Neil B. Marya

Computerized 3-dimensional localization of a video capsule in the abdominal cavity: validation by digital radiography

BACKGROUND Wireless video capsule endoscopy allows the noninvasive visualization of the small intestine. Currently, capsules do not provide localization information while traversing the GI tract. OBJECTIVE To report on the radiological validation of 3-dimensional localization software incorporated in a newly developed capsule. By using radiofrequency transmission, the software measures the strength of the capsules signal to locate the position of the capsule. SETTING This study was performed at the University of Massachusetts Medical Center, Worcester, Mass. PATIENTS Thirty healthy volunteers consented to the experimental procedure. DESIGN After ingestion of the capsule, subjects had 5 sets of anteroposterior and lateral radiographs taken every 30 minutes while the software calculated the position of the capsule. By using the radiographs, we calculated the location of the capsule in the abdominal cavity and compared the results with those generated by the software. RESULTS Average error (and standard deviation) among the 3-dimensional coordinates was X, 2.00 cm (1.64); Y, 2.64 cm (2.39); and Z, 2.51 cm (1.83). The average total spatial error among all measurements was 13.26 cm(3) (22.72). There was a correlation between increased subject body mass index and the 3-dimensional software measurement error. LIMITATIONS This study was performed in healthy volunteers and needs further validation in patients with small intestinal disorders. CONCLUSIONS The new 3-dimensional software provides localization of the capsule consistent with radiological observations. However, further validation of the softwares clinical utility is required with a prospective clinical trial.

Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding

The diagnosis and management of obscure gastrointestinal bleeding (OGIB) have changed dramatically since the introduction of video capsule endoscopy (VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB.

Small Intestinal Angioectasia: Characterization, Risk Factors, and Rebleeding.

Background: Gastrointestinal angioectasias (AEs) represent the most common vascular malformation within the gastrointestinal tract. This study sought to characterize epidemiologic/comorbid risk factors for AEs, rebleeding, and patterns of anatomic distribution within the small intestine. Study: This retrospective observational cohort study included 158 patients with AEs on capsule endoscopy (CE) from 2007 to 2015. Epidemiologic/comorbid data were collected and incorporated into final analysis. Each AE was categorized by location using a small bowel transit time-based quartile system. Rebleeding was evaluated following CE. Multivariate logistic regression was applied to statistically significant factors on univariate analysis to determine independent risk factors for rebleeding. Results: Most lesions were found in the first quartile (67.1%). Rebleeding occurred in 46 (29.7%) of the 156 patients for whom data were available. Rates of rebleeding were significantly higher among older patients (74.4 vs. 67.7 y, P=0.001), those with active bleeding on CE (41.3% vs. 16.5%, P=0.001), those with a history of aortic stenosis (21.7% vs. 9.2%, P=0.033), and those with AEs presents in quartile 3 (26.1% vs. 8.3%, P=0.003). Age, active bleeding on CE, and AE presence in quartile 3 were independently associated with rebleeding in multivariate analysis (P=0.009, 0.023, and 0.008, respectively). Conclusions: These data help improve our knowledge of AEs regarding risk factors for rebleeding, and utilizes a novel small bowel transit time-based quartile localization method that may simplify future research and comparisons of anatomic distribution and behavior of small bowel AEs.

Clostridium difficile in Inflammatory Bowel Disease: A Retrospective Study

Aim To investigate the epidemiology and risk factors of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD). Methods This is a retrospective study of patients diagnosed with IBD. 1006 charts were screened and 654 patients met the inclusion criteria. Patients were divided into 2 cohorts based on the presence of prior diagnosis of CDI. Statistical analysis with Pearsons chi-squared and two-sample t-test was performed. Results The incidence of CDI among IBD patients was 6.7%. There was equal prevalence of CDI among Crohns disease (CD) (n = 21, 49%) and ulcerative colitis (UC) (n = 22, 51%). IBD patients acquired CDI at a mean age of 42.7 years, with 56% of infections acquired in the community and only 28% associated with healthcare. Only 30% of IBD patients with CDI had prior antibiotic use, and 16% had prior steroid use. IBD patients were significantly more likely to require biologic therapy (57% versus 37%, p < 0.01) and have extraintestinal manifestations of IBD (43% versus 28%, p < 0.02). Conclusions IBD patients are more susceptible to CDI at a younger age and often lack traditional risk factors. IBD patients with at least one CDI were more likely to require biologic therapy and had greater rates of extraintestinal manifestations.

Sa1216 Management Differences Between Early and Late-Onset Inflammatory Bowel Disease

Background: As our population has aged more patients are being diagnosed with inflammatory bowel disease (IBD) at a later age. Despite the limited literature on the subject, clinical observation suggests that patients with late-onset IBD (LOIBD) have a different severity of disease compared to younger patients and, therefore, may have different management requirements. The primary objective of this study was to perform a retrospective analysis of the disease severity and therapy requirements of patients with a LOIBD as compared to those diagnosed at an earlier age. Methods: Patients were selected at random from a list of those billed for diagnosis codes attributed to inflammatory bowel disease. Of our initial list of 350 patients, we excluded 88 patients who were inappropriately coded as having IBD leaving us with a final list of 262 patients. We separated our list into three cohorts: those diagnosed with IBD before the age of 45, but who are currently younger than 45 (Group 1); those diagnosed with IBD before the age of 45, but who are currently older than 45