直肠上皮瘤行内镜黏膜下层切除术

Background and Study Aims: The technique of endoscopic submucosal dissection (ESD) has recently been developed for en-bloc resection of gastric tumors. For oncological reasons and in order to improve the patients’quality of life, it may be desirable to use the same technique for rectal neoplasia. Patients and Methods: Thirty-five consecutive patients with rectal neoplasia who had a preoperative diagnosis of large intraepithelial neoplasias with submucosal fibrosis or located on the rectal folds were enrolled. ESD was carried out with the same technique previously described for the stomach, with some modifications. The efficacy, complications, and follow-up results of the treatment were assessed. Results: The rates of en-bloc resection and en-bloc plus RO resection were 88.6%(31 of 35) and 62.9%(22 of 35), respectively. Hemoglobin levels did not drop by more than 2 g/dl in any of the patients after ESD. None of the patients had to receive blood transfusions or undergo emergency colonoscopy due to bleeding during ESD or hematochezia after ESD. Perforation during ESD occurred in two patients (5.7%), who were managed with conservative medical treatment after endoscopic closure of the perforation. Excluding three patients in whom additional surgery was carried out, all but one of 32 patients were free of recurrence during a mean follow-up period of 36 months (range 12-60 months). The exception was a patient in whom a multiple-piece resection was required; the recurrent (residual) tumor, found 2 months after ESD, was a small adenoma that was again treated endoscopically. Conclusions: ESD is applicable in the rectum with promising results, but the technique is still at a developmental stage and patients should be informed of the potential risks.

胆管支架阻塞机制:共聚焦激光扫描和扫描电镜的研究结果

Background and study aims: Endoscopic insertion of plastic biliary endoprostheses is a well-established treatment for obstructive jaundice. The major limitation of this technique is late stent occlusion. In order to compare events involved in biliary stent clogging and identify the distribution of bac-teria in unblocked stents, confocal laser scanning (CLS) and scanning electron microscopy (SEM) were carried out on two different stent materials - polyethylene (PE) and hydrophilic polymer-coated polyurethane (HCPC). Patien-ts and methods: Ten consecutive patients with postoperative benign biliary strictures were included in the study. Two 10-Fr stents 9 cm in length, one made of PE and the other of HCPC, were inserted. The stents were electively exchanged after 3 months and examined using CLS and SEM. Results: No differences were seen between the two types of stent. The inner stent surface was covered with a uniform amorphous layer. On top of this layer, a biofilm of living and dead bacteria was found, which in most cases was unstructured. The lumen was filled with free-floating colonies of bacteria and crystals, surrounded by mobile laminar structures of mucus. An open network of large dietary fibers was seen in all of the stents. Conclusions: The same clogging events occurred in both PE and HCPC stents. The most remarkable observation was the identification of networks of large dietary fibers, resulting from duodenal reflux, acting as a filter. The build-up of this intraluminal framework of dietary fibers appears to be a major factor contributing to the multifactorial process of stent clogging.

双球囊肠镜检查:275例疑似小肠疾病患者的适应证、诊断结果和并发症

Background and study aims: Until recently, only the proximal small bowel was accessible for diagnostic and therapeutic endoscopy. This paper describes experience in the first 275 patients examined and treated with the new method of double-balloon enteroscopy (DBE), which is expected to make full-length enteroscopy possible. Patients and methods: Between November 2003 and May 2005, double-balloon enteroscopy was conducted in 275 consecutive patients presenting at two tertiary referral hospitals. The characteristics of the patients, indications for the procedures, procedural parameters, and diagnostic yield are described here. All conventional treatment options were available. The tolerability of the procedure was assessed in a small subset of the patients. After the procedure, the patients were monitored in a recovery room for at least 2 h. They were discharged afterwards, provided there were no signs of complications or complaints. Results: The main indication for DBE was suspected small-bowel bleeding (n = 168), and the lesions responsible for the bleeding were found in 123 patients (73 % ) and treated in 61 (55 % ). In patients with refractory celiac disease (n = 25), DBE revealed a high proportion (six patients, 23% ) of enteropathy-associated T-cell lymphomas that had not been suspected on other tests. Further DBE indications were surveillance and treatment of hereditary polyposis syndromes (n = 20); and suspected Crohn’ s disease, which was diagnosed with DBE in four of 13 patients (30 % ). No relevant pathology was found in 24% of the patients. Panenteroscopy was successfully performed in 26 of 62 patients (42% ) in whom it was attempted, in either one or two sessions. The average duration of the procedures was 90 min (range 30-180 min, SD 42), and the average insertion length was 270 cm (range 60-600 cm, SD 104). Patients’ tolerance of the procedure was excellent. Severe complications were recognized in three cases (1 % ), all involving pancreatitis. Conclusions: This large pilot series shows that DBE is a well-tolerated and safe new endoscopic technique with a high diagnostic yield in selected patients.

