In 2000, the small bowel capsule revolutionized the management of patients with small bowel disorders. Currently, the technological development achieved by the new models of double-headed endoscopic ...capsules, as miniaturized devices to evaluate the small bowel and colon pan-intestinal capsule endoscopy (PCE), makes this non-invasive procedure a disruptive concept for the management of patients with digestive disorders. This technology is expected to identify which patients will require conventional invasive endoscopic procedures (colonoscopy or balloon-assisted enteroscopy), based on the lesions detected by the capsule,
those with an indication for biopsies or endoscopic treatment. The use of PCE in patients with inflammatory bowel diseases, namely Crohn's disease, as well as in patients with iron deficiency anaemia and/or overt gastrointestinal (GI) bleeding, after a non-diagnostic upper endoscopy (esophagogastroduodenoscopy), enables an effective, safe and comfortable way to identify patients with relevant lesions, who should undergo subsequent invasive endoscopic procedures. The recent development of magnetically controlled capsule endoscopy to evaluate the upper GI tract, is a further step towards the possibility of an entirely non-invasive assessment of all the segments of the digestive tract, from mouth-to-anus, meeting the expectations of the early developers of capsule endoscopy.
Anemia is considered a public health issue and is often caused by iron deficiency. Iron-deficiency anemia (IDA) often originates from blood loss from lesions in the gastrointestinal tract in men and ...postmenopausal women, and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%. However, few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been published.
To review current evidence and guidelines concerning IDA management in gastrointestinal bleeding patients to develop recommendations for its diagnosis and therapy.
Five gastroenterology experts formed the Digestive Bleeding and Anemia Workgroup and conducted a systematic literature search in PubMed and professional association websites. MEDLINE (
PubMed) searches combined medical subject headings (MeSH) terms and the keywords "gastrointestinal bleeding" with "iron-deficiency anemia" and "diagnosis" or "treatment" or "management" or "prognosis" or "prevalence" or "safety" or "iron" or "transfusion" or "quality of life", or other terms to identify relevant articles reporting the management of IDA in patients over the age of 18 years with gastrointestinal bleeding; retrieved studies were published in English between January 2003 and April 2019. Worldwide professional association websites were searched for clinical practice guidelines. Reference lists from guidelines were reviewed to identify additional relevant articles. The recommendations were developed by consensus during two meetings and were supported by the published literature identified during the systematic search.
From 494 Literature citations found during the initial literature search, 17 original articles, one meta-analysis, and 13 clinical practice guidelines were analyzed. Based on the published evidence and clinical experience, the workgroup developed the following ten recommendations for the management of IDA in patients with gastrointestinal bleeding: (1) Evaluation of hemoglobin and iron status; (2) Laboratory testing; (3) Target treatment population identification; (4) Indications for erythrocyte transfusion; (5) Treatment targets for erythrocyte transfusion; (6) Indications for intravenous iron; (7) Dosages; (8) Monitoring; (9) Indications for intravenous ferric carboxymaltose treatment; and (10) Treatment targets and monitoring of patients. The workgroup also proposed a summary algorithm for the diagnosis and treatment of IDA in patients with acute or chronic gastrointestinal bleeding, which should be implemented during the hospital stay and follow-up visits after patient discharge.
These recommendations may serve as a starting point for clinicians to better diagnose and treat IDA in patients with gastrointestinal bleeding, which ultimately may improve health outcomes in these patients.
OBJECTIVEThe Albumin–Bilirubin (ALBI) score was developed recently to assess the severity of liver dysfunction. We aimed to assess its prognostic performance in patients with liver cirrhosis ...complicated with upper gastrointestinal bleeding (UGIB) while comparing it with Child–Pugh (CP) and Model for End-stage Liver Disease (MELD) scores.
PATIENTS AND METHODSThis was a retrospective unicentric study, including consecutive adult patients with cirrhosis admitted for UGIB between January 2011 and November 2015. Clinical, analytical, and endoscopic variables were assessed and ALBI, CP, and MELD scores at admission were calculated.
RESULTSThis study included 111 patients. During the first 30 days of follow-up, 12 (10.8%) patients died, and during the first year of follow-up, another 10 patients died (first-year mortality of 19.8%).On comparing the three scores, for in-stay and 30-day mortality, only the ALBI score showed statistically significant results, with an area under the curve (AUC) of 0.80 (P<0.01) for both outcomes. For first-year mortality, AUC for ALBI, CP, and MELD scores were 0.71 (P<0.01), 0.64 (P<0.05), and 0.66 (P=0.02), respectively, whereas for global mortality, AUC were 0.75 (P<0.01), 0.72 (P<0.01), and 0.72 (P<0.01), respectively. On comparing the AUC of the three scores, no significant differences were found in first-year mortality and global mortality.
CONCLUSIONIn our series, the ALBI score accurately predicted both in-stay and 30-day mortality, whereas CP and MELD scores could not predict these outcomes. All scores showed a fair prognostic prediction performance for first-year and global mortality. These results suggest that the ALBI score is particularly useful in the assessment of short-term outcomes, with a better performance than the most commonly used scores.
Background
The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE).
Aims
To evaluate the ...efficacy of bowel preparation protocols regarding ACR and CR.
Methods
We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and “booster”. The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models.
Results
Twenty-six observational studies and five RCTs included (
n
= 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8–77.5%;
I
2
= 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7–87.7%;
I
2
= 96.5%). The highest ACR were obtained using a low-fibre diet 78.5% (95% C.I. 72.0–85.6%);
I
2
= 57.0%, adjunctive laxatives 74.7% (95% C.I. 69.8–80.1%);
I
2
= 85.3%, and split dose < 4L polyethylene glycol (PEG) as purgative 77.5% (95% C.I. 68.4–87.8%);
I
2
= 47.3%. The highest CR were observed using routine prokinetics prior to capsule ingestion 84.4% (95% C.I. 79.9–89.2%);
I
2
= 89.8%, and sodium phosphate (NaP) as “booster” 86.2% (95% C.I. 82.3–90.2%);
I
2
= 86.8%. In univariable models, adjunctive laxatives were associated with higher ACR OR 1.81 (95% C.I. 1.13; 2.90);
p
= 0.014. CR was higher with routine prokinetics OR 1.86 (95% C.I. 1.13; 3.05);
p
= 0.015 and split-dose PEG purgative OR 2.03 (95% C.I. 1.01; 4.09),
p
= 0.048.
Conclusions
Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as
booster
.
Since its emergence in 2000, small bowel capsule endoscopy(SBCE) has assumed a pivotal role as an investigation method for small bowel diseases. The PillCam~ SB2-ex offers 12 h of battery time, 4 ...more than the previous version(SB2). Rahman et al recently found that the PillCam~ SB2-ex has a significantly increased completion rate, although without higher diagnostic yield, compared with the SB2. We would like to discuss these somewhat surprising results and the new potentialities of the PillCam~ SB3 regarding the diagnostic yield of small bowel studies. PillCam~ SB3 offers improved image resolution and faster adaptable frame rate over previous versions of SBCE. We recently compared the major duodenal papilla detection rate obtained with PillCam~ SB3 and SB2 as a surrogate indicator of diagnostic yield in the proximal small bowel. The PillCam~ SB3 had a significantly higher major duodenal papilla detection rate than the PillCam~ SB2(42.7% vs 24%, P = 0.015). Thus, the most recent version of the PillCam~ capsule, SB3, may increase diagnostic yield, particularly in the proximal segments of the small bowel.
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