Background Capsule endoscopy (CE) has been widely used in clinical practice. Objective To provide systematically pooled results on the indications and detection, completion, and retention rates of ...small-bowel CE. Design A systematic review. Main Outcome Measurements We searched the PubMed database (2000-2008) for original articles relevant to small-bowel CE for the evaluation of patients with small-bowel signs and symptoms. Data on the total number of capsule procedures, the distribution of different indications for the procedures, the percentages of procedures with positive detection (detection rate), complete examination (completion rate), or capsule retention (retention rate) were extracted and/or calculated, respectively. In addition, the detection, completion, and retention rates were also extracted and/or calculated in relation to indications such as obscure GI bleeding (OGIB), definite or suspected Crohn's disease (CD), and neoplastic lesions. Results A total of 227 English-language original articles involving 22,840 procedures were included. OGIB was the most common indication (66.0%), followed by the indication of only clinical symptoms reported (10.6%), and definite or suspected CD (10.4%). The pooled detection rates were 59.4%; 60.5%, 55.3%, and 55.9%, respectively, for overall, OGIB, CD, and neoplastic lesions. Angiodysplasia was the most common reason (50.0%) for OGIB. The pooled completion rate was 83.5%, with the rates being 83.6%, 85.4%, and 84.2%, respectively, for the 3 indications. The pooled retention rates were 1.4%, 1.2%, 2.6%, and 2.1%, respectively, for overall and the 3 indications. Limitations Inclusion and exclusion criteria were loosely defined. Conclusions The pooled detection, completion, and retention rates are acceptable for total procedures. OGIB is the most common indication for small-bowel CE, with a high detection rate and low retention rate. In addition, angiodysplasia is the most common finding in patients with OGIB. A relatively high retention rate is associated with definite or suspected CD and neoplasms.
Background EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, ...little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. Objective To systematically review the morbidity and mortality associated with EUS-FNA. Design MEDLINE and EMBASE were searched to identify relevant English-language articles. Main Outcome Measurements EUS-FNA-specific morbidity and mortality rates. Results We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions ( P = .000), whereas it was 2.33% versus 5.07% for pancreatic cysts ( P = .036). Limitations Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA. Conclusions EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity.
Background Double-balloon endoscopy (DBE) has been used in clinical practice for nearly 10 years. Objective To systematically collect and produce pooled data on indications, detection rate, total ...enteroscopy, complications, and the composition of positive findings in diagnostic DBE. Design A systematic review. Main Outcome Measurements We searched PubMed between January 1, 2001 and March 31, 2010 for original articles about DBE evaluation of small-bowel diseases. Data on total number of procedures, distribution of indications, pooled detection rate, pooled total enteroscopy rate, and composition of positive findings were extracted and/or calculated. In addition, the data involving DBE-associated complications were analyzed. Results A total of 66 English-language original articles involving 12,823 procedures were included. Suspected mid-GI bleeding (MGIB) was the most common indication (62.5%), followed by symptoms/signs only (7.9%), small-bowel obstruction (5.8%), and Crohn's disease (5.8%). The pooled detection rates were 68.1%, 68.0%, 53.6%, 63.4%, and 85.8% for overall, suspected MGIB, symptoms/signs only, Crohn's disease, and small-bowel obstruction, respectively. Inflammatory lesions (37.6%) and vascular lesions (65.9%) were the most common findings, respectively, in suspected MGIB patients of Eastern and Western countries. The pooled total enteroscopy rate was 44.0% by combined or antegrade-only approach. The pooled minor and major complication rates were 9.1% and 0.72%, respectively. Limitations Inclusion and exclusion criteria were loosely defined. Conclusion The detectability and complication risk of diagnostic DBE are acceptable. Suspected MGIB is the most common indication, with a relatively high detection rate, but there was a difference in its causes between Western and Eastern countries.
Background and Aims Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a ...protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort. Methods In this observational cohort study, medical records of patients with CP (CP group) and biliary diseases (BD group) in a tertiary hospital from January 2011 to May 2015 were examined. The difference in the incidence of PEP between CP group and BD group and the risk of PEP at different clinical stages of CP were calculated by the χ2 test or the Fisher exact test. The predictive and protective factors for PEP were investigated by univariate and multivariate analysis. Results In total, 2028 ERCP procedures were performed in 1301 patients with CP and 2000 procedures in 1655 patients with BD. The overall incidence of PEP in CP group (4.5%) was similar to that in the BD group (4.8%; P = .747). However, CP patients had significantly lower rates of moderate and severe attacks (0% vs 1.3%, P < .01). According to the M-ANNHEIM classification, the PEP incidences of CP at stages 0, I, II, III, and IV were 4.4%, 5.1%, 3.8%, 2.0%, and 2.0%, respectively. CP patients at stage Ia had the highest PEP incidence (8.0%) among all CP patients, significantly higher than that at stages Ib + Ic (3.9%) and II (3.8%). Female gender, history of acute pancreatitis, and prior PEP were independent risk factors of PEP, whereas extracorporeal shock wave lithotripsy was a protective factor. Conclusions Compared with BD patients, CP patients had similar incidence of PEP overall but lower grades of severity. The incidence of PEP in CP patients decreased significantly with disease progression. (Clinical trial registration number: NCT02781987.)
Background and Aims We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts ...(PPCs) in chronic pancreatitis (CP). Methods This is a prospective study performed in CP patients with at least 1 stone (≥5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression. Results A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life ( P < .001), physical health ( P < .001), and weight loss ( P < .001) improved. Conclusions In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.