Pattern and Risk Factors of Liver Injury among Hospitalized Covid-19 Patients:The Experience of a Greek Referral Hospital

Background:Although the new coronavirus(SARS-COV-2)affects predominantly the respiratory system,concomitant liver manifestations are common among COVID-19 patients.Aim:To investigate the prevalence and pattern of liver impairment(hepatocellular,cholestatic,mixed)and identify risk factors potentially associated with the liver injury in hospitalized patients with Covid-19.Materials and Methods:This retrospective study enrolled consecutive patients with Covid-19 who had evidence of liver injury on admission and/or during hospitalization in a tertiary hospital.Patient demographic,clinical and laboratory data were captured from the hospital’s electronic data monitoring system.Univariate and multivariate logistic regression analysis were applied to identify risk factors for liver injury.Results:Overall,of the 113 hospitalized Covid-19 patients,73(64.6%)patients had evidence of liver injury.Admission to Intensive Care Unit and length of in-hospital stay were identified as independent risk factors for liver injury by multivariate analysis(p=0.014 and p=0.001,respectively).35 patients(47.9%)had hepatocellular and 18 patients(24.7%)had cholestatic liver injury.Admission to Intensive Care Unit was statistically significantly associated with hepatocellular injury(p=0.006).Conclusions:Liver injury is common in hospitalized Covid-19 patients.Hepatocellular-type injury is more common and is associated with a more severe course of disease.

胃溃疡患者幽门螺杆菌根除治疗对复发及组织学情况的长期影响:一项为期2年的随访研究

Background: The main purpose of this study was to compare omeprazole (ome) plus two antibiotics (OMC) with omeprazole plus placebo (OP) with regard to gastric ulcer relapse for a period of 2 years in patients who were Helicobacter pylori-positive at inclusion. Methods: Using double-blind randomization 125 patients with gastric ulcer were treated with either OMC (ome 20 mg b.i.d., metronidazole 400 mg b.i.d., clarithromycin 250 mg b.i.d.) (n = 64) or OP (ome 20 mg and placebo) (n = 61) for 1 week, followed by ome 20-40 mg o.d. until healing was confirmed endoscopically after 4, 8 or 12 weeks. Endoscopy and H. pylori diagnostics using culture, histology and serology were performed 6, 12 and 24 months after treatment or at symptomatic relapse. At inclusion, 35%of the OMC group and 38%of the OP group were taking non-steroidal anti-inflammatory drugs (NSAIDs). Nine percent (11/125) of the ulcers were malignant. Results: The prevalence of H. pylori was 82%and the eradication rate 88%in the OMC group and 3%in the OP group. More than 90%of the ulcers were healed after 12 weeks. After 2 years, 76%of patients in the OMC group were in remission compared with 28%in the OP group (ITT) (P < 0.001). Sixty percent of patients in the OMC group that continued to take NSAIDs were in remission after 2 years compared with none in the OP group. Atrophy but not intestinal metaplasia decreased after treatment. Conclusions: Gastric ulcers are mainly caused by H. pylori, and relapse is effectively prevented by H. pylori eradication, even in patients on NSAIDs.

