Background and study aims: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertion cirrhotic patients, especially ...Background and study aims: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertion cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. Patients and methods: In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100 mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients’ preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. Results: Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6-1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 % ); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). Conclusions: Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.展开更多
Aim-To evaluate the relationship between histopathology results and magnetic resonance imaging (MRI) on in-and opposed-phase sequences grading of fat deposition within human liver. Materials and methods-In-and opposed...Aim-To evaluate the relationship between histopathology results and magnetic resonance imaging (MRI) on in-and opposed-phase sequences grading of fat deposition within human liver. Materials and methods-In-and opposed-phase T1-weighted gradient-echo sequences (double echo time 2.3 ms and 4.6ms)were performed in 25 patients,using a 1.5-T clinical MR imaging system. Fat/water ratio on in-and opposed-phase images of the liver was compared with pathologically defined degree or steatosis. The signal intensity in the images was acquired with operator-defined regions of interest at the same location in both fat and water images and the ratio was calculated by dividing signal intensity of liver in opposed phased sequence on signal intensity of liver in phased sequence. Fat/water ratio and the degree of steatosis were compared using linear regression. The sensitivity and specificity of opposed-phase for diagnosing steatosis were defined by ROC analysis. Furthermore, a correlation between visual signal intensity variation (SIV)and the degree of steatosis was assessed using Pearson correlation coefficient. Results-Histology demonstrated fatty liver infiltrations in 81 %of specimens. The percentage of fatty hepatocytes was 28 +/-30 %. Fat/water ratio was significantly correlated with the pathologic grading of steatosis (r = 0.816, P < 0.001). The opposed phase MR imaging sensibility and specificity for the diagnosis of hepatic steatosis were respectively 80%and 71%. We obtained a statistically significant correlation between visual SIV and fatty liver grading (P = 0.017). Conclusion-We demonstrated a significant correlation between fat/water ratio and histological findings for the detection and grading of fatty liver.展开更多
文摘Background and study aims: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertion cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. Patients and methods: In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100 mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients’ preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. Results: Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6-1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 % ); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). Conclusions: Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.
文摘Aim-To evaluate the relationship between histopathology results and magnetic resonance imaging (MRI) on in-and opposed-phase sequences grading of fat deposition within human liver. Materials and methods-In-and opposed-phase T1-weighted gradient-echo sequences (double echo time 2.3 ms and 4.6ms)were performed in 25 patients,using a 1.5-T clinical MR imaging system. Fat/water ratio on in-and opposed-phase images of the liver was compared with pathologically defined degree or steatosis. The signal intensity in the images was acquired with operator-defined regions of interest at the same location in both fat and water images and the ratio was calculated by dividing signal intensity of liver in opposed phased sequence on signal intensity of liver in phased sequence. Fat/water ratio and the degree of steatosis were compared using linear regression. The sensitivity and specificity of opposed-phase for diagnosing steatosis were defined by ROC analysis. Furthermore, a correlation between visual signal intensity variation (SIV)and the degree of steatosis was assessed using Pearson correlation coefficient. Results-Histology demonstrated fatty liver infiltrations in 81 %of specimens. The percentage of fatty hepatocytes was 28 +/-30 %. Fat/water ratio was significantly correlated with the pathologic grading of steatosis (r = 0.816, P < 0.001). The opposed phase MR imaging sensibility and specificity for the diagnosis of hepatic steatosis were respectively 80%and 71%. We obtained a statistically significant correlation between visual SIV and fatty liver grading (P = 0.017). Conclusion-We demonstrated a significant correlation between fat/water ratio and histological findings for the detection and grading of fatty liver.
