Background and study aims: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20% mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screene...Background and study aims: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20% mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett’ s esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. Patients and methods: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient’ s medical history and EGD findings. Results: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6% for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. Conclusions: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.展开更多
Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD)...Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. Patients and methods: 42 patients with GERD symptoms and eight patients with a history of Barrett’ s esophagus had an esophagogastroduodenoscopy (EGD).All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4 fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14 fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett’ s esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. Results: The 4 fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 % ) and 6/8 cases of Barrett’ s esophagus (sensitivity 75 % ). The 14 fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett’ s esophagus (sensitivity 100 % ). The total diagnostic miss rate in the 4 fps group was 5/27 (18 % ) whereas the diagnostic miss rate in the 14 fps group was 0/23 (0 % ) P < 0.02. The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 % ) in the 4 fps group and in 20/25 patients (80% ) in the 14 fps group (P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 % ) by the 4 fps device and in 19/25 (76 % ) by the 14 fps device (P < 0.01). The superiority of the 14 fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14 fps PillCam thismeans one image transmitted per 3 cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. Conclusions: Capsule endoscopy using the 14 fps PillCam ESO showed a greater sensitivity than that of the 4 fps device for identifying GERD. The 14 fps PillCam ESO was statistically superior to the 4 fps device in visualizing the opening of the UES and the entirety of the esophagus.展开更多
Background: Celiac disease (CD) is a gluten- sensitive enteropathy in genetically susceptible individuals. Anecdotal reports suggest that the nervous system might be affected in the disorder, but the severity and prev...Background: Celiac disease (CD) is a gluten- sensitive enteropathy in genetically susceptible individuals. Anecdotal reports suggest that the nervous system might be affected in the disorder, but the severity and prevalence of such an involvement have not been systematically evaluated. Materials and methods: Analysis of files of CD patients diagnosed between 1980 and 1999 for neurological abnormalities. Diagnosis of CD was based on the modified criteria of the European Society for Pediatric Gastroenterology and Nutrition. Results: Of 148 CD patients, 18 (12% ) had 21 neurological disorders that could not be attributed to any other condition including muscle abnormality (3), epilepsy (3), psychiatric disease (4), peripheral neuropathy (3), cerebrovascular disease (1), myelopathy (1) and Down syndrome (2). Other disorders probably unrelated to CD were present in 8 patients. Conclusion: If this association is not coincidental, both the central and the peripheral nervous systems maybe affected in CD by a spectrum of neurological disorders that are either the outcome of CD or share the same pathogenesis with the enteropathy.展开更多
Patients with iron deficiency anemia are subjected to multiple endoscopic and radiologic examinations of the GI tract. If negative, some of the examinations are repeated, occasionally with positive findings. The diagn...Patients with iron deficiency anemia are subjected to multiple endoscopic and radiologic examinations of the GI tract. If negative, some of the examinations are repeated, occasionally with positive findings. The diagnostic yield of a second capsule endoscopy in such patients is unknown. The aim of the current study was to assess the diagnostic yield of a second capsule endoscopy in patients with significant iron deficiency anemia and a previous negative evaluation. Twenty patients with iron deficiency anemia (Hb <10 g/dL) were enrolled. All had at least one normal evaluation of the GI tract, including capsule endoscopy. A second capsule endoscopy examination was offered to all patients. The time between the first and the second capsule endoscopy ranged from 2 months to 1 year. Depending on the nature of an abnormality and its relevance to blood loss, the findings were classified as positive, suspicious, clinically irrelevant, or negative. In 7 patients, the second capsule endoscopy disclosed findings that were classified a seither positive or suspicious findings, including arteriovenous malformations (2), flat polypoid lesion (1), edematous inflamed mucosa (1), erosions (1), and hemorrhagic gastritis (1). Lesions were located in the small intestine (5), the stomach (1), and the cecum (1). Based on the findings of the second capsule endo scopy, therapy was changed in two patients (10%). A second capsule endoscopy should be considered for patients with severe iron deficiency anemia and negative initial evaluation.展开更多
Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esopha...Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. Aim: Compare the accuracy (specifi-city, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. Methods: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. Results: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92% ; specificity, 95% ). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97% , 99% , 97% , and 99% , respectively, and for esophagitis 89% , 99% , 97% , and 94% , respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. Conclusions: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.展开更多
文摘Background and study aims: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20% mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett’ s esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. Patients and methods: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient’ s medical history and EGD findings. Results: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6% for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. Conclusions: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.
