scholarly journals Efficacy and safety of capsule endoscopy in octogenarian and elderly patients: A retrospective study

2021 ◽  
Author(s):  
Alessandro Pezzoli ◽  
Matteo Guarino ◽  
Nadia Fusetti ◽  
Elena Pizzo ◽  
Marzia Simoni ◽  
...  
Keyword(s):  
Small Bowel ◽  
Elderly Patients ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Control Group ◽  
Efficacy And Safety ◽  
Old Patients ◽  
Group A ◽  
Group B

Abstract Background Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy in patients aged over 80 years. Patients and Methods In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥ 80 years (group A) and 99 patients aged 40–60 years (control group B) were randomly selected. Results Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (p < 0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. Conclusions Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.

scholarly journals Effectiveness of Improved Use of Chewing Gum During Capsule Endoscopy in Decreasing Gastric Transit Time: A Prospective Randomized Controlled Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Liang Huang ◽  
Yue Hu ◽  
Fang Chen ◽  
Shan Liu ◽  
Bin Lu
Keyword(s):  
Small Bowel ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Controlled Study ◽  
Chewing Gum ◽  
Control Group ◽  
Completion Rates ◽  
Patients Âgés ◽  
Gastric Transit Time

Background/Aim: Chewing gum throughout small bowel capsule endoscopy (SBCE) increases completion rates (CRs) but decreases small bowel transit time (SBTT) and diagnostic yield (DY). We determined the effects of chewing gum early during SBCE on gastric transit time (GTT), SBTT, CR, DY, and gastroscopy intervention.Methods: We prospectively enrolled patients (ages 16–80 years) undergoing SBCE between January and June 2019. Patients were randomized to a chewing gum group (103 patients) and a control group (102 patients). Patients in the former group chewed one piece of gum for ~15 min every 30 min during the first hour of SBCE. Two gastroenterologists blinded to the study group examined the data.Results: GTT was shorter in the chewing gum group (19.0 min, interquartile range: 17.0–52.0 min) than in the control group [42.5 min (23.25–60 min); P = 0.01]. SBTT was similar in the two groups [318.5 min (239.5–421.3 min) vs. 287.0 min (216.0–386.0 min); P = 0.08]. Gastroscopy rate was lower in the chewing gum group (15.53 vs. 32.35%, P = 0.005). CR (95.15 vs. 89.22%, P = 0.114) and DY (66.02 vs. 59.80%, P = 0.359) did not differ between the groups. The number of abnormal-lesion types detected per patient was higher in the chewing gum group [1.0 (0.0–2.0) vs. 2.0 (0.0–2.0); P = 0.049].Conclusions: Chewing gum early during SBCE significantly reduced GTT and gastroscopy intervention, with no influence on SBTT (Trial number: NCT03815136).

scholarly journals Diagnostic yield of small bowel capsule endoscopy in obscure gastrointestinal bleeding: a real-world prospective study

2021 ◽  
Author(s):  
Samanta Romeo ◽  
Benedetto Neri ◽  
Michelangela Mossa ◽  
Maria Elena Riccioni ◽  
Ludovica Scucchi ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Prospective Study ◽  
Capsule Endoscopy ◽  
Real World ◽  
Diagnostic Yield ◽  
Obscure Gastrointestinal Bleeding ◽  
Group A ◽  
Group B ◽  
A Prospective Study

