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Omori T, Hara T, Murasugi S, Kambayashi H, Sasaki Y, Koroku M, Yonezawa M, Morishita K, Nakamura S, Tokushige K. A case of incorrect evaluation of intestinal patency by early dissolution of a patency capsule. DEN Open 2024; 4:e288. [PMID: 37636993 PMCID: PMC10449806 DOI: 10.1002/deo2.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
A 60-year-old man presented with a suspected small intestinal tumor on positron-emission tomography-computed tomography. Small bowel capsule endoscopy (SBCE) was planned for close examination of the small intestine. To avoid retention of the SBCE due to strictures, a patency capsule (PC) was first used to evaluate patency. However, PC discharge was not visually confirmed during the 24-h period. No obvious PC was observed on plain abdominal radiography performed in the standing position. The patient underwent SBCE, assuming that the PC had been shed inconspicuously. SBCE revealed a neoplastic lesion with stenosis at a site thought to be the upper small intestine and remained stagnant at the same site for the duration of the battery. In addition, in the SBCE image, a PC shell was captured in the intestinal tract on the oral side of the stenosis. When the pre-SBCE plain abdominal radiograph was enlarged to confirm the details, PC was observed in the lateral and decubitus views as a dissolved shell only. To the best of our knowledge, no previous report has described the complete dissolution of a PC leaving only its shell during a 30-hour patency evaluation period. This case illustrates that, in the absence of visual confirmation of a PC discharge, PC may have remained in the body due to premature dissolution. Additional examinations or plain X-ray imaging should be performed to confirm this, with no preconceived notions that the PC will not dissolve within 30 hours of administration.
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Affiliation(s)
- Teppei Omori
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Toshifumi Hara
- Department of GastroenterologyHachioji Digestive Disease HospitalTokyoJapan
| | - Shun Murasugi
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | | | - Yu Sasaki
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Miki Koroku
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Maria Yonezawa
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Keiichi Morishita
- Department of GastroenterologyHachioji Digestive Disease HospitalTokyoJapan
| | - Shinichi Nakamura
- Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
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2
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Omori T, Ohmiya N, Watanabe K, Hirai F, Nakamura M, Kitamura K, Ozeki K, Oka S, Kawano S, Handa O, Kawai M, Ninomiya K, Sagawa T, Wakamatsu T, Araki A, Koike Y, Kato S, Hashimoto S, Mannami T, Nakaji K, Tanaka S, Matsui T. Nationwide multicenter study on adverse events associated with a patency capsule: Additional survey of appropriate use of patency capsule study. J Gastroenterol Hepatol 2024; 39:337-345. [PMID: 37842961 DOI: 10.1111/jgh.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 09/10/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND AIM The PillCam patency capsule (PC) without a radio frequency identification tag was released to preclude retention of the small bowel capsule endoscope (CE) in Japan in 2012. We conducted a multicenter study to determine tag-less PC-related adverse events (AEs). METHODS We first conducted a retrospective survey using a standardized data collection sheet for the clinical characteristics of PC-related AEs among 1096 patients collected in a prospective survey conducted between January 2013 and May 2014 (Cohort 1). Next, we retrospectively investigated additional AEs that occurred before and after Cohort 1 within the period June 2012 and December 2014 among 1482 patients (Cohort 2). RESULTS Of the 2578 patients who underwent PC examinations from both cohorts, 74 AEs occurred among 61 patients (2.37%). The main AEs were residual parylene coating in 25 events (0.97%), PC-induced small bowel obstruction, suspicious of impaction, in 23 events (0.89%), and CE retention even after patency confirmation in 10 events (0.39%). Residual parylene coating was significantly associated with Crohn's disease (P < 0.01). Small bowel obstruction was significantly associated with physicians with less than 1 year of experience handling the PC and previous history of postprandial abdominal pain (P < 0.01 and P < 0.03, respectively). CE retention was ascribed to erroneous judgment of PC localization in all cases. CONCLUSIONS This large-scale multicenter study provides evidence supporting the safety and efficiency of a PC to preclude CE retention. Accurate PC localization in patients without excretion and confirmation of previous history of postprandial abdominal pain before PC examinations is warranted (UMIN000010513).
