Bing-Ling Zhang

OMOM capsule endoscopy in diagnosis of small bowel disease.

ObjectiveTo assess the diagnostic efficiency of OMOM capsule endoscopy (CE) in a group of patients with different indications.MethodsData from 89 consecutive patients (49 males, 40 females) with suspected small bowel disease who underwent OMOM CE (Jinshan Science and Technology Company, Chongqing, China) examination were obtained by retrospective review. The patients’ indications of the disease consisted of the following: obscure gastrointestinal bleeding (OGIB), abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers.ResultsCE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for patients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea (85.7% vs 53.3%, P<0.005). Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases.ConclusionOMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB (small bowel) CE (Given Imaging, Yoqneam, Israel).

Diagnosis of obscure gastrointestinal hemorrhage with capsule endoscopy in combination with multiple-detector computed tomography

Aim:  To demonstrate the clinical efficacy of combination capsule endoscopy (CE) and multiple‐detector computed tomography (MDCT) diagnostic imaging in the identification of gastrointestinal hemorrhages.

Is adult celiac disease really uncommon in Chinese

Celiac disease (CD) is a type of intestinal malabsorption syndrome, in which the patients are intolerant to the gliadin in dietary gluten, resulting in chronic diarrhea and secondary malnutrition. The disease is common in Europe and the United States, but only sporadic reports are found in East Asia including China. Is CD really rare in China? We examined 62 patients by capsule endoscopy for chronic diarrhea from June 2003 to March 2008. Four patients with chronic diarrhea and weight loss were diagnosed to have CD. Under the capsule endoscopy, we observed that the villi of the proximal small bowel became short, and that the mucous membrane became atrophied in these four patients. Duodenal biopsies were performed during gastroscopy and the pathological changes of mucosa were confirmed to be Marsh 3 stage of CD. A gluten free diet significantly improved the conditions of the four patients. We suspect that in China, especially in the northern area where wheat is the main food, CD might not be uncommon, and its under-diagnosis could be caused by its clinical manifestations that could be easily covered by the symptoms from other clinical situations, particularly when it came to subclinical patients without obvious symptom or to patients with extraintestinal symptoms as the initial manifestations.

Effect of small bowel preparation with simethicone on capsule endoscopy

BackgroundCapsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators.MethodsSixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded.ResultsSimethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003).ConclusionBowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

Patients with nonalcoholic fatty liver disease display increased serum resistin levels and decreased adiponectin levels.

Aim Resistin and adiponectin are recently discovered protein hormones, which are produced and secreted by adipocytes. Nonalcoholic fatty liver disease (NAFLD) is a metabolic syndrome, which is associated with obesity. The aim of this study was to evaluate the changes of serum adiponectin and resistin in patients with NAFLD and to determine the relationship between serum adipokine levels and clinicopathologic parameters of NAFLD. Methods Forty-three patients with NAFLD and 43 controls were enrolled in this pair-matched study. Body weight, height, body mass index, abdominal wall fat thickness, waist circumference, hip circumference, and the percentage of body fat were measured. Additionally, serum lipid, glucose, alanine aminotransferase, aspartate aminotransferase, adiponectin, and resistin were determined in all individuals. Serum adiponectin and resistin levels were determined using ELISA kits. Results Serum adiponectin levels were significantly lower in patients with NAFLD compared to the control group (control: 2.01±1.10 mg/l vs. NAFLD: 1.38±0.65 mg/l, P<0.01). Serum resistin levels were significantly elevated in patients with NAFLD compared to the control group (control: 4.70±3.30 ng/ml vs. NAFLD: 9.20±7.20 ng/ml, P<0.05). Serum adiponectin concentration was negatively correlated with the waist circumference (ρ=−0.425), body mass index (ρ=−0.329), percentage of body fat (ρ=−0.256), abdominal wall fat thickness (ρ=−0.226), and fasting blood glucose concentration (ρ=−0.242), but was positively correlated with HDL (ρ=0.226). Serum resistin concentration was positively correlated with waist circumference (ρ=0.237). No correlation was found between resistin levels and blood pressure, fasting blood glucose concentration, triglyceride, total cholesterol, and HDL. Conclusion NAFLD patients had lower adiponectin levels and higher resistin levels. A positive correlation was found between resistin and waist circumference, whereas a negative correlation was found between adiponectin and waist circumference, body mass index, percentage of body fat, abdominal wall fat thickness, and fasting blood glucose concentration. These data suggested that hypoadiponectinemia and hyperresistinemia might be involved in the development of NAFLD.

The value of endoscopic ultrasonography on diagnosis and treatment of esophageal hamartoma

ObjectiveTo examine the values of endoscopic ultrasonography (EUS) on diagnosis and treatment of esophageal hamartoma.MethodsWe compared and analyzed various kinds of imaging examinations such as barium esophagram, contrast-enhanced computed tomography (CT) and conventional gastroscopy in retrospectively reviewing the clinical data of an esophageal hamartoma patient seen in our clinic in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Having received various imaging examinations, this patient was finally diagnosed with esophageal hamartoma and underwent gastroscopic resection of hamartoma with the diagnostic information obtained from EUS. The patient had been regularly followed up for 13 months after treatment.ResultsBarium esophagram, CT and conventional gastroscopy detected the lesion, but were unable to distinguish it from common esophagopolypus and other submucosal lesions, and unable to determine etiopathogenisis. EUS detected the hamartoma and identified its internal structure, echo, exact size, depth of invasion, origin and the relationship between adjacent tissues and organs, differentiating the lesion from other submucosal tumors and clearly defining the diagnosis. EUS-guided fine needle aspiration (FNA) also helped to identify the etiological diagnosis.ConclusionEUS was superior to other imaging means in diagnosis and treatment of hamartoma.