AbstractSmall bowel capsule endoscopy (SBCE) visualizes the small bowel (SB) mucosa. Gastrointestinal (GI) bleeding from SB accounts for the majority of SBCE indications. We aimed to assess, in a “real-world” prospective study, the diagnostic yield of SBCE in a cohort of consecutive patients with obscure gastrointestinal bleeding (OGIB). Secondary end point was to assess the frequency of adverse events and the role of SBCE in determining the diagnostic work-up and clinical outcome. From 2016 to 2018, all patients referred for SBCE examination were enrolled. Indication for SBCE was re-assessed by 2 dedicated gastroenterologists. Inclusion criteria: (1) age ≥ 18 and ≤ 85 years; (2) diagnosis of OGIB; 3) non-diagnostic standard bidirectional endoscopy; (4) informed consent. Exclusion criteria: (1) deglutition impairment; (2) SBCE contraindications; (3) pregnancy. The cohort included 50 patients [males 18 (36%), age 68 (27–83)]. SBCE indication: patients with ongoing overt OGIB (Group A) (n = 11; 22%), previous overt OGIB (Group B) (n = 14; 28%), occult bleeding (with Iron Deficiency Anaemia) (Group C) (n = 25; 50%). SBCE detected clinically relevant lesions in 46 (92%) cases. Clinically relevant lesions were more frequent in Group C (24/25; 96%), followed by Group A (10/11; 91%) and Group B (12/14; 85.5%). After SBCE, treatment was medical (60%); endoscopic (14%), surgical (36%) or conservative (18%). Clinical follow-up showed complete resolution in 63.2%, partial/absent resolution in 18.4% of cases. In a prospective study, the high diagnostic yield of SBCE supports its role as first-line investigation in patients with OGIB. However, this achievement requires an accurate and timely assessment by dedicated gastroenterologists.

scholarly journals Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized–controlled study

2019 ◽  
Vol 8 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Stephanie L Hansel ◽  
Joseph A Murray ◽  
Jeffrey A Alexander ◽  
David H Bruining ◽  
Mark V Larson ◽  
...  
Keyword(s):  
Small Bowel ◽  
Capsule Endoscopy ◽  
Bowel Preparation ◽  
Diagnostic Yield ◽  
Completion Rate ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background Capsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE. Methods Single-blind, prospective randomized–controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE, 5 mL simethicone and 5 mg metoclopramide 20 minutes prior to CE and laid in the right lateral position 30 minutes after swallowing CE. Controls had no solid food after 7 p.m. the night prior to CE and no liquids 4 hours prior to CE. Participants completed a satisfaction survey. Capsule readers completed a small-bowel-visualization assessment. Results Fifty patients were prospectively enrolled (56% female) with a median age of 54.4 years and 44 completed the study (23 patients in the control group and 21 in the preparation group). There was no significant difference between groups on quartile-based small-bowel visualization (all P &gt; 0.05). There was no significant difference between groups in diagnostic yield (P = 0.69), mean gastric (P = 0.10) or small-bowel transit time (P = 0.89). The small-bowel completion rate was significantly higher in the preparation group (100% vs 78%; P = 0.02). Bowel-preparation subjects reported significantly more discomfort than controls (62% vs 17%; P = 0.01). Conclusions Combined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort. The CE completion rate improved in the preparation group but the diagnostic yield was unaffected. Based on our findings, a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction (ClinicalTrials.gov, No. NCT01243736).

scholarly journals Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Alfredo Escartín ◽  
Marta González ◽  
Elena Cuello ◽  
Ana Pinillos ◽  
Pablo Muriel ◽  
...  
Keyword(s):  
Disease Management ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Old Patients ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Very Old Patients ◽  
Grade Iii ◽  
Severe Grade

Background. The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years. Methods. This was a retrospective analysis of data from a prospective single-center patient registry. Results. The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85.4 years). Although demographic and clinical characteristics of the two groups were similar, the disease management was clearly different, with older patients undergoing cholecystectomy less frequently (n=80 46.0% in Group A vs n=39 22.4% in Group B; p<0.001). The outcomes in both groups of age were similar, with 30-day mortality of 3.7%, morbidity of 17.2%, and readmissions of 4.2% and two-year AC recurrence in nonoperated patients of 22.5%. No differences were seen between operated and no operated patients. Severe (Grade III) AC was the only independent factor significantly associated with mortality (OR 86.05 (95% CI: 11–679); p<0.001). Conclusions. In elderly patients with AC, the choice of therapeutic options was not limited by the age per se, but rather by the disease severity (grade III AC) and/or poor physical status (ASA III-IV). In case of grade I-II AC, laparoscopic cholecystectomy can be safely performed and yield good results even in very old patients. Patients with grade III AC present high risk of morbidity and mortality, and the treatment should be individualized. ASA IV patients should avoid cholecystectomy, being antibiotic treatment and cholecystectomy the best option.