对疑有结肠结核患者外观正常的末端回肠和盲肠进行内镜活检

Background and Study Aims: Colonic tuberculosis is generally diagnosed by colonoscopy and targeted biopsy of lesions.However, the diagnostic yield of colonic biopsies is not very good. So far as we are aware, there have been no studies investigating the role of biopsies from endoscopically normal appearing cecum and terminal ileum in diagnosing colonic or ileal tuberculosis, or both. Patients and Methods: Patients with a clinical suspicion of colonic tuberculosis, in whom no endoscopic abnormalities were found on colonoscopy or ileoscopy,were included in the study. Multiple biopsies were obtained from the cecum and ileum. Results: Fifty patients were studied.Intubation of the terminal ileum was possible in 43 patients(86% ). Histological examination of biopsies obtained from the cecum and terminal ileum showed noncaseating granuloma in two patients. Both of these biopsies were from the terminal ileum. In two other patients, collections of loosely arranged epithelioid cells were observed. This established the diagnosis in these four patients (8% ). In the remaining 46 patients,histology showed nonspecific inflammation in 18 patients (in the cecum in 15 and in the terminal ileum in seven). The other biopsies did not show any abnormalities (33 from the cecum, 34 from the terminal ileum). Conclusions: Histological examination of biopsies from the normal-appearing cecum and terminal ileum is useful in a small but significant number of patients with colonic tuberculosis.

胰腺括约肌切开术后胰腺炎的患病风险:一项572例患者回顾

Background and study aims:Endoscopic pancreatic sphinc-terotomy is indispensable for many therapeutic endoscopic maneuvers,but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP) .In this study,this subgroup of patients was investigated in order to identify risk factors and protective factors.Patients and methods:A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria.Charts were examined for indications,endoscopic technique,and outcomes,including pancreatitis.Results:A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period.Indications for sphincterotomy included chronic pancreatitis(n = 398) ,access for tissue sampling(n = 52) ,acute recurrent pancreatitis(n = 45) ,transpapillary drainage of a pancreatic pseudocyst(n = 32) ,precut access to the common bile duct(n = 29) ,and others(n = 16) .Pancreatic duct drainage was performed in 69.1% of the procedures(nasopancreatic catheter,n = 290,or pancreatic stent placement,n = 105) .Post-ERCP pancreatitis occurred in 69 cases(12.1%) and was severe in 10.The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis,while an elevated C-reactive protein level,pancreatic ductal stones,sphincterotomy at only the major papilla,and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk.Conclusions:This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis.In addition to providing further definition of which patients are at risk,it also suggests that pancreatic duct drainage is an independently significant protective maneuver.

结肠镜操作中CO_2充气法:在使用镇静剂的患者中应用的安全性和有效性

Background and study aims: Several studies have shown that insufflation of carbon dioxide (CO2) instead of air dur-ing colonoscopy can reduce postprocedural pain. However, CO2 insufflation might also lead to CO2 retention in the human body. It was recently shown that this side effect does not occur in unsedated patients, but that sedation leads to impaired respiration. Sedated patients may therefore be more prone to CO2 retention. This randomized, double-blinded study was designed to investigate whether CO2 insufflation leads to CO2 retention in sedated patients. Patients and methods: A total of 103 consecutive patients undergoing colonoscopy were randomly assigned to the use of either CO2 or air insufflation. End-tidal carbon dioxide (ETCO2), a noninvasive parameter for arterial PCO2, was recorded before the examination, twice during it, and 10 min after it. Midazolam or pethidine, or both, were used for sedation. The patient’s pain during the examination and 1, 3, 6, and 24 h afterwards was registered using a questionnaire. Results: CO2 was used in 52 patients and air insufflation in 51. A total of 52 patients (51% ) received sedation. There were no differences in ETCO2 between the CO2 and air group. A slight increase in ETCO2 was observed in sedated patients, while there was no increase in unsedated patients. CO2 insufflation significantly reduced pain after the procedure at all time points. Conclusions: This study indicates that CO2 insufflation reduces pain and is safe to use in colonoscopy for sedated patients.

