Transcript שקופית 1 - tasmc.org.il
ICCE 2006
Clinical Practice/Outcomes
• A team of researchers at the Martin-Luther University Hospitals and Clinics, Germany, conducted a 22 patient study comparing the comfort of capsule endoscopy in diagnosing small bowel to MRI and Enteroclysis. Patient comfort was graded in a questionnaire on a scale of 0 for no stress at all to 10 for unbearable stress for each imaging method. The mean stress grade for capsule endoscopy was 1.1, significantly less than stress associated with MRI 4.4 and enteroclysis 5.6. ( Abstract 371907 )
Clinical Practice/Outcomes
Physicians from Catholic University Digestive Endoscopy Unit in Rome, Italy, evaluated the feasibility and safety of non-assisted capsule endoscopy in eleven patients who previously had undergone stomach surgery. In nine of the eleven patients, the capsule passed into the small bowel directly as confirmed by fluoroscopy. In two other patients, endoscopy assisted positioning of the capsule was necessary. Researchers concluded that capsule endoscopy is safe and feasible in patients who have undergone gastro duodenal surgery. (Abstract 366720)
ICCE 2006 - Bleeding
Researchers at the Georges Pompidou European Hospital in Paris, France, examined the diagnostic yield of capsule endoscopy in detecting lesions outside of the small intestine that are missed by traditional endoscopy. Researchers identified a cause of bleeding outside of the small intestine in 26 patients or 7% of cases. Lesions were found in the stomach, proximal duodenum and cecum. (Abstract 366470)
Bleeding
Members of the Italian Capsule Endoscopy Club conducted a 274 patient retrospective study evaluating the cost-effectiveness of capsule endoscopy in patients with mid-GI bleeding (MGIB). The study found that 58.4% of patients had positive findings with capsule endoscopy compared to 30.4% with other imaging procedures. The study found the mean cost of a positive diagnosis with capsule endoscopy was €2,090 while that with other procedures was €3,828, implying a mean cost savings of €1,738. (Abstract 364658)
Bleeding
Final results of a randomized, controlled trial evaluating the efficiency of capsule endoscopy compared to push enteroscopy as a first line tool in the detection of obscure gastrointestinal bleeding were presented by researchers from Georges Pompidou European Hospital and France and Lariboisiere Hospital, both located in Paris.
Authors concluded that capsule endoscopy as a first line exploration for obscure gastrointestinal bleeding is the most efficient strategy in terms of diagnosis, accurately detecting the lack of disease and number of added examinations performed, provided that the negative predictive value of capsule endoscopy for small bowel lesions is taken into account and any source of bleeding is accurately detected by conventional endoscopy. (Abstract 366477)
Bleeding
Researchers at the Georges Pompidou European Hospital in Paris, France, examined the diagnostic yield of capsule endoscopy in detecting lesions outside of the small intestine that are missed by traditional endoscopy. Researchers identified a cause of bleeding outside of the small intestine in 26 patients or 7% of cases. Lesions were found in the stomach, proximal duodenum and cecum. (Abstract 366470)
Bleeding – DDW2006
• • • •
500
. Long Term Follow-up of Patients with Obscure Gastrointestinal Bleeding after Negative Capsule Endoscopy.
L. Lai; G. Wong; D. Chow; J. Lau; J. Sung; W. Leung
4
97
. Variation in Diagnostic Yield of Back-to-Back Capsule Endoscopy in Obscure GI Bleeding: Preliminary Results.
J. S. Kimble; R. C. Wong; A. Chak; G. A. Isenberg; G. S. Cooper
M1301
. Comparison of wireless video small bowel capsule endoscopy (CE) and upper endoscopy (EGD) in evaluation of iron-deficiency anemia (IDA) in patients with negative colonoscopy.
G. Isenberg; J. Taylor; H. Sigmundsson; A. Chak; R. Wong; M. Sivak
.
S1463
. Capsule Endoscopy Findings And Clinical Outcome In Patients With Obscure Gastrointestinal Bleeding M.E.Riccioni, S.Shah, A.Bizzotto, G.P.Lecca, C.Spada,*S.Rausei, G.Costamagna Digestive Endoscopy Unit, * General Surgery Unit – Catholic University- Rome, Italy
G. Costamagna; M. Riccioni; S. shah; A. Bizzotto; P. Lecca; C. Spada; S. Rausei
Bleeding – DDW2006
•
Iron Deficiency Anemia
"Comparison of Wireless Video Small Bowel Capsule Endoscopy (CE) and Upper Endoscopy (EGD) in Evaluation of Iron-deficiency Anemia (IDA) in Patients with Negative Colonoscopy," (Abstract M1301)
Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial.