scholarly journals A Double-Blind, Randomized Controlled 12-Week Follow-Up Trial to Evaluate the Efficacy and Safety of Polycan in Combination with Glucosamine for the Treatment of Knee Osteoarthritis

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Thi Thanh Thuy Truong ◽  
Jong Min Lim ◽  
Hyung-Rae Cho ◽  
Young Suk Kim ◽  
Duc Giang Dao ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Rescue Medication ◽  
Secondary Outcome ◽  
Control Group ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Group A ◽  
Group B

Aim. The aim of the present study was to examine the efficacy and safety of Polycan, a β-glucan produced from the black yeast Aureobasidium pullulans SM-2001, in combination with glucosamine in reducing knee osteoarthritis-associated symptoms. Methods. This was a double-blind, randomized controlled trial of a formulated product composed of 16.7 mg of Polycan and 250 mg of glucosamine (Group A), 16.7 mg of Polycan and 500 mg of glucosamine (Group B), or 500 mg of glucosamine (control group) per capsule, administered as three capsules once per day over a period of 12 weeks, conducted with 100 osteoarthritis patients, aged 35–80 years. The primary outcome measure was osteoarthritis symptoms assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The secondary outcome measures included rescue medication use (according to data from a patient-reported diary) and other safety indices (body weight, blood pressure, hematological, and biochemistry markers). Results. Compared with the control group, Group B demonstrated a statistically significant reduction in the total WOMAC score after 12 weeks of treatment (p < 0.05). There was a significant reduction in the frequency of rescue medication used in Groups A and B compared with the control group (p < 0.05). There were no significant changes in hematology and biochemistry parameters or health indices between the active and the control group. Conclusion. Among patients with mild or moderate osteoarthritis, a daily oral dose of Polycan (50 mg) in combination with glucosamine (750 mg or 1500 mg; Group A or B, respectively) resulted in a better treatment outcome than treatment with glucosamine (1500 mg) alone.

scholarly journals Bowel Preparation for Small Bowel Capsule Endoscopy: Is There Still a Role for Polyethylene Glycol?

2020 ◽  
Vol 11 (03) ◽  
pp. 215-222
Author(s):  
Paul Collins ◽  
Neil Haslam ◽  
Anthony Morris ◽  
Thomas Skouras ◽  
Ashley Bond
Keyword(s):  
Polyethylene Glycol ◽  
Small Bowel ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Bowel Preparation ◽  
Diagnostic Yield ◽  
Statistical Significance ◽  
Deficiency Anemia ◽  
Bowel Cleansing ◽  
The Impact

Abstract Objectives This study aimed to assess the impact of polyethylene glycol (PEG) bowel cleansing on performance characteristics of small bowel capsule endoscopy (SBCE). Materials and Methods Data from consecutive patients undergoing SBCE in the period before and after the introduction of PEG 2 L bowel cleansing with PEG were collated retrospectively. The indication, diagnostic yield (DY), clinical outcome, small bowel transit time, gastric transit time, and completion rate were recorded for each procedure. Results Data from 286 patients were analyzed. PEG 2 L was not superior to 12-hour fasting for DY (66 [53%] vs. 76 [47%] patients [p = 0.348]), or DY for significant findings (findings requiring a further intervention or investigation; 29 [23%] vs. 52 [32%] patients [p = 0.090]).There was a trend toward an increased DY for significant findings in patients undergoing investigation for iron-deficiency anemia (IDA) receiving PEG 2 L that just failed to meet statistical significance (13 [31%] and 25 [21%] patients, respectively [p = 0.06]). Transit times and completion rates were unaffected by bowel cleansing. Conclusion Bowel cleansing with PEG 2 L is not superior to fasting for overall DY in SBCE. PEG 2 L may confer an advantage for the detection of significant lesions in patient with IDA. Further investigation of optimal modes of bowel preparation is indicated.

