Li-Rung Shyung

Proposed Scoring System to Determine Small Bowel Mass Lesions Using Capsule Endoscopy

BACKGROUND/PURPOSE Capsule endoscopy is a highly sensitive method for the detection of small bowel lesions. False-positive findings are important confounding factors. This study reports on a scoring system for evaluating the role of capsule endoscopy in small bowel tumors. METHODS Ten men and two women (age, 23-79 years) with suspected small bowel tumors were included from 120 patients referred for capsule endoscopy between March 2004 and March 2008. The indications were gastrointestinal bleeding (n = 9), melanoma workup (n = 1), physical checkup (n = 1), and iron deficiency anemia (n = 1). The proposed tumor score was composed of five components: bleeding, mucosal disruption, an irregular surface, color, and white villi. These can be scored for probability of mass lesions seen at capsule endoscopy. Small bowel mass lesions were probably present in those with a score of >or= 4, and a score of <or= 2 indicated a low probability of a small bowel mass lesion. RESULTS Capsule endoscopy showed probable small bowel mass lesions in six patients, and a low lesion probability in the other six. Capsule endoscopy showed that new lesions were not detected by esophagogastroduodenoscopy or colonoscopy. All six patients with probable small bowel tumors were found to have pathological findings upon capsule endoscopy: two with lymphangioma, and one each with ileal ectopic pancreas, with melanoma metastasis, gastrointestinal lymphoma, and gastrointestinal stromal tumor. CONCLUSION Capsule endoscopy may detect small bowel tumors more reliably by using the scoring system outlined. It should be considered in suspected cases of small bowel tumor.

Capsule endoscopy in elderly patients with obscure gastrointestinal bleeding: retrospective analysis of 152 cases.

SUMMARY Background: Capsule endoscopy (CE) is a highly sensitive examination for the detection of small bowel lesions. However, there are few clinical studies on obscure gastrointestinal bleeding (OGIB) among elderly patients. This study reports the risk factors of angiodysplasia with CE in the elderly. Methods: To ascertain the predictive clinical associations for angiodysplastic lesions as a cause of OGIB in the elderly, we retrospectively analyzed CE results in consecutive cases over a period of 4 years and 9 months (March 2004 to November 2008). Data were collected regarding patient demographics and potential risk factors. Risk factors were analyzed by the χ 2 test and binary logistic regression analyses. Results: From March 2004 to November 2008, a total of 121 consecutive patients (71 male and 50 female; mean age and standard deviation, 57.9 ± 17.9 years) were referred to our department for CE evaluation of OGIB. All cases had undergone standard investigation with negative results within the 3 months prior to CE. Angiodysplastic lesions of the small bowel, the most common cause of OGIB in the elderly, were found in 52% of cases. Clinical associations with angiodysplastic lesions as a cause of OGIB were examined. One risk factor was increased age (≥ 65 years) (odds ratio, 2.76; 95% confidence interval, 1.20–6.35; p = 0.02). Conclusion: The use of CE in the elderly is a simple and safe diagnostic tool in the evaluation of OGIB. CE affords great precision while avoiding radiation, and should thus be the preferred method of investigation in

The Association between Intestinal Transit Time and Uncertain Significance of Diagnostic Yields in Capsule Endoscopy

Background: Capsule endoscopy is a highly sensitive examination for the detection of small bowel lesions. However, lesions can be missed due to rapid or delayed small bowel transit. The objective of this study was to determine whether the diagnostic yields vary according to intestinal transit times. Methods: In patients with complete small intestinal mucosa evaluation were assessed after negative upper and lower endoscopy, positive findings could be established in twenty-six of 49 cases (53.1%), which included angiodysplasias, active bleeding, ulcers and tumors. The mean intestinal transit time for all patients was 258.3±67.2 minutes. The patients were divided into two groups: faster than mean intestinal transit time (Group Ⅰ) and slower than mean intestinal transit time (Group Ⅱ). The intestinal transit time was analyzed by computerized software SPSS, comparisons between both groups were carried out using x^2 test. Results: The intestinal transit time were 199.6±37.4 minutes in group I and 310.2±38.2 minutes in group Ⅱ. Diagnostic yields were 47.8% in group Ⅰ and 57.7% in group Ⅱ (p=0.69). Conclusion: The diagnostic yields of capsule endoscopy did not significantly increase for group Ⅱ than group Ⅰ. However, the higher diagnostic yield is obtained in patients with slower intestinal transit time.

Diffuse Large B-Cell Lymphoma with Extensive Gastrointestinal Tract Involvement: Report of a Case

Capsule endoscopy is a new technology developed to investigate diseases of small intestine. It has been shown to be superior to current modalities such as small bowel radiology and enteroscopy. A 77-year-old man presented with occult gastrointestinal bleeding was found to have extensive small bowel mucosal lesion by capsule endoscopy. However his earlier serial examinations, i.e. gastroduodenoscopy, colonoscopy, and small bowel series, computed tomography and angiography, failed to disclose the bleeding source. The final diagnosis of diffuse large B cell lymphoma was established by histology & immunohistochemical studies of biopsy specimen from push enteroscopy Patient was treated with systemic chemotherapy and currently remains in complete remission. Our experience suggests capsule endoscopy is a valuable, complementary tool in the detection and evaluation of small bowel lymphoma.