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Reena Sidhu - One of the best experts on this subject based on the ideXlab platform.
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Push enteroscopy in the era of Capsule Endoscopy.
Journal of Clinical Gastroenterology, 2008Co-Authors: Reena Sidhu, Mark E. Mcalindon, Kapil Kapur, David P. Hurlstone, Maria C. Wheeldon, David SandersAbstract:Goals: To evaluate the diagnostic yield of push enteroscopy in relation to indication and compare the yield in patients who had Capsule Endoscopy followed by push enteroscopy against Capsule Endoscopy naive patients. Background: With the advent of Capsule Endoscopy the role of push enteroscopy needs to be reevaluated. Study: Patients who underwent push enteroscopy from January 2002 to May 2006 were included. Results: One hundred fifty-five patients underwent push enteroscopy: 93 females, average age 55 years. There were 74 cases where both push enteroscopy (PE) and Capsule Endoscopy (CE) were performed. Indications for PE were iron deficiency anemia (n = 51), overt bleeding (n = 31), suspected celiac disease (n = 32), refractory celiac disease (n = 19), assessment for Crohn's disease (n = 10), and miscellaneous (n = 12). In 148 patients, an average length of 70 cm of small bowel was examined (range 30 to 130cm). PE was unsuccessful in 7 patients due to anatomic strictures or patient distress. The overall diagnostic yield was 30% with the highest yield in overt bleeding when compared with other subgroups (P < 0.001). Nine percent of lesions were within the reach of a standard endoscope. Comparison of the diagnostic yield in patients who had CE followed by PE against CE naive patients was 41% versus 47%, respectively (P< 1). There were no cases where push enteroscopy recognized a lesion that had not been already detected by Capsule Endoscopy. Conclusions: Push enteroscopy has the greatest diagnostic yield in patients with overt bleeding when compared with other referral indications. PE should be used as an adjuvant to CE for therapeutic intervention.
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guidelines on small bowel enteroscopy and Capsule Endoscopy in adults
Gut, 2007Co-Authors: Reena Sidhu, David S. Sanders, A J Morris, M E McalindonAbstract:1.0 Introduction 2.0 Formulation of guidelines 2.1 Grading of recommendations 2.2 Scheduled review 3.0 Summary of recommendations 4.0 Types of small bowel enteroscopy 4.1 Enteroscopy using a colonoscope 4.2 Sonde enteroscopy 4.3 Push enteroscopy 4.4 Intraoperative enteroscopy 4.5 Double balloon (push and pull) enteroscopy 5.0 Capsule Endoscopy 5.1. Technique 5.2 Indications for Capsule Endoscopy 5.3 Complications of Capsule Endoscopy 5.4 Patency Capsule 6.0 Service provision and training References The small bowel has historically been a difficult area to examine due to its anatomy, location and relative tortuosity. Examination beyond the duodenojejunal flexure is of importance in a number of small bowel disorders. Before the advent of enteroscopy or Capsule Endoscopy, radiographic studies had been the main investigative modality of the small bowel. Barium follow-through and enteroclysis permits indirect examination of the small bowel but has a low diagnostic yield particularly in the context of obscure gastrointestinal bleeding.1–3 Capsule Endoscopy and enteroscopy are now the preferred methods to examine the small bowel in most situations. These guidelines are intended to provide an evidence based document describing endoscopic investigation of small bowel disorders. These guidelines were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) and have been produced by the small bowel and Endoscopy sections of the BSG. The guidelines have been produced to conform to the North of England evidence based guidelines development project.4 5 They have been drawn up from a Medline, Embase and Ovid literature search using terms “enteroscopy”, “push enteroscopy”, “intraoperative enteroscopy”, “double balloon enteroscopy” and “Capsule Endoscopy”. There have been 180 peer review studies, seven review articles, 58 case reports and letters, and one set of American guidelines on enteroscopy.6 The literature search for Capsule Endoscopy includes 100 peer review studies, 51 review articles, 74 …
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Capsule Endoscopy in the evaluation of gastrointestinal disease.
Current opinion in pediatrics, 2007Co-Authors: Reena Sidhu, Mark E. Mcalindon, David S. Sanders, Michael A ThomsonAbstract:Purpose of review The small bowel has been a technically difficult area to examine. Indirect modalities such as barium follow-through have the disadvantage of attendant radiation exposure. Capsule Endoscopy, a novel wireless method of investigation of the small bowel, has acquired an important role in both adult and paediatric medicine. Recent findings The clinical utility of Capsule Endoscopy has rapidly expanded since its approval by the Food & Drug Administration in the USA in 2001. It has developed an established role in adults, in the investigation of obscure gastrointestinal bleeding, small bowel Crohn's disease, complications of coeliac disease and surveillance of polyposis syndromes. Despite a lag in its use in paediatrics, Capsule Endoscopy offers an accurate and effective means of investigating the small bowel in children. It has opened up new horizons and permitted a noninvasive approach to identifying occult lesions in the small bowel of children when conventional imaging has been unhelpful. Summary This review appraises the current literature to define the clinical indications and practical aspects of Capsule Endoscopy that are of interest to the paediatrician.