scholarly journals The Effect of Prucalopride on Small Bowel Transit Time in Hospitalized Patients Undergoing Capsule Endoscopy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Majid Alsahafi ◽  
Paula Cramer ◽  
Nazira Chatur ◽  
Fergal Donnellan
Keyword(s):  
Small Bowel ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Small Bowel Resection ◽  
Hospitalized Patients ◽  
Control Group ◽  
Technical Failure ◽  
Small Bowel Transit ◽  
Small Bowel Transit Time ◽  
Academic Center

Background. The inpatient status is a well-known risk factor for incomplete video capsule endoscopy (VCE) examinations due to prolonged transit time. We aimed to evaluate the effect of prucalopride on small bowel transit time for hospitalized patients undergoing VCE. Methods. We included all hospitalized patients who underwent VCE at a tertiary academic center from October 2011 through September 2016. A single 2 mg dose of prucalopride was given exclusively for all patients who underwent VCE between March 2014 and December 2015. VCE studies were excluded if the capsule was retained or endoscopically placed, if other prokinetic agents were given, in cases with technical failure, or if patients had prior gastric or small bowel resection. Results. 442 VCE were identified, of which 68 were performed in hospitalized patients. 54 inpatients were included, of which 29 consecutive patients received prucalopride. The prucalopride group had a significantly shorter small bowel transit time compared to the control group (92 versus 275.5, p<0.001). There was a trend for a higher completion rate in the prucalopride group (93.1% versus 76%, p=0.12). Conclusions. Our results suggest that the administration of prucalopride prior to VCE is a simple and effective intervention to decrease small bowel transit time.

Single-Dose Linaclotide Is Equal in Efficacy to Polyethylene Glycol for Bowel Preparation Prior to Capsule Endoscopy

2019 ◽  
Vol 37 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Daniel J. Stein ◽  
Andrew Copland ◽  
Deborah McDaniel ◽  
R. Ann Hays
Keyword(s):  
Single Dose ◽  
Polyethylene Glycol ◽  
Small Bowel ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Small Bowel Transit ◽  
Chi Square ◽  
Significant Difference ◽  
And Control

Background: Video capsule endoscopy provides noninvasive visualization of the small bowel, but yield is often limited by debris. At our institution, preparation with polyethylene glycol (PEG) and simethicone is used to improve visualization. Aims: We hypothesized that linaclotide and simethicone would yield equal to better results. Methods: We enrolled 29 subjects for the experimental regimen of linaclotide and simethicone. We maintained standard NPO status, clear liquid period, and simethicone dose. Subjects received 290 μg of linaclotide 1 h prior to capsule. We randomly selected 30 historical PEG controls. Two blinded gastroenterologists graded visualization as ideal/excellent, good, fair, or poor and measured small bowel transit time. Results: Thirteen men and 16 women were enrolled with an average age of 61. There was no significant difference in exam quality between linaclotide and control. Preparation was rated as ideal/excellent or good in 19 of 28 of linaclotide and 18 of 28 PEG subjects when recorder entered the small bowel (p = 0.78, chi-square). Median small bowel transit was 192 min (linaclotide) versus 202 min (PEG), respectively (p = 0.93, t test). Three studies (1 linaclotide and 2 PEG) failed to leave the stomach; 1 linaclotide subject had recorder failure. Diagnostic yield was similar (18/29 for linaclotide and 16/30 for PEG, p = 0.50, chi-square). There were no serious side effects. No differences in age, sex, BMI, or frequency of diabetes, GERD, or gastroparesis were measured between the groups. Conclusions: Single-dose linaclotide 1 h before capsule endoscopy was equally effective when compared to PEG in terms of visualization and transit time. This trial was registered at ClincialTrials.gov, number NCT02465385.

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