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Affiliation(s)
- Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Watanabe
- Department of Internal Medicine for Inflammatory Bowel Disease, Toyama University, Toyama, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Tonami General Hospital, Toyama, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Handa
- Depatment of Gastroenterology, Kawasaki Medical School, Okayama, Japan
| | - Mikio Kawai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | | | - Tamotsu Sagawa
- Department of Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan
| | - Takahiro Wakamatsu
- Wakamatsu Clinic, Osaka, Japan
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Akihiro Araki
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Yuji Koike
- Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomohiko Mannami
- Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
- Department of Internal Medicine, Chugoku Central Hospital, Hiroshima, Japan
| | | | - Shinji Tanaka
- Department of Endoscopy and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ho AHY, Lui RN. The current and future clinical applications of capsule endoscopy. J Gastroenterol Hepatol 2024; 39:28-33. [PMID: 38238541 DOI: 10.1111/jgh.16490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Agnes H Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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O'Hara F, Walker C, McNamara D. Patency testing improves capsule retention rates but at what cost? A retrospective look at patency testing. Front Med (Lausanne) 2023; 10:1046155. [PMID: 37621464 PMCID: PMC10445123 DOI: 10.3389/fmed.2023.1046155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Capsule retention is one of the major complications of capsule endoscopy, which range from 2.1 to 8.2% depending on the indication. Over the last few years, reported rates of retention have fallen due to better patient selection due to the recognition of risk factors for capsule retention as well as the introduction of the patency capsule. The patency capsule is a dissolvable capsule with the same dimensions as the functional capsule. It breaks down in the GI tract after approximately 30 h, reducing the risk of symptomatic retention. Failure to pass this patency capsule out of the small bowel results in the patient being excluded from capsule endoscopy. We performed a retrospective analysis of the patency capsules performed in our unit over a 12-month period. A total of 166 (14.7%) of 1,127 patients referred for capsule endoscopy were deemed to require patency assessment (45.8% men, mean age 48 years). Of those who passed the patency assessment and underwent capsule endoscopy, no capsule retention was seen. Indication for patency assessment was found to be appropriate in 87.0% (n = 147). Overall, the failure rate at the patency assessment was 43.1%. The patency capsule remains an imperfect but useful tool in examining functional patency of the GI tract prior to capsule endoscopy.
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Affiliation(s)
- Fintan O'Hara
- Trinity Academic Gastroenterology Group (TAGG), Department of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Caroline Walker
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group (TAGG), Department of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
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Rosa B, Dray X, Koulaouzidis A. Retention of small bowel capsule endoscopy. Curr Opin Gastroenterol 2023; 39:227-233. [PMID: 37144540 DOI: 10.1097/mog.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Capsule endoscopy is widely recognized as a safe and effective procedure to evaluate the small bowel and/or the colon noninvasively. Although infrequent, capsule retention is the most feared adverse event related to this technique. A better knowledge of risk factors, improvement of patients' selection and precapsule patency assessment may further contribute to reducing the incidence of capsule retention, even in patients at increased risk for this complication. RECENT FINDINGS This review addresses the main risk factors for capsule retention, strategies for risk reduction such as patients' selection, dedicated cross-sectional imaging and rational use of the patency capsule, as well as management options and outcomes in the case of capsule retention. SUMMARY Capsule retention is infrequent, and it is usually manageable conservatively with favorable clinical outcomes. Patency capsules and dedicated small-bowel cross-sectional techniques such as CT or MR enterography should be used selectively and are both effective in decreasing the rate of capsule retention. However, none of them can completely eliminate the risk of retention.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Anastasios Koulaouzidis
- Department of Clinical Research, University of Southern Denmark (SDU), Odense
- Department of Medicine, Odense University Hospital Svendborg Sygehus, Svendborg