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Capsule Endoscopy: is there a role for nurses as physician extenders?
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates, 2007Co-Authors: Reena Sidhu, Kapil Kapur, David P. Hurlstone, David S. Sanders, Laura Marshall, Mark E. McalindonAbstract:Capsule Endoscopy is a novel technique for examining the small bowel; however, data interpretation is time consuming and requires expertise. This study aimed to compare the interpretation of Capsule Endoscopy between an experienced gastroenterologist and a nurse. A total of 50 consecutive videos were viewed independently by a nurse and a physician, both blinded to the referral indications. The nurse had no prior experience with Capsule Endoscopy. Possible pathology was graded in a pre-agreed standardized manner, with findings described as "relevant," "uncertain," or "irrelevant." Another gastroenterologist, who had knowledge of all the cases including follow-up data and clinical outcomes, independently arbitrated. Findings showed no difference in the number of relevant or uncertain pathologies identified. The nurse reader was more likely to record irrelevant findings (4.7 vs. 2.0 lesions; p < .01) and required more time to read the videos than the physician (mean = 73 vs. 58 min; p < .01). This study shows that a nurse Capsule Endoscopy reader is as capable as an experienced physician in identifying small bowel mucosal abnormalities on Capsule Endoscopy. Capsule Endoscopy is an area in which nurses could develop as physician extenders.
Miguel Muñoz-navas - One of the best experts on this subject based on the ideXlab platform.
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Intestinal preparation prior to Capsule Endoscopy administration.
World journal of gastroenterology, 2008Co-Authors: Vicente Pons Beltrán, Iñaqui Fernandez-urien, Cristina Carretero, Begoña González-suárez, Miguel Muñoz-navasAbstract:In order to have an adequate view of the whole small intestine during Capsule Endoscopy, the preparation recommended consists of a clear liquid diet and an overnight fast. However, visualization of the small bowel during video Capsule Endoscopy can be impaired by intestinal contents. To improve mucosal visualization, some authors have evaluated different regimens of preparation. There is no consensus about the necessity of intestinal preparation for Capsule Endoscopy and it should be interesting to develop adequate guidelines to improve its efficacy and tolerability. Moreover, the effect of preparation type (purgative) on intestinal transit time is not clear. Since a bowel preparation cannot definitively improve its visibility (and theoretically the yield of the test), it is not routinely recommended.
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Esophageal Capsule Endoscopy.
World journal of gastroenterology, 2008Co-Authors: Iñaqui Fernandez-urien, Cristina Carretero, Raul Armendariz, Miguel Muñoz-navasAbstract:Capsule Endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new Capsule Endoscopy applications have been developed, such as esophageal Capsule Endoscopy and colon Capsule Endoscopy. Esophageal Capsule Endoscopy in patients with suspected esophageal disorders is feasible and safe, and could be also an alternative procedure in those patients refusing upper Endoscopy. Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients, current results are encouraging and open a new era in esophageal examination.
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Colon Capsule Endoscopy
World journal of gastroenterology, 2008Co-Authors: Iñaqui Fernandez-urien, Cristina Carretero, Ana Borda, Miguel Muñoz-navasAbstract:Wireless Capsule Endoscopy has become the first imaging tool for small bowel examination. Recently, new Capsule Endoscopy applications have been developed, such as esophageal Capsule Endoscopy and colon Capsule Endoscopy. Clinical trials results have shown that colon Capsule Endoscopy is feasible, accurate and safe in patients suffering from colonic diseases. It could be a good alternative in patients refusing conventional colonoscopy or when it is contraindicated. Upcoming studies are needed to demonstrate its utility for colon cancer screening and other indications such us ulcerative colitis. Comparative studies including both conventional and virtual colonoscopy are also required.
Dirk Hartmann - One of the best experts on this subject based on the ideXlab platform.
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Capsule Endoscopy and Crohn's disease.
Digestive diseases (Basel Switzerland), 2011Co-Authors: Dirk HartmannAbstract:Capsule Endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of Capsule Endoscopy in patients suspected of having Crohn's disease. Capsule Endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test Capsule is available to assess for small bowel strictures and thus avoid Capsule retention. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.
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Capsule Endoscopy and Crohn's disease.
Digestive Diseases, 2011Co-Authors: Dirk HartmannAbstract:Capsule Endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of Capsule Endoscopy in
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Capsule Endoscopy, technical impact, benefits and limitations
Langenbeck's Archives of Surgery, 2004Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Jürgen F. RiemannAbstract:Background The small bowel is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations. However, for a wide variety of specific lesions, the diagnostic value of other tests for imaging the small bowel is low. For the first time wireless Capsule Endoscopy has made non-invasive imaging of the entire small bowel possible. A number of peer-reviewed studies has been published that compare the method with push-enteroscopy in patients with obscure gastrointestinal bleeding and have shown superior diagnostic results. Conclusion Capsule Endoscopy has opened up new horizons for the diagnosis of small-bowel disease. All published studies show a higher diagnostic yield of Capsule Endoscopy compared with push-enteroscopy and standard radiographic investigations.