原发性硬化性胆管炎患者伴重度胆管狭窄的胆管镜特征

Background and Study Aims:Primary sclerosing cholangitis(PSC) is associated with the development of cholangiocarcinoma in up to 10% of patients.Cholangiography or endoscopic tissue sampling does not reliably distinguish between cholangiocarcinoma and a benign dominant bile duct stenosis.The aim of the present study was to assess the value of cholangioscopy for distinguishing between benign and malignant dominant stenoses in PSC patients.Patients and Methods:Fifty-three PSC patients with dominant bile duct stenoses were prospectively studied.Transpapillary cholangioscopy and endoscopic tissue sampling were carried out in addition to endoscopic retrograde cholangiography(ERC) .The cholangiography and cholangioscopic findings were classified as malignant or benign by the investigators.A final diagnosis of malignant stenosis was based on positive histology and/or cytology,whereas a benign condition was assumed in cases of negative tissue sampling and uneventful extended clinical follow-up.Results:Twelve PSC patients(23%) had dominant bile duct stenoses caused by cholangiocarcinoma,whereas 41 of the 53 patients(77%) had benign dominant bile duct stenoses.Cholangioscopywas significantly superior to ERC for detecting malignancy in terms of its sensitivity(92% vs.66% ;P = 0.25) ,specificity(93% vs.51% ;P < 0.001) ,accuracy(93% vs.55% ;P< 0.001) ,positive predictive value(79% vs.29% ;P< 0.001) ,and negative predictive value(97% vs.84% ;P < 0.001) .Transpapillary cholangioscopy is more sensitive and specific for characterizing malignant bile duct stenosis in comparison with endoscopic brush cytology.Conclusions:Transpapillary cholangioscopy significantly increases the ability to distinguish between malignant and benign dominant bile duct stenoses in patients with PSC.

应用单克隆抗体的粪便抗原检测用于诊断幽门螺杆菌感染的精确性

Background: Recent availability of tests for Helicobacter pylori antigens in stool samples has provided potentially useful tools for epidemiological studies and clinical settings. The aim of this study was to evaluate a monoclonal antibody-based H. pylori antigen stool test in the primary diagnosis of H. pylori infection, and to study the test performance after patients were treated with lanzoprazole, and after eradication therapy. Methods: The study included 122 dyspeptic patients. At gastroscopy, biopsy specimens were obtained for culture and histology. Stool antigen and [14C]-urea breath tests were performed concurrently. Positive culture alone or a positive [ 14C]-urea breath test in combination with positive histology defined the reference standard. Forty-three Hp +ve patients were treated with lanzoprazole for 2 to 4 weeks, and stool antigen tests were performed on days 1 and 7 post-treatment. After eradication therapy, 32 patients were re-examined for H. pylori infection. Results: Prevalence of H. pylori was 44.3%. Sensitivity and specificity for the stool antigen test in the primary diagnosis of H. pylori infection were 98%and 94%, with positive and negative likelihood ratios of 16.7 and 0.02, respectively. All patients had positive stool tests immediately after lanzoprazole treatment, whereas 2 patients had negative stool tests after 7 days. Triple therapy rendered all patients stool test negative. Conclusions: The monoclonal antibody-based stool antigen test is an accurate tool in the primary diagnosis of H. pylori infection and after eradication therapy. Lanzoprazole treatment does not influence the clinical performance of the test.

高清晰内镜结合色素内镜或窄带成像在Barrett食管中的应用:一项前瞻性、随机、交叉研究

Background and study aims: High- resolution endoscopy (HRE) may improve the detection of early neoplasia in Barrett s esophagus. Indigo carmine chromoendoscopy (ICC) and narrow- band imaging (NBI) may be useful techniques to complement HRE. The aim of this study was to compare HRE- ICC with HRE- NBI for the detection of high- grade dysplasia or early cancer (HGD/EC) in patients with Barrett s esophagus. Patients and methods: Twenty- eight patients with Barrett s esophagus underwent HRE- ICC and HRE- NBI (separated by 6- 8weeks) in a randomized sequence. The two procedures were performed by two different endoscopists, who were blinded to the findings of the other examination. Targeted biopsies were taken from all detected lesions, followed by four- quadrant biopsies at 2- cm intervals. Biopsy evaluation was supervised by a single expert pathologist, who was blinded to the imaging technique used. Results: Fourteen patients were diagnosed with HGD/EC. The sensitivity for HGD/EC was 93 % and 86% for HRE- ICC and HRE- NBI, respectively. Targeted biopsies had a sensitivity of 79% with HRE alone. HGD was diagnosed from random biopsies alone in only one patient. ICC and NBI detected a limited number of additional lesions occult to HRE, but these lesions did not alter the sensitivity for identifying patients with HGD/EC. Conclusions: In most patients with high- grade dysplasia or early cancer in Barrett s esophagus, subtle lesions can be identified with high- resolution endoscopy. Indigo carmine chromoendoscopy and narrow- band imaging are comparable as adjuncts to high- resolution endoscopy.