- Surgical Research Unit, Odense University Hospital, Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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Blanco Velasco G, Ramos-García J, García-Contreras LF, Solórzano-Pineda OM, Martínez-Camacho C, Murcio-Pérez E, Hernández-Mondragón ÓV. Predictive value of patency capsule and magnetic resonance enterography for capsule endoscopy retention in patients with established Crohn's disease. Rev Esp Enferm Dig 2023; 115:110-114. [PMID: 35656921 DOI: 10.17235/reed.2022.8848/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION retention is the most common adverse event of the small bowel capsule endoscopy procedure. Patency capsule (Medtronic, Dublin, Ireland) and magnetic resonance enterography are two diagnostic methods that can prevent small bowel capsule endoscopy retention. The aim of this study was to evaluate the predictive value of these two diagnostic methods. MATERIAL AND METHODS a prospective, comparative and observational study was performed in patients with established Crohn's disease. All patients had undergone magnetic resonance enterography and patency capsule procedures. If the patency capsule was not retained, the patient underwent a small bowel capsule endoscopy; otherwise, double balloon enteroscopy was performed to locate the stenosis. Magnetic resonance enterography predictive criteria for retention were analyzed in all cases. Sensitivity, specificity, positive predictive value and negative predictive value of the patency capsule and magnetic resonance enterography compared to small bowel capsule endoscopy or double balloon enteroscopy were calculated. RESULTS forty patients were included (24 female, 55 ± 13 years old). Retention criteria with capsule endoscopy or double balloon enteroscopy were found in six patients, agreeing in five cases with patency capsule and in three cases with magnetic resonance enterography. Sensitivity, specificity, positive predictive value, negative predictive value and Kappa coefficient for predicting retention with the patency capsule were 83 %, 100 %, 100 % and 97 %, respectively, and 50 %, 91 %, 50 % and 91 %, respectively, with magnetic resonance enterography. CONCLUSIONS patency capsule has a higher sensitivity and positive predictive value than magnetic resonance enterography for preventing small bowel capsule endoscopy retention in Crohn's disease patients.
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Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Pennazio M, Rondonotti E, Despott EJ, Dray X, Keuchel M, Moreels T, Sanders DS, Spada C, Carretero C, Cortegoso Valdivia P, Elli L, Fuccio L, Gonzalez Suarez B, Koulaouzidis A, Kunovsky L, McNamara D, Neumann H, Perez-Cuadrado-Martinez E, Perez-Cuadrado-Robles E, Piccirelli S, Rosa B, Saurin JC, Sidhu R, Tacheci I, Vlachou E, Triantafyllou K. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2023; 55:58-95. [PMID: 36423618 DOI: 10.1055/a-1973-3796] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | | | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tom Moreels
- Division of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
| | - David S Sanders
- Sheffield Teaching Hospitals NHS Foundation Trust, Gastroenterology Sheffield, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Begona Gonzalez Suarez
- Gastroenterology Department - ICMDiM, Hospital Clínic of Barcelona, DIBAPS, CiBERHED, Barcelona, Spain
| | - Anastasios Koulaouzidis
- Centre for Clinical Implementation of Capsule Endoscopy, Store Adenomer Tidlige Cancere Center, Svendborg, University of Southern Denmark, Denmark
| | - Lumir Kunovsky
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | | | | | - Stefania Piccirelli
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, United Kingdom
| | - Ilja Tacheci
- 2nd Department of Internal Medicine - Gastroenterology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | | | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Iwama I, Nambu R, Nakayama Y. Small bowel endoscopy for children: Collaboration of capsule endoscopy and device-assisted enteroscopy. Dig Endosc 2022. [PMID: 36576231 DOI: 10.1111/den.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE) have become indispensable techniques for the diagnosis and management of small bowel disease in both adult and pediatric cases. However, relevant differences exist in the indications between these cohorts, with body weight and age having particular relevance in decisions for the latter. Both CE and BAE are designed for adult physique and they were not widely used among children. In addition, the types of small intestinal diseases differ between adults and children, and consequently, the indications also differ between them. This review focuses on the issues relevant to pediatric cases and describes the practical application of endoscopy in clinical practice. In conclusion, although there are age and weight restrictions, both CE and BAE are safe and useful devices for use in children, and their indications for use in children are likely to expand in the future.