Neu B
,
Ell C
,
May A
,
Schmid E
,
Riemann JF
,
Hagenmuller F
,
Keuchel M
,
Soehendra N
,
Seitz U
,
Meining A
,
Rosch T
.
Technical University of Munich, Munich, Germany.
• BACKGROUND: Capsule endoscopy (CE) is a new modality for obscure digestive bleeding (OBD), but little is known about its influence on management and outcome. PATIENTS AND METHODS: Fifty-six patients (male/female 26/30; mean age 63 yr) with ODB, and negative upper and lower gastrointestinal (GI) endoscopy were included in this multicenter study. The diagnostic yield of CE was compared to three other tests (OT: push enteroscopy, enteroclysis, angiography), and patients were followed up for at least 6 months. Parameters were analyzed that led to major management changes such as surgical or endoscopic intervention or specific medical therapy, as well as their correlation to further bleeding. RESULTS: CE had a diagnostic yield higher than OT (68% vs 38%). Major management changes and an improvement in bleeding activity were observed in 21 and 44 patients, respectively. The number and type of positive findings on CE were associated with significant management changes (p < 0.05). The number of positive findings detected by CE as well as by OT correlated with further bleeding episodes (p < 0.05). However, clinical parameters (lowest hemoglobin (Hb) value, number of blood transfusions) were also significantly associated with outcome. Diagnoses of specific diseases (tumor, Crohn, NSAID ulcer) by CE led to a favorable outcome in 64% of cases, whereas negative CE cases were associated with no further bleeding in 80%. • CONCLUSION: CE helps with management decisions and can replace other more complex and risky standard tests. Nevertheless, clinical parameters are equally important for predicting further bleeding and should also be used to decide on further management.
Crohn's Disease – DDW2006
• "Mucosal Healing in the Small Intestine Detected by Wireless Capsule Endoscopy," (Abstract S1407) • "Usefulness of the Capsule Endoscopy in the Study of Inflammatory Bowel Disease: Preliminary results," (Abstract T1122)
Crohn's Disease
Researchers at Malmö University Hospital, Lund University, Sweden, conducted a study of 65 patients with suspected or known Crohn's disease comparing the diagnostic value of capsule endoscopy to conventional imaging methods including barium enterography, push enteroscopy and ileo-colonoscopy. One or more of the diagnostic imaging methods identified Crohn's lesions in the small bowel in 38, or 58%, of the patients. All cases of small bowel Crohn's disease detected by conventional imaging methods were detected using capsule endoscopy. Capsule endoscopy alone identified eight additional patients with Crohn's disease and detected more extensive disease in 12 patients. The sensitivity of capsule endoscopy for detecting small bowel Crohn's disease was 0.87, whereas sensitivity of ileoscopy, barium enterography and push enteroscopy was only 0.58, 0.21 and 0.13, respectively.
The authors concluded that capsule endoscopy should be the method of choice in patients with suspected non stricturing Crohn's disease in the small bowel
. (Abstract 366760)
Crohn ’s disease
• Crohn’s score • Indications: – Suspected disease – Indeterminate disease – Assessing mucosal healing – Post operation – Sub-clinical (markers, genetics) – Before colectomy – Classification of pouchitis
Gut, may 2006
A Meta-Analysis of the Yield of Capsule Endoscopy Compared to Other Diagnostic Modalities in Patients with Non-Stricturing Small Bowel Crohn's Disease
Stuart L. Triester , M.D. 1 Fleischer , M.D. 1 , Jonathan A. Leighton , M.D. , Amy K. Hara , M.D. 2 1 , Grigoris I. Leontiadis , M.D. , Russell I. Heigh , M.D. 1 3 , Suryakanth R. Gurudu , M.D. , Arthur D. Shiff , M.D. 1 1 , David E. , and Virender K. Sharma , M.D. 1
Affiliations
• • • • OBJECTIVES: Capsule endoscopy (CE) allows for direct evaluation of the small bowel mucosa in patients with Crohn's disease (CD). A number of studies have revealed significantly improved yield for CE over other modalities for the diagnosis of CD, but as sample sizes have been small, the true degree of benefit is uncertain. Additionally, it is not clear whether patients with a suspected initial presentation of CD and those with suspected recurrent disease are equally likely to benefit from CE. The aim of this study was to evaluate the yield of CE compared with other modalities in symptomatic patients with suspected or established CD using meta-analysis.
METHODS: We performed a recursive literature search of prospective studies comparing the yield of CE to other modalities in patients with suspected or established CD. Data on yield among various modalities were extracted, pooled, and analyzed. Incremental yield (IY) (yield of CE − yield of comparative modality) and 95% confidence intervals (95% CI) of CE over comparative modalities were calculated. Subanalyses of patients with a suspected initial presentation of CD and those with suspected recurrent disease were also performed.