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Capsule Endoscopy versus push enteroscopy in patients with occult gastrointestinal bleeding.
Zeitschrift für Gastroenterologie, 2003Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Hahne M, Ralf Jakobs, Siegel E, Uwe Weickert, H E Adamek, Jürgen F. RiemannAbstract:Background Wireless Capsule Endoscopy is a new method enabling non-invasive diagnostic Endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of Capsule Endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. Methods Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using Capsule Endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using Capsule Endoscopy and push enteroscopy. Results On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before Capsule Endoscopy was used. Definitive bleeding sites were diagnosed by push enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule Endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push enteroscopy localised an additional bleeding source in comparison with Capsule Endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. Discussion The present study shows that Capsule Endoscopy had the highest diagnostic yield and was superior to push enteroscopy in patients with chronic gastrointestinal bleeding. By using the Capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.
Jürgen F. Riemann - One of the best experts on this subject based on the ideXlab platform.
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Capsule Endoscopy, technical impact, benefits and limitations
Langenbeck's Archives of Surgery, 2004Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Jürgen F. RiemannAbstract:Background The small bowel is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations. However, for a wide variety of specific lesions, the diagnostic value of other tests for imaging the small bowel is low. For the first time wireless Capsule Endoscopy has made non-invasive imaging of the entire small bowel possible. A number of peer-reviewed studies has been published that compare the method with push-enteroscopy in patients with obscure gastrointestinal bleeding and have shown superior diagnostic results. Conclusion Capsule Endoscopy has opened up new horizons for the diagnosis of small-bowel disease. All published studies show a higher diagnostic yield of Capsule Endoscopy compared with push-enteroscopy and standard radiographic investigations.
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Capsule Endoscopy versus push enteroscopy in patients with occult gastrointestinal bleeding.
Zeitschrift für Gastroenterologie, 2003Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Hahne M, Ralf Jakobs, Siegel E, Uwe Weickert, H E Adamek, Jürgen F. RiemannAbstract:Background Wireless Capsule Endoscopy is a new method enabling non-invasive diagnostic Endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of Capsule Endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. Methods Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using Capsule Endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using Capsule Endoscopy and push enteroscopy. Results On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before Capsule Endoscopy was used. Definitive bleeding sites were diagnosed by push enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule Endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push enteroscopy localised an additional bleeding source in comparison with Capsule Endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. Discussion The present study shows that Capsule Endoscopy had the highest diagnostic yield and was superior to push enteroscopy in patients with chronic gastrointestinal bleeding. By using the Capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.
Gregory B. Haber - One of the best experts on this subject based on the ideXlab platform.
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Capsule Endoscopy in obscure gastrointestinal bleeding.
Gastrointestinal endoscopy clinics of North America, 2004Co-Authors: Shou-jiang Tang, Gregory B. HaberAbstract:Wireless Capsule Endoscopy is being used increasingly in the investigation of obscure gastrointestinal (GI) bleeding. Capsule Endoscopy can establish a diagnosis in a high proportion of patients with obscure GI bleeding, detecting small bowel lesions but also, on occasion, detecting lesions outside the small bowel. Capsule Endoscopy seems to be useful in selecting patients with obscure GI bleeding for intra-operative enteroscopy for optimal management and outcomes. There is growing recognition that many bleeding lesions diagnosed by Capsule Endoscopy are within the reach of routine Endoscopy. Capsule Endoscopy has been proposed as a replacement for push enteroscopy in the investigation of obscure GI bleeding after negative initial Endoscopy. The authors recommend that patients with obscure GI bleeding should have a second look or "second opinion" Endoscopy.
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Diagnosis of small-bowel varices by Capsule Endoscopy
Gastrointestinal endoscopy, 2004Co-Authors: Shou-jiang Tang, Gregory B. Haber, Simon A. Zanati, Elena Dubcenco, Maria Cirocco, Dimitrios K. Christodoulou, Gabor Kandel, Paul Kortan, Norman E. MarconAbstract:Abstract Background Capsule Endoscopy is being used increasingly to investigate GI bleeding of obscure origin and disorders of the small bowel. Methods Four cases of small-bowel varices of various etiologies diagnosed by Capsule Endoscopy are described: a bleeding small-bowel varix because of hepatic portal hypertension, oozing small-bowel anastomotic or adhesion-related varices, small-bowel varices secondary to mesenteric vein thrombosis, and "idiopathic intestinal varices." Observations Over a 12-month period, small-bowel varices were found in 4 of 46 patients (8.7%) who underwent Capsule Endoscopy for GI bleeding. Fresh blood adjacent to the varices was documented in 3 patients. The small-bowel varices had serpiginous or nodular shapes, with or without a bluish coloration. The variceal mucosa appeared mosaic-like, shining, or normal compared with surrounding mucosa. Conclusions Capsule Endoscopy is invaluable for the diagnosis of small-bowel varices. It is highly sensitive for detection of fresh blood in the small bowel. Clinical suspicion, Capsule Endoscopy image recognition, and alertness during Capsule Endoscopy interpretation are keys to diagnosis.