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Affiliation(s)
- Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
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10
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Kawano S, Oka S, Shiotani A, Hashimoto S, Takahashi S, Handa O, Takami T, Inaba T, Okada H, Tanaka S. Safety and efficacy of capsule endoscopy for patients with newly diagnosed Crohn's disease: A multicenter retrospective study. Medicine (Baltimore) 2022; 101:e32424. [PMID: 36550892 PMCID: PMC9771187 DOI: 10.1097/md.0000000000032424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory disease that develops at a young age and frequently leads to intestinal resection. Capsule endoscopy (CE) can directly and non-invasively inspect the entire small bowel mucosa. We suspected that CE could be a good diagnostic tool for detecting CD in young patients. The aim of this study was to investigate the safety and efficacy of CE in patients with newly diagnosed CD and to evaluate the CE findings, especially in the upper small bowel of young patients. We retrospectively investigated 32 patients with newly diagnosed CD from 5 institutions. Patient characteristics, clinical course, and characteristics of CE findings were analyzed. The total small intestine observation rate was 93%, and the retention rate was 3% (1/32). No abnormality was identified by ileocolonoscopy in 46% (15/32), and transition of small bowel lesions (TSL) was found in 35% (12/34) of the patients. The frequency of longitudinal ulcers and cobblestones in the upper small intestine was significantly higher in younger patients (≤20 years). Moreover, positive findings in the upper small intestine were predominantly observed in younger patients (≤20 years). CE for patients with newly diagnosed CD was safe and useful, especially for the detection of upper small bowel lesions in young patients.
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Affiliation(s)
- Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- *Correspondence: Seiji Kawano, Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan 2-5-1 Shikata-cho, Okayama 700-8558, Japan (e-mail: )
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiko Shiotani
- Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, Okayama, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi Japan
| | - Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Osamu Handa
- Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, Okayama, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Tanaka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Miyazu T, Osawa S, Tamura S, Tani S, Ishida N, Matsuura T, Yamade M, Iwaizumi M, Hamaya Y, Furuta T, Sugimoto K. Modified method of patency judgement using patency capsule prior to capsule endoscopy in clinical practice. Sci Rep 2022; 12:14335. [PMID: 35995963 DOI: 10.1038/s41598-022-18569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
In 2012, Japan approved the use of a tag-less patency capsule (PC), which evaluates gastrointestinal patency before small-bowel capsule endoscopy (SBCE). This study aimed to evaluate the validity of our modification on the passage criteria for this PC in clinical practice. We retrospectively enrolled 326 consecutive patients who underwent PC examination before SBCE. If X-ray could not reveal the PC in the body during the judgement time (30–33 h after ingestion), we defined it as ‘estimated patency’ and performed SBCE. We employed plain computed tomography (CT) for the second judgement, as needed. The overall patency rate was 95.1%. By X-ray, 41 (12.6%) patients were judged to have ‘estimated patency’, and SBCE could be safely performed. Plain CT judgement was necessary in 106 patients (32.5%). One PC case had a residual coating film associated with stenosis in a patient with Crohn’s disease (CD), and one (0.3%) SBCE case had capsule retention resulting from false CT judgement. Multivariate analysis revealed that established CD and inpatient were factors related to no-patency. In conclusion, PC is useful for examining gastrointestinal patency, keeping in mind CT misjudgement. If PC was not found in the body via X-ray, performing SBCE as ‘estimated patency’ seemed appropriate.
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12
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Ohmiya N, Oka S, Nakayama Y, Iwama I, Nakamura M, Shimizu H, Sumioka A, Abe N, Kudo T, Osawa S, Honma H, Okuhira T, Mtsufuji S, Imaeda H, Ota K, Matsuoka R, Hotta N, Inoue M, Nakaji K, Takamaru H, Ozeki K, Kobayashi T, Hosoe N, Tajiri H, Tanaka S. Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE-J study). Dig Endosc 2022; 34:543-552. [PMID: 34379849 DOI: 10.1111/den.14104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIM We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes. METHODS We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers. RESULTS Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years, respectively (P = 0.6661), but the total enteroscopy rate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantly more common than prolonged lodging in the stomach (64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc. CONCLUSIONS: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.
