BACKGROUND Obscure small bowel bleeding is defined as gastrointestinal bleeding(GIB)that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy(VCE)being the next gold standar...BACKGROUND Obscure small bowel bleeding is defined as gastrointestinal bleeding(GIB)that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy(VCE)being the next gold standard step for evaluation.Small bowel transit time(SBTT)is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.AIM To determine if SBTT within the VCE study,correlates to overall detection of obscure small bowel bleeds.Furthermore,we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.METHODS This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center,Philadelphia,between 2015 and 2019.Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB.Patients with incomplete VCEs,poor preparation,or with less than 6 mo of follow up were excluded.A re-bleeding event was defined either as overt or occult within a 6-mo timeframe.Overt rebleeding was defined as Visible melena or hematochezia with>2 gm/dL drop in hemoglobin defined an overt re-bleeding event;whereas an unexplained>2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.RESULTS Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008.However,the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.CONCLUSION In terms of SBTT and association with accuracy of VCE finding a bleeding focus,220 min was found to be adequate transit time to accurately find a bleeding focus,when present.It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.展开更多
AIM:To investigate whether the small bowel transit time(SBTT)influences the diagnostic yield of capsule endoscopy(CE).METHODS:Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed....AIM:To investigate whether the small bowel transit time(SBTT)influences the diagnostic yield of capsule endoscopy(CE).METHODS:Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed.SBTT and CE findings were recorded.A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman's correlation test.Subgroup analyses were performed for the various indications for the procedure.RESULTS:There was a positive correlation between the diagnostic yield and SBTT(Spearman's rho 0.58,P <0.01).Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding(r=0.54,P<0.01),for polyposis and carcinoid combined(r=0.56,P<0.01)and for the other indications(r=0.90,P<0.01),but not for suspected Crohn's disease(r=-0.40).CONCLUSION:The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time.This is true for all indications except for suspected Crohn's disease.展开更多
AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the L...AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2(significant findings) and P0-1(normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance(outpatients vs inpatients), bowel cleanliness, and center volume.RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records(62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815(57%) were males. In comparison with patients in the P0-1 group, those in the P2 group(n = 776, 54%) were older(P < 0.0001), had a longer small-bowel transit time(P = 0.0015), and were more frequently examined in low-volume centers(P < 0.001). Age and smallbowel transit time were correlated(P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations(54.5%), inflammatory(23.6%) and protruding(10.4%) lesions, and luminal blood(11.5%).CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.展开更多
AIM: To determine the effect of Prepacol?, a com- bination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy (CE). METHODS: Fivety two consecutive patients were included in this prospectiv...AIM: To determine the effect of Prepacol?, a com- bination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy (CE). METHODS: Fivety two consecutive patients were included in this prospective study. CE was performed following a 12 h fasting period. Twenty six patients were randomized for additional preparation with Prepacol?. The quality of CE was assessed separately for the proximal and the distal small bowel by 3 experienced endoscopists on the basis of a graduation which was initially developed with 20 previous CE. RESULTS: Preparation with Prepacol? accelerated small bowel transit time (262 ± 55 min vs 287 ± 97 min), but had no effect on the quality of CE. Visibility was significantly reduced in the distal compared to the proximal small bowel. CONCLUSION: The significantly reduced visibility of CE in the distal small bowel allocates the need for a good preparation. Since Prepacol? has no beneficial effect on CE the modality of preparation and the ideal time of application remains unclear. Further standardized examinations are necessary to identify sufficient preparation procedures and to determine the impact of the volume of the preparation solution.展开更多
AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa.METHODS: Ninety-five patients underwent capsule endoscopy...AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa.METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor.RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology.The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion.CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.展开更多
AIM: To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. METHODS: We conducted a ...AIM: To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. METHODS: We conducted a retrospective, blinded (to the type of preparation) review of 100 CE studies, 50 with no preparation with prokinetics from one medical center (Group A) and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B). Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. RESULTS: The erythromycin group had a slightly shorter gastric transit time (21 min vs 28 min, with no statistical significance). SB transit time was similar for both groups (all P > 0.05). Total transit time was almost identical in both groups. The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37). Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P > 0.05). CONCLUSION: Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.展开更多
AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were ...AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.展开更多
文摘BACKGROUND Obscure small bowel bleeding is defined as gastrointestinal bleeding(GIB)that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy(VCE)being the next gold standard step for evaluation.Small bowel transit time(SBTT)is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.AIM To determine if SBTT within the VCE study,correlates to overall detection of obscure small bowel bleeds.Furthermore,we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.METHODS This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center,Philadelphia,between 2015 and 2019.Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB.Patients with incomplete VCEs,poor preparation,or with less than 6 mo of follow up were excluded.A re-bleeding event was defined either as overt or occult within a 6-mo timeframe.Overt rebleeding was defined as Visible melena or hematochezia with>2 gm/dL drop in hemoglobin defined an overt re-bleeding event;whereas an unexplained>2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.RESULTS Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008.However,the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.CONCLUSION In terms of SBTT and association with accuracy of VCE finding a bleeding focus,220 min was found to be adequate transit time to accurately find a bleeding focus,when present.It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.
