Capsule endoscopy

Capsule endoscopy aspiration and respiratory physician's treatment insights: a case report and literature review

Background

Capsule endoscopy (CE) is widely used for intestinal examination; however, capsule aspiration into the airway is a serious complication that requires urgent intervention. We present a management case report and review 39 cases from 2003 to 2023, providing insights into the prevention and treatment of capsule aspiration.

Case presentation

A 69-year-old man with chronic bronchitis and emphysema presented with 7 months of intermittent melena. After swallowing a capsule endoscope (PillCam™ SB 3), he had a brief cough and chest tightness. Imaging confirmed aspiration in the right intermediate bronchus, and non-invasive removal procedures were unsuccessful.

Methods

Real-time imaging confirmed the lodged capsule. Non-invasive methods, such as coughing and chest percussion, were unsuccessful. Therefore, flexible bronchoscopy was performed under general anesthesia to retrieve the capsule using a snare, which was then placed into the duodenum using a gastroscope.

Results

The capsule was successfully retrieved, and the patient recovered well, completing the endoscopy without further issues.

Conclusion

Our case study and literature review highlight the need for careful attention to high-risk groups in CE, including the elderly and individuals with neurological or swallowing difficulties. A thorough history review and real-time monitoring are essential for preventing complications. Bronchoscopy is preferred for CE retrieval due to its advantages. Manufacturers are urged to improve CE safety, with respiratory physicians helping internists in managing this potentially life-threatening complication.

Application of nanotechnology in the early diagnosis and comprehensive treatment of gastrointestinal cancer

Gastrointestinal cancer (GIC) is a common malignant tumour of the digestive system that seriously threatens human health. Due to the unique organ structure of the gastrointestinal tract, endoscopic and MRI diagnoses of GIC in the clinic share the problem of low sensitivity. The ineffectiveness of drugs and high recurrence rates in surgical and drug therapies are the main factors that impact the curative effect in GIC patients. Therefore, there is an urgent need to improve diagnostic accuracies and treatment efficiencies. Nanotechnology is widely used in the diagnosis and treatment of GIC by virtue of its unique size advantages and extensive modifiability. In the diagnosis and treatment of clinical GIC, surface-enhanced Raman scattering (SERS) nanoparticles, electrochemical nanobiosensors and magnetic nanoparticles, intraoperative imaging nanoparticles, drug delivery systems and other multifunctional nanoparticles have successfully improved the diagnosis and treatment of GIC. It is important to further improve the coordinated development of nanotechnology and GIC diagnosis and treatment. Herein, starting from the clinical diagnosis and treatment of GIC, this review summarizes which nanotechnologies have been applied in clinical diagnosis and treatment of GIC in recent years, and which cannot be applied in clinical practice. We also point out which challenges must be overcome by nanotechnology in the development of the clinical diagnosis and treatment of GIC and discuss how to quickly and safely combine the latest nanotechnology developed in the laboratory with clinical applications. Finally, we hope that this review can provide valuable reference information for researchers who are conducting cross-research on GIC and nanotechnology.

Endoscopic and radiographic evaluation of the small bowel in 2012

Traditionally, the diagnosis of small bowel disorders has been challenging secondary to the small intestine's length, tortuosity, and anatomic location. Recent technologic advancements in the field of enteroscopy and radiographic imaging have facilitated a more thorough endoscopic evaluation of patients with small bowel disease ranging from obscure gastrointestinal bleeding to inflammatory bowel disease and small bowel tumors. Such developments have made it possible to avoid invasive surgical procedures in certain clinical scenarios where they were previously the gold standard. In this review, we report an update on the diagnostic and management approach to patients with small bowel disease, emphasizing the advantages and limitations of the latest modalities now available to primary care physicians and gastroenterologists for evaluating patients with presumed disease of the small intestine.

Long-term outcomes of obscure gastrointestinal bleeding after CT enterography: does negative CT enterography predict lower long-term rebleeding rate?

BACKGROUND AND AIM

Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long-term outcomes based on CTE findings, with special reference to negative CTE.

METHODS

A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre- and post-CTE clinical data were collected. "Specific treatments" were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while "non-specific treatments" were defined as symptomatic treatments for anemia.

RESULTS

Among 60 patients for whom long-term follow-up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023).

CONCLUSIONS

CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long-term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.