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Affiliation(s)
- Naoki Ohmiya
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiko Sumioka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Abe
- Division of Infectious Diseases and Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hitoshi Honma
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeru Okuhira
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shoji Mtsufuji
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryo Matsuoka
- Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan
| | - Naoki Hotta
- Department of Internal Medicine, Masuko Memorial Hospital, Aichi, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | | | | | - Keiji Ozeki
- Departments of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Taku Kobayashi
- Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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13
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Abstract
The retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibit the progress of PC and SBCE, even though they do not have any stenotic symptoms or abnormalities on imaging. In this review, we summarize the indications and limitations of PC prior to SBCE, especially the contraindications, and discuss clinical scenarios in which even PC should be avoided, and therefore such areas of stenosis should be evaluated by alternative modalities. We thus propose this new algorithm to evaluate the patency of the GI tract for patients with suspected and known small bowel stenosis in order that they may undergo SBCE safely.
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Affiliation(s)
- Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | | | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
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14
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Handa O, Shiotani A, Handa Y, Fukushima S, Osawa M, Murao T, Matsumoto H, Umegaki E, Hata J. Usefulness of radiographic targeting on the evaluation of the location of a patency capsule using abdominal ultrasonography. Eur J Gastroenterol Hepatol 2021; 33:1260-5. [PMID: 34581688 DOI: 10.1097/MEG.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM The usefulness of a radio-tag-free PillCam patency capsule (PatCap) has been reported to evaluate the patency of the small intestine. If the PatCap is not excreted within 33 h, the location of the failed PatCap must be confirmed. Although several methods for locating the failed PatCap have been reported, a universal method has not been established. In this study, we aimed to confirm the clinical feasibility of abdominal ultrasonography combined with abdominal X-ray in the determination of the location of a failed PatCap. PATIENTS AND METHODS Consecutive patients who were scheduled to undergo the capsule endoscopy and had received PatCap examination between July 2012 and September 2019 were retrospectively analyzed. Failed PatCap was assessed using ultrasonography combined with abdominal X-ray. RESULTS Among the eligible 250 patients, 129 retrieved the PatCap in their stool within 33 h after ingestion. Among the remaining 121 patients, abdominal X-ray was performed and the PatCaps were suspected to be in the small bowel in 57 patients. Among these 57 patients, abdominal ultrasonography identified 17 PatCaps in the small bowel. Among the selected 250 patients, 233 patients (93.2%) were eligible for capsule endoscopy examination, while 17 patients (6.8%) were not eligible. Capsule endoscopy passed through the small intestine without any incident. CONCLUSION We confirmed that the abdominal ultrasonography with a radiographic targeting of the PatCap location is a reliable indicator to avoid the risk of capsule endoscopy retention or impaction and can be performed in most hospitals and clinics.
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15
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Otsuka H, Nakamura M, Yamamura T, Maeda K, Sawada T, Mizutani Y, Ishikawa E, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Honda T, Ishigami M, Fujishiro M. Feasibility of patency capsule and colon capsule endoscopy in patients with suspected gastrointestinal stenosis: a prospective study. Nagoya J Med Sci 2021; 83:419-430. [PMID: 34552280 PMCID: PMC8438001 DOI: 10.18999/nagjms.83.3.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
Patency capsule (PC) can evaluate the patency of gastrointestinal (GI) tract. We hypothesized preceding patient selection using PC would improve the successful rate of colon capsule endoscopy (CCE). Therefore, a prospective single-arm study using PC followed by CCE was conducted with a control group of CCE alone. Patients with suspected or known GI stenosis scheduled for CCE were enrolled. CCE was performed only when the PC was excreted out of the body within 33 hours of ingestion. Primary endpoint was the rate of observation of the entire GI tract within the duration of examination. The secondary endpoints were complications and CCE findings. Twenty-three patients (17 men) were enrolled. The mean age was 50.5±19.8 years. Suspected stenotic sites were 8, 5, and 10 in the small, large, and small and large bowel, respectively. Sixteen, 12, and 10 patients had abdominal pain, active inflammatory bowel disease, and history of surgery for suspected stenosis, respectively. Patency of GI tract was confirmed in 96% (22/23) of the patients by administered PC. Of the 22 patients who underwent CCE, the entire GI tract was observed in 86% (19/22). No complications were observed. The median transit times in the small bowel and colon were 99 (21–682) and 160 (5–328) minutes, respectively. CCE findings revealed ulcers, erosions, and diverticula in 5, 9, and 4 patients, respectively. In conclusion, CCE with PC might be a safer and useful modality to observe the large colon for patients with suspected GI stenosis.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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