文摘Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. Patients and methods: 42 patients with GERD symptoms and eight patients with a history of Barrett’ s esophagus had an esophagogastroduodenoscopy (EGD).All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4 fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14 fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett’ s esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. Results: The 4 fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 % ) and 6/8 cases of Barrett’ s esophagus (sensitivity 75 % ). The 14 fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett’ s esophagus (sensitivity 100 % ). The total diagnostic miss rate in the 4 fps group was 5/27 (18 % ) whereas the diagnostic miss rate in the 14 fps group was 0/23 (0 % ) P < 0.02. The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 % ) in the 4 fps group and in 20/25 patients (80% ) in the 14 fps group (P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 % ) by the 4 fps device and in 19/25 (76 % ) by the 14 fps device (P < 0.01). The superiority of the 14 fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14 fps PillCam thismeans one image transmitted per 3 cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. Conclusions: Capsule endoscopy using the 14 fps PillCam ESO showed a greater sensitivity than that of the 4 fps device for identifying GERD. The 14 fps PillCam ESO was statistically superior to the 4 fps device in visualizing the opening of the UES and the entirety of the esophagus.
文摘Background: Celiac disease (CD) is a gluten- sensitive enteropathy in genetically susceptible individuals. Anecdotal reports suggest that the nervous system might be affected in the disorder, but the severity and prevalence of such an involvement have not been systematically evaluated. Materials and methods: Analysis of files of CD patients diagnosed between 1980 and 1999 for neurological abnormalities. Diagnosis of CD was based on the modified criteria of the European Society for Pediatric Gastroenterology and Nutrition. Results: Of 148 CD patients, 18 (12% ) had 21 neurological disorders that could not be attributed to any other condition including muscle abnormality (3), epilepsy (3), psychiatric disease (4), peripheral neuropathy (3), cerebrovascular disease (1), myelopathy (1) and Down syndrome (2). Other disorders probably unrelated to CD were present in 8 patients. Conclusion: If this association is not coincidental, both the central and the peripheral nervous systems maybe affected in CD by a spectrum of neurological disorders that are either the outcome of CD or share the same pathogenesis with the enteropathy.
文摘Patients with iron deficiency anemia are subjected to multiple endoscopic and radiologic examinations of the GI tract. If negative, some of the examinations are repeated, occasionally with positive findings. The diagnostic yield of a second capsule endoscopy in such patients is unknown. The aim of the current study was to assess the diagnostic yield of a second capsule endoscopy in patients with significant iron deficiency anemia and a previous negative evaluation. Twenty patients with iron deficiency anemia (Hb <10 g/dL) were enrolled. All had at least one normal evaluation of the GI tract, including capsule endoscopy. A second capsule endoscopy examination was offered to all patients. The time between the first and the second capsule endoscopy ranged from 2 months to 1 year. Depending on the nature of an abnormality and its relevance to blood loss, the findings were classified as positive, suspicious, clinically irrelevant, or negative. In 7 patients, the second capsule endoscopy disclosed findings that were classified a seither positive or suspicious findings, including arteriovenous malformations (2), flat polypoid lesion (1), edematous inflamed mucosa (1), erosions (1), and hemorrhagic gastritis (1). Lesions were located in the small intestine (5), the stomach (1), and the cecum (1). Based on the findings of the second capsule endo scopy, therapy was changed in two patients (10%). A second capsule endoscopy should be considered for patients with severe iron deficiency anemia and negative initial evaluation.
文摘Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. Aim: Compare the accuracy (specifi-city, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. Methods: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. Results: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92% ; specificity, 95% ). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97% , 99% , 97% , and 99% , respectively, and for esophagitis 89% , 99% , 97% , and 94% , respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. Conclusions: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.