ERCP service in China: results from a national survey Liao, Zhuan, MD; Hu, Liang-Hao, MD; Xin, Lei, MD ...
Gastrointestinal endoscopy,
2013, January 2013, 2013-Jan, 2013-01-00, 20130101, Letnik:
77, Številka:
1
Journal Article
Recenzirano
Background ERCP had been performed throughout China for decades. Objective To determine the status of ERCP service in China. Design A national survey. Setting All of the hospitals performing ERCP in ...mainland China in 2006. Patients All of the patients undergoing ERCP in mainland China in 2006. Main Outcome Measurements The questionnaire included the (1) type of hospitals involved; (2) ownership of the endoscopy unit; (3) ERCP infrastructure; (4) volume, indication, setting, and anesthesia methods; and (5) training and research. The correlation between economic development and ERCP status in different regions was investigated, and the ERCP rates in China and developed countries were compared. Results Completed questionnaires were returned by 449 (95.5%) of the 470 hospitals providing ERCP service. Among the 449 hospitals, 186 (41.4%) did not have separate ERCP suites, 379 (84.4%) shared fluoroscopy with their radiology departments, and the average number of duodenoscopes was 1.58. A total of 63,787 ERCP procedures were performed in mainland China in 2006, with an estimated annual ERCP rate of 4.87 per 100,000 inhabitants, much lower than that of developed countries. Ninety-six percent of patients were admitted to undergo ERCP, and 94.4% of hospitals used pharyngeal local anesthesia and conscious sedation, whereas 5.6% used general anesthesia. There was a significant correlation between the ERCP rate and gross domestic product per capita ( r = 0.871, P < .001). Limitations The survey was retrospective and descriptive. Conclusions There is an enormous gap in ERCP service between China and developed countries. The imbalance of ERCP status between different regions is significant, which correlates with economic development. Great effort is needed to develop the technique nationwide.
Background A capsule endoscope failed to reach the cecum in approximately 20% of cases, with delayed gastric emptying being the most common cause. We hypothesized that reduction of the capture rate ...in the stomach saves the battery life and thus allows the capsule endoscope to reach the cecum. Objective The aim of this study was to determine whether reduction of the capture rate of a capsule endoscope in the stomach increases the complete examination rate (CER). Setting An endoscopy center in a teaching hospital in Shanghai. Design A prospective randomized controlled trial. Patients A total of 50 patients were prospectively randomized into 2 groups: modified capture rate (MCR) group (n = 25) and the control group (n = 25). Interventions The OMOM capsule endoscopy system, which has the functions of viewing images in real time and modifying the capture rate during the examination, was used. In patients in the MCR group, the capture rate of the capsule endoscope was initially set at 0.5 frames per second (fps) and then was modified to 2 fps once the capsule endoscope passed the pylorus; whereas, in patients in the control group, the capture rate of the capsule endoscope was set and kept at 2 fps during the entire recording. Main Outcome Measurements The primary outcome was CER, and the secondary outcome was the total work time of the capsule. Results There was no significant difference in sex distribution, mean age, the number of hospitalized patients, and indications between the 2 groups. The CER was significantly higher in the MCR group than in the control group (100% vs 72%, respectively; P = .014). The mean (SD) total work time was much longer in the MCR group than in the control group (650 145 minutes vs 439 69 minutes, P < .001). There were no significant differences in gastric transit time, colon imaging time, and the diagnostic yield between the 2 groups. Limitations The sample size was small, although statistical significance of the primary outcome was achieved. However, this could have limited representativeness. Conclusions Reduction of the capture rate of the OMOM capsule endoscope in the stomach increased the complete small-bowel examination rate, although the diagnostic yield was not increased in our patient setting.
Background Previous studies suggest that string capsule endoscopy is feasible, safe, accurate, highly acceptable, and likely to be proven as a more cost-effective technique than conventional EGD. ...However, this technique needs proper high-level disinfection, and the string attachment is not easy to perform. We developed a modified esophageal capsule endoscopy, called sleeve string capsule endoscopy (SSCE). Objective To assess the feasibility and safety of SSCE in the evaluation of esophageal diseases. Design A pilot study. Setting Outpatient setting in a tertiary hospital, Shanghai, China. Patients Two healthy volunteers and 8 patients with suspected esophageal diseases were enrolled. Interventions The OMOM capsule endoscope was enclosed in a small, transparent, thin, latex sleeve, with a string attached to the caudal end. Both the sleeve and the string were for single use and were discarded after completion of the procedure. Two healthy volunteers without previous EGD and 8 patients who had undergone EGD swallowed the capsules. Pictures of the esophagus were viewed in real time. Main Outcome Measurements Discomfort associated with the procedure, quality, and diagnostic value of the pictures were documented. In addition, patient preference between SSCE and conventional EGD was recorded. Results SSCE was successfully carried out in the 10 subjects. The procedures were easy and safe to perform. No sleeves and strings were disrupted or broken, and no capsule was lost. The mean overall discomfort score during SSCE in the 8 patients was 2.88 (range 2-5). Pictures generated during SSCE were generally of high quality and produced identical diagnoses to those obtained by EGD in all 8 patients. In addition, all the 8 patients preferred SSCE to EGD. Limitations This was a single-center nonrandomized study with a small sample size. Conclusions SSCE was a feasible, easy-to-operate, and safe method for the diagnosis of esophageal diseases without the need for disinfection. SSCE appears to possess the same diagnostic capacity as that of EGD.
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