双球囊内镜的诊断与疗效评估

Background and study aims: Double-balloon enteroscopy (DBE) is a new endoscopic method for examining the small intestine. Most reports of DBE have been from Japan, and very few data on this new technique have been reported by centers outside Japan. The aim of the present study was to determine the diagnostic yield of DBE, measure the frequency of management changes made on the basis of the results, and evaluate the clinical outcome for patients undergoing the procedure. Patients and methods: All patients undergoing DBE using a Fujinon enteroscope (length 200 cm, diameter 8 mm) during a 11-month period were studied. All of the patients had previously undergone esophagogastroduodenoscopy and colonoscopy. They underwent small-bowel cleansing on the day before the procedure using a standard colon lavage solution. Results: Seventy DBE procedures were carried out in 53 patients (34 men, 19 women; mean age 60 years, range 24-80) by the oral route in 46 cases and the anal route in 24. The indications for the examination were g astrointestinal bleeding (n = 29), suspected Crohn‘s disease (n = 6), abdominal pain (n = 4), polyp removal or evaluation in polyposis syndromes (n = 6), chron ic diarrhea (n = 4), and surveillance or tumor search (n = 4). The mean duration of the procedure was 72 min (range 25 min -3 h). The mean radiation exposure w as 441 dGy/cm (range 70 -1462), and the mean depth of small-bowel insertion wa s 150 cm (range 1 -470 cm). It was possible to evaluate the entire small bowel in four patients (8%). A new diagnosis was obtained in 26 of the 53 patients (4 9%). The findings in the 70 procedures were angiodysplasia (n = 13), ulceration s or erosions (n = 5), jejunitis or ileitis (n = 5), tumors (n = 5), stenosis (n = 4), polyps (n = 5), lymphangiectasias (n = 4), Crohn‘s disease (n = 4), and normal (n = 17). DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfusions) in 57%of the patients (30 of 53). T he only complication (1.4%) observed was one case of intraprocedural postpolype ctomy bleeding, which resolved with injection of epinephrine. Conclusion: In alm ost two-thirds of the patients examined, DBE was clinically useful for obtainin g a new diagnosis and starting new treatments, changing existing treatments, car rying out surgical intervention, or providing therapeutic endoscopy. DBE is a us eful and safe method of obtaining tissue for diagnosis, providing hemostasis, an d carrying out polypectomy.

回肠镜检、回肠末端活检正常且结肠镜检正常或无明显异常的患者无需小肠钡餐造影检查

Background: There is an increase of reliance on ileoscopy in preference to small-bowel barium follow-through in the diagnosis of terminal ileal Crohn disease. In this study the role of small-bowel barium follow-through after a normal or unremarkable ileocolonoscopy was investigated. Methods: A retrospective analysis of all patients who had a colonoscopy followed by a small-bowel barium follow-through over a 7-year period was performed. Patients with a previously established diagnosis of inflammatory bowel disease and those who had colonoscopic evidence of inflammatory bowel disease were excluded. Results: Of the 96 patients who had a normal ileoscopy and normal or unremarkable colonoscopy, 3 had abnormalities detected at small-bowel barium follow-through. Two patients had abnormal terminal ileal biopsies, although the terminal ileum appeared macroscopically normal. The small-bowel barium follow-through helped to establish the diagnosis of Crohn disease. The other patient presented changes consistent with a previously established diagnosis. Of the 47 patients who had a normal or unremarkable total colonoscopy without ileoscopy, 1 had abnormalities detected at small-bowel barium follow-through consistent with a previously established diagnosis. Conclusions: Small-bowel barium follow-through is rarely required in patients who have had a normal ileoscopy and terminal ileum biopsy and a normal or unremarkable colonoscopy. It should only be performed if there is a very high index of suspicion of small-bowel pathology. In patients with suspected Crohn disease, it is important to take terminal ileum biopsies even if the ileum appears macroscopically normal at ileoscopy.