RESULTS: Nine studies (n = 250) compared the yield of CE with small bowel barium radiography for the diagnosis of CD. The yield for CE
versus
barium radiography for all patients was 63% and 23%, respectively (IY = 40%,
p
< 0.001, 95% CI = 28 –51%). Four trials compared the yield of CE to colonoscopy with ileoscopy (n = 114). The yield for CE
versus
ileoscopy for all patients was 61% and 46%, respectively (IY = 15%,
p
= 0.02, 95% CI = 2 –27%). Three studies compared the yield of CE to computed tomography (CT) enterography/CT enteroclysis (n = 93). The yield for CE
versus
CT for all patients was 69% and 30%, respectively (IY = 38%,
p
= 0.001, 95% CI = 15 –60%). Two trials compared CE to push enteroscopy (IY = 38%,
p
< 0.001, 95% CI = 26 –50%) and one trial compared CE to small bowel magnetic resonance imaging (MRI) (IY = 22%,
p
= 0.16, 95% CI =−9% to 53%). Subanalysis of patients with a suspected initial presentation of CD showed no statistically significant difference between the yield of CE and barium radiography (
p
= 0.09), colonoscopy with ileoscopy (
p
= 0.48), CT enterography ( modalities (barium radiography (
p p
= 0.07), or push enteroscopy ( < 0.001), colonoscopy with ileoscopy (
p p
= 0.51). Subanalysis of patients with established CD with suspected small bowel recurrence revealed a statistically significant difference in yield in favor of CE compared with all other = 0.002), CT enterography (
p
< 0.001), and push enteroscopy (
p
< 0.001)).
CONCLUSIONS: In study populations, CE is superior to all other modalities for diagnosing non-stricturing small bowel CD, with a number needed to test (NNT) of 3 to yield one additional diagnosis of CD over small bowel barium radiography and NNT = 7 over colonoscopy with ileoscopy. These results are due to a highly significant IY with CE over all other modalities in patients with established non-stricturing CD being evaluated for a small bowel recurrence. While there was no significant difference seen between CE and alternate modalities for diagnosing small bowel CD in patients with a suspected initial presentation of CD, the trend toward significance for a number of modalities suggests the possibility of a type II error. Larger studies are needed to better establish the role of CE for diagnosing small bowel CD in patients with a suspected initial presentation of CD. (Am J Gastroenterol 2006;101:954 –964 )
PillCam ESO
Researchers at the Hôpital Edouard Herriot in Lyon, France conducted a 20-patient prospective study comparing esophageal capsule endoscopy to esophago-gastro duodenoscopy (EGD) in evaluating portal hypertension in cirrhotic patients. The study concluded that PillCam ESO is feasible, safe, accurate and preferred by cirrhotic patients undergoing screening of portal hypertension. (Abstract 314834)
PillCam ESO
• Ill
Varices • Grading • Stomach variced • Post eradication surveillance ?
• Cost effectiveness
Eisen, Endosocpy 2006, 38:31-5
•
The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study.
Eisen GM
,
Eliakim R
,
Zaman A
,
Schwartz J
,
Faigel D
,
Rondonotti E
,
Villa F
,
Weizman E
,
Yassin K
,
deFranchis R
.
Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA. [email protected]
BACKGROUND AND STUDY AIMS: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. PATIENTS AND METHODS: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings. \ • RESULTS: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy .
• CONCLUSIONS: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large scale trial is underway to validate and expand these findings .
Tumors
A team of researchers at the Centre Hospitalier Universitaire de Nancy, Toulouse, France, conducted a 389-patient study aimed at describing the clinical course and outcome of patients with tumors diagnosed by capsule endoscopy. In the study, capsule endoscopy found tumors in 11.7% of the patients who presented with obscure GI bleeding. The 38 of the 48 patients diagnosed with tumors underwent surgery, and 87% of the surgical patients were alive after one year. This study concluded that the prevalence of intestinal tumors is higher than previously reported in patients with obscure GI bleeding and that surgical or endoscopic removal of the tumor improves patient outcome. (Abstract 367091)
Tumors (2)
Researchers at the Malmö University Hospital, Lund University, Sweden, conducted a 667 patient study to determine the value of capsule endoscopy in diagnosing small bowel tumors. The study found that capsule endoscopy identified tumors in 7.7% of patients with obscure GI bleeding. Overall, the tumor incidence rate was 2.7%. This study concluded that the tumor incidence rate in the small bowel is higher than previously thought. The study also suggests the importance of including capsule endoscopy in the work-up of patients with obscure GI bleeding. (Abstract 366764)