Role of videocapsule endoscopy for gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB) is defi ned as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies. Several techniques, such as endoscopy, arteriography, scintigraphy and barium radiology are helpful for recognizing the bleeding source; nevertheless, in about 5%-10% of cases the bleeding lesion cannot be determined. The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa. We will analyze those techniques in more detail. The diagnostic yield of CE for OGIB varies from 38% to 93%, being in the higher range in those cases with obscure-overt bleeding.

Z-line examination by the PillCam^(TM) SB:Prospective comparison of three ingestion protocols

AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 were included in the study. They swallowed the capsule in the standing(Group A= 30),supine(Group B=30)and right supine positions (Group C=30).Baseline patient characteristics, difficulties in capsule ingestion,esophageal transit times(ETT)and Z-line visualization were noted. RESULTS:No significant differences were found between the groups with regard to baseline patient characteristics,ingestion difficulties and complete SB examinations(P>0.05).At least 1 frame of the Z-line was detected in 15.8%,46.7%and 90%of patients in groups A,B and C,respectively(P<0.001).The average number of Z-line images was 0.21±0.53,3.23 ±6.59 and 5.53±7.55 and the mean%of the Z-linedetected was 71.3,25.1 and 8.3,in groups A,B and C, respectively(both P<0.001).ETT times were longer in the supine group followed by the right supine and the standing groups(median of 237 s vs 64 s and 39 s, respectively;P<0.001). CONCLUSION:Z-line visualization in patients undergoing SBCE can be accurately achieved in most cases when the capsule is swallowed in the right supine position.

Esophageal capsule endoscopy

Capsule endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe, and could be also an alternative procedure in those patients refusing upper endoscopy. Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients, current results are encouraging and open a new era in esophageal examination.

Colon capsule endoscopy

Wireless capsule endoscopy has become the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Clinical trials results have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases. It could be a good alternative in patients refusing conventional colonoscopy or when it is contraindicated. Upcoming studies are needed to demonstrate its utility for colon cancer screening and other indications such us ulcerative colitis. Comparative studies including both conventional and virtual colonoscopy are also required.

Endoscopic ultrasound-guided drainage of pelvic collections and abscesses

Pelvic abscesses are usually the end stage in the progression of an infection.They may occur from surgical complications,generalized abdominal infections such as appendicitis or diverticulitis,or from localized infections such as pelvic inflammatory disease or inflammatory bowel disease.Although surgery has been considered as the treatment of choice by some authors,pelvic abscesses can be managed by non-invasive methods such as ultrasound and computed tomography-guided drainage.The development of therapeutic linear echoendoscopes has allowed the endoscopist to perform therapeutic procedures.Recently,endoscopic ultrasonography(EUS)-guided drainage of pelvic collections has been demonstrated to be feasible,efficient and safe.It allows the endoscopist to insert stents and drainage catheters into the abscess cavity which drains through the large bowel.This article reviews technique, current results and future prospects of EUS-guided drainage of pelvic lesions.

Capsule endoscopy capture rate: Has 4 frames-per-second any impact over 2frames-per-second?

AIM: To compare the current capsule and a new prototype at 2 and 4 frames-per-second, respectively, in terms of clinical and therapeutic impact. METHODS: One hundred patients with an indication for capsule endoscopy were included in the study. All procedures were performed with the new device(SB24). After an exhaustive evaluation of the SB24 videos, they were then converted to "SB2-like" videos for their evaluation. Findings, frames per finding, and clinical and therapeutic impact derived from video visualization were analyzed. Kappa index for interobserver agreement and χ2 and Student's t tests for qualitative/quantitative variables, respectively, were used. Values of P under 0.05 were considered statistically significant.RESULTS: Eighty-nine out of 100 cases included in the study were ultimately included in the analysis. The SB24 videos detected the anatomical landmarks(Zline and duodenal papilla) and lesions in more patients than the "SB2-like" videos. On the other hand, the SB24 videos detected more frames per landmark/lesion than the "SB2-like" videos. However, these differences were not statistically significant(P > 0.05). Both clinical and therapeutic impacts were similar between SB24 and "SB2-like" videos(K = 0.954). The time spent by readers was significantly higher for SB24 videos visualization(P < 0.05) than for "SB2-like" videos when all images captured by the capsule were considered. However, these differences become non-significant if we only take into account small bowel images(P > 0.05).CONCLUSION: More frames-per-second detect more landmarks, lesions, and frames per landmark/lesion, but is time consuming and has a very low impact on clinical and therapeutic management.