内镜专题会议期间内镜下逆行胆胰管造影现场演示的并发症

Background and study aims: Endoscopy workshops are thought to be associated with larger numbers of complications than routine clinical treatment. In this study, patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during live demonstrations were compared with matched patients treated in an ERCP unit. Patients and methods: Patients who underwent ERCP during workshops over a 12-year period were reviewed. The control for each patient was the next patient admitted to the same ERCP unit with similar indications. Possible delays before treatment, ERCP indications, the use of general anesthesia, standard endoscopic and special treatments, success and complication rates for ERCP, prolonged hospitalization periods, and financial benefits for patients were assessed. Results: A total of 168 workshop patients and 168 control patients were compared. ERCP was delayed in 18 patients to allow treatment during the workshops. General anesthesia was used in 87.5% of the workshop patients, in comparison with 44% of the control patients (P < 0.001). The duration of the endoscopies and radiation exposure did not differ, and the endoscopic treatments carried out also did not differ significantly, with the exception of cholangiopancreatoscopy (7% in the workshop group versus 0% ; P < 0.01). The success and complication rates were similar in the workshop and control patients, as was the duration of hospitalization. Among the patients treated during workshops, 45% benefited financially, as they were not charged for stents or other devices. Conclusions: These results suggest that, in this setting, ERCP performed during live demonstrations is safe and raises no major ethical problems.

三维超声内镜测量肿瘤大小:一项实验与临床研究

Background and Study Aims: The Olympus EU-IP2 threedimensional endoscopic ultrasound (3D-EUS) imaging system makes it possible to display tumors in three dimensions and estimate their volume. Materials and Methods: Experimental and clinical studies of the volume estimation function of the Olympus EU-IP2 system was carried out to evaluate its accuracy and assess the extent of tumor shrinkage caused by fixation, dehydration, and staining. Results. In the experimental studies, compared with the actual volume of a 1000-mm3 gelatin column, the estimated volume was found to be equivalent to 114 ±1.8% with the 3R probe and 143 ±0.8 % with the 2R probe (mean plus or minus standard deviation). The mean estimated volume of tumor models was 127 ±8.5%with the 3R probe and 131 ±6.8% with the 2R probe. Greater distance from the probe was associated with a greater degree of error than the target object’s size, angle, or the number of traces of its outline made. In the clinical studies, compared with the histologically determined tumor volume (100%), the mean estimated tumor volume was 178 ±48.2%in situ, 168 ±31.3%in resected specimens, and 137 ±31.5%after fixation. Fixation, dehydration, and staining were thus associated with tumor shrinkage. Conclusions: The volume of gastrointestinal lesions can be estimated by 3D-EUS, although it is overestimated in comparison with actual values. 3D-EUS also allows direct comparisons to be made between the tumor volume before surgery and the volume of fixed pathological specimens, so that the rate of tumor shrinkage can be estimated.

经过肠道准备后,胶囊内窥镜检查效果得到改善

The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small-bowel wall and complete passage through the small bowel. This study examined the effect of bowel preparation on the volume of intestinal content and on small-bowel transit. Sixty-one consecutive patients (34 men, 27 women; mean age 56 years, range 17-88 years)were enrolled in the study. Although not randomized, 33 patients received a bowel preparation, and 28 had no preparation. Gastric emptying, small-bowel transit time, overall preparation assessment, and bowel-wall visualization were evaluated by 3 investigators who were unaware of whether the patient had undergone bowel preparation. Small-bowel transit time was significantly shorter in patients with bowel preparation (median 213 minutes: 95%CI[190, 267]) than in those without preparation (median 253 minutes: 95%CI[228, 307]) (p < 0.01). The capsule reached the cecum in 97%of patients in the bowel-preparation group, compared with 76%in the nonpreparation group (p = 0.02). Bowel preparation improved the quality of visualization significantly; this effect was more pronounced in the distal small bowel. This study demonstrated that bowel preparation accelerates small-bowel capsule transit and leads to a higher rate of complete capsule endoscopy. Visualization of the small bowel was improved by bowel preparation. Bowel preparation before capsule endoscopy is recommended.