OMOM capsule endoscopy in diagnosis of small bowel disease

Objective： To assess the diagnostic efficiency of OMOM capsule endoscopy （CE） in a group of patients with different indications. Methods： Data from 89 consecutive patients （49 males, 40 females） with suspected small bowel disease who underwent OMOM CE （Jinshan Science and Technology Company, review. The patients＇ indications of the disease consisted of the Chongqing, China） examination were obtained by retrospective following： obscure gastrointestinal bleeding （OGIB）, abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. Results： CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for patients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea （85.7% vs 53.3%, P〈0.005）. Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. Conclusion： OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB （small bowel） CE （Given Imaging, Yoqneam, Israel）.

Enteroscopy in children and adults with inflammatory bowel disease

Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.

Metastatic Lobular Carcinoma of the Breast Presenting with Small Bowel Metastases:Case Report and Literature Review

Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no evidence of local, regional, or distant recurrence, and she is still on endocrine therapy. Discussion: The time interval between primary breast cancer and gastrointestinal involvement may range from synchronous presentation to as long as 30 years. The clinical manifestations in GI lobular breast cancer metastasis may range from non-specific complaints to acute GI symptoms, such as a bowel obstruction. There are multiple controversies in the management of ILC. Systemic treatment should be initiated as soon as possible. Indications for postmastectomy radiotherapy are also controversial, given the propensity for multifocal/multicentric tumors and late recurrences, sometimes in atypical locations. Five years of postoperative adjuvant hormonal therapy is an option for women with poor prognosis. Remissions are observed in 32% to 53% of patients. Conclusion: Metastatic lobular carcinoma of the breast has a wide range of clinical presentations. Patients with a history of breast cancer who present with new GI tumors should have these lesions evaluated for evidence of metastasis through histopathologic and immunohistochemical analysis, this will allow for appropriate management. Currently, breast cancer management involves a multidisciplinary approach including surgery, radiotherapy, and systemic medical therapy, and the treatment must be tailored to the patient’s needs.

Prevalence of celiac disease in an urban area of Brazil with predominantly European ancestry

AIM： To determine the prevalence of celiac disease in a group of volunteer blood donors at a blood bank in the city of Curitiba, Brazil through detection of the serum marker immunoglobulin A （IgA） antitransglutaminase antibody. METHODS： Blood samples collected from 2086 healthy subjects at the Paraná State Center for Hematology and Hemotherapy in Curitiba were submitted to ELISA testing for the IgA antitransglutaminase antibody. Positive samples received IgA antiendomysium antibody test through indirect immunofluorescence using human umbilical cord as substrate. Subsequently, patients who were positive on both tests underwent small bowel （distal duodenum） biopsy. RESULTS： Six subjects, four males and two females, tested positive for the two serum markers. Five of the six were submitted to intestinal biopsy （one declined the procedure）. Biopsy results revealed changes in the distal duodenum mucosa （three classified as Marsh mb lesions and two as Marsh Ⅱ lesions）. Most donors diagnosed having celiac disease presented multiple symptoms （gastrointestinal tract complaints）. One donor reported having a family history of celiac disease （in a niece）. CONCLUSION： Among apparently healthy blood donors,the prevalence of biopsy-confirmed celiac disease was approximately 1：417, similar to that seen in European countries.

Five years' experience with capsule endoscopy in a single center

Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its effi cacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.

Double balloon enteroscopy in the old: Experience from China

AIM: To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases. METHODS: DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis.RESULTS: Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively. CONCLUSION: DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.

Clinical profile,diagnostic yield,and procedural outcomes of single balloon enteroscopy:A tertiary care hospital experience

BACKGROUND Single balloon enteroscopy(SBE)allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications.It provides the advantage of performing various therapeutic interventions alongside the diagnostic procedure.SBE has also been considered a relatively safe procedure with no major complications.AIM To investigate the indications,safety,and clinical yield of SBE,and determine its effect on disease outcome.METHODS A retrospective,descriptive study was conducted at a tertiary care hospital in Karachi,Pakistan.Medical records of 56 adult patients(≥18 years)who underwent SBE between July 2013 and December 2021 were reviewed and data were collected using a structured proforma.A descriptive analysis of the variables was performed using Statistical Package of Social Sciences Version 19.Results are reported as the mean±SD for quantitative variables and numbers and percentages for qualitative variables.Missing data are reported as unknown.RESULTS A total of 56 patients who underwent 61 SBE procedures were included.The mean age was 50.93±16.16 years,with 53.6%of them being males.Hypertension(39.3%)and diabetes mellitus(25.0%)were the most common pre-existing comorbidities.Obscure gastrointestinal bleed(39.3%)was the most common indication for enteroscopy,followed by chronic diarrhea(19.7%)and unexplained anemia(16.4%).The majority of procedures were performed in the endoscopy suite(90.2%)under monitored anaesthesia care(93.4%).Most procedures were diagnostic(91.8%)and completed without complications(95.1%).The depth of examination ranged from 95 cm to 500 cm with a mean of 282.05±90.04 cm.The most common findings were inflammation and ulcerations(29.5%),followed by masses(19.7%)and vascular malformations(14.8%).As a result of the findings,a new diagnosis was made in 47.5%of the cases and a previous one was ruled out in 24.6%of them;65.6%of the cases had a change in management.CONCLUSION SBE is a suitable modality for investigating diseases in the small bowel.It is shown to be technically efficient and reasonably safe and is associated with high diagnostic and therapeutic yield.

Motorized spiral enteroscopy:A cautious step forward in technological innovation

With the continuous advancement in medical technology,endoscopy has gained significant attention as a crucial diagnostic tool.The introduction of motorized spiral enteroscopy(MSE)represents a significant advancement in the diagnosis and treatment of small bowel diseases.While there are safety concerns and a high reliance on the operator’s skills,MSE should not be disregarded entirely.Instead,it should be considered as a supplementary endoscopic technique,particularly in situations where conventional endoscopy proves ineffective.Through continuous research and technical optimization,MSE has the potential to become an im-portant addition to the endoscopy toolbox in the future.We call on colleagues in the industry to work together to promote the improvement of MSE technology through continuous research and practice,with the aim to bring out its unique value in endoscopy while ensuring patient safety.