT, Sandrasegaran K, Chiorean M, Dewitt J, McHenry L, Lappas JC. Radiologic Investigations Complement and Add Diagnostic Information to Capsule Endoscopy of Small-Bowel Diseases. AJR Am J Roentgenol 2007; 189:306-12. [PMID: 17646455 DOI: 10.2214/ajr.07.2253] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of our study was to review how commonly performed radiologic examinations compare with capsule endoscopy in the investigation of small-bowel diseases, to analyze the limitations of capsule imaging, and to propose an algorithm for use of specific radiologic examinations to complement wireless capsule endoscopy. CONCLUSION The diagnostic yield of capsule endoscopy is superior to that of radiologic examinations except air double-contrast enteroclysis for mucosal details. Radiologic investigations find new applications in clinical practice by complementing capsule endoscopy to overcome its limitations.
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine and Indiana University Hospital, 550 N University Blvd., UH 0279, Indianapolis, IN 46202-5253, USA.
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50
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Abstract
CT enteroclysis overcomes the individual deficiencies of both barium enteroclysis and conventional CT and combines the advantages of both into one technique whose clinical applicability has been simplified and made more reliable with multidetector CT technology. This article examines the techniques of CT enteroclysis and presents an overview of its clinical applications relative to other methods of small bowel imaging.
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine, 550 N. University Blvd, UH 0279, Indianapolis, IN 46202-5253, USA.
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