基金Supported by A clinical fellow grant(90700281)from the Netherlands Organization for Scientific Research(NWO)
文摘AIM:To investigate whether the small bowel transit time(SBTT)influences the diagnostic yield of capsule endoscopy(CE).METHODS:Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed.SBTT and CE findings were recorded.A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman's correlation test.Subgroup analyses were performed for the various indications for the procedure.RESULTS:There was a positive correlation between the diagnostic yield and SBTT(Spearman's rho 0.58,P <0.01).Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding(r=0.54,P<0.01),for polyposis and carcinoid combined(r=0.56,P<0.01)and for the other indications(r=0.90,P<0.01),but not for suspected Crohn's disease(r=-0.40).CONCLUSION:The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time.This is true for all indications except for suspected Crohn's disease.
文摘AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2(significant findings) and P0-1(normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance(outpatients vs inpatients), bowel cleanliness, and center volume.RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records(62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815(57%) were males. In comparison with patients in the P0-1 group, those in the P2 group(n = 776, 54%) were older(P < 0.0001), had a longer small-bowel transit time(P = 0.0015), and were more frequently examined in low-volume centers(P < 0.001). Age and smallbowel transit time were correlated(P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations(54.5%), inflammatory(23.6%) and protruding(10.4%) lesions, and luminal blood(11.5%).CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
文摘AIM: To determine the effect of Prepacol?, a com- bination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy (CE). METHODS: Fivety two consecutive patients were included in this prospective study. CE was performed following a 12 h fasting period. Twenty six patients were randomized for additional preparation with Prepacol?. The quality of CE was assessed separately for the proximal and the distal small bowel by 3 experienced endoscopists on the basis of a graduation which was initially developed with 20 previous CE. RESULTS: Preparation with Prepacol? accelerated small bowel transit time (262 ± 55 min vs 287 ± 97 min), but had no effect on the quality of CE. Visibility was significantly reduced in the distal compared to the proximal small bowel. CONCLUSION: The significantly reduced visibility of CE in the distal small bowel allocates the need for a good preparation. Since Prepacol? has no beneficial effect on CE the modality of preparation and the ideal time of application remains unclear. Further standardized examinations are necessary to identify sufficient preparation procedures and to determine the impact of the volume of the preparation solution.
文摘AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa.METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor.RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology.The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion.CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.
文摘AIM: To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. METHODS: We conducted a retrospective, blinded (to the type of preparation) review of 100 CE studies, 50 with no preparation with prokinetics from one medical center (Group A) and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B). Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. RESULTS: The erythromycin group had a slightly shorter gastric transit time (21 min vs 28 min, with no statistical significance). SB transit time was similar for both groups (all P > 0.05). Total transit time was almost identical in both groups. The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37). Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P > 0.05). CONCLUSION: Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.
文摘AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.
