Small-Bowel Capsule Endoscopy (SBCE) is a useful diagnostic modality in the investigation of Obscure Gastrointestinal Bleeding (OGIB). Its role though in Iron Deficiency Anaemia (IDA) is less clear.
Aim
To assess the usefulness of SBCE in the diagnostic work-up of patients with IDA with neither complicating pathology nor specific GI symptomatology.
Methods
Design: Retrospective study. Setting: University hospital & tertiary referral centre for capsule endoscopy for South East of Scotland. A review of SBCE database was carried out for the period between March 2005 and June 2011. Only patients with IDA and no other GI symptoms or known previous diagnosis contributing to IDA for example, Crohn9s or coeliac disease were included in the analysis. Electronic and paper case notes were reviewed for information relating to procedure indications, investigations carried out prior to SBCE and subsequent findings. Cases with failed examinations due to SBCE retention and/or incomplete small-bowel transit were excluded from further analysis. SBCE findings were classified as clinically significant (small-bowel malignancy, significant inflammation and/or strictures and coeliac disease) or clinically relevant pathology that is, angioectasias (P1/P2 lesions).
Results
A total of 811 SBCE examinations were performed during the above period. IDA as the sole indication for SBCE was recorded in 27% (n=221; 151F/70M, mean age: 62 yr) patients. All patients had bi-directional endoscopies prior to SBCE. The overall diagnostic yield (DY) of SBCE was 30.7% (68/221). The DY for significant pathology and angioectasias was 9% and 21.7%, respectively. In those ≤40 yr (n=20; 13F/7M, mean age: 26.5 yr), significant pathology was found in 25% (5/20); in the >40 yr group (n=201; 138F/63M, mean age: 72.2 yr), significant pathology was found in 7.5% (15/201), p=0.0231. Although none of the patients ≤40 yr had angioectasias, P1 or P2 lesions were found in 48/201 (21.7%) of those >40 yr, p=0.009. Age-range analysis showed angioectasias in 11.1%, 13%, 20% and 42% in the age-groups 41–50, 50–60, 60–70, 70–80 yr, respectively. Interestingly, in those >80 yr (n=16; 12F/4M, mean age: 82.5 yr) angioectasias were present in 50% of SBCE but no significant pathology was identified.
Conclusion
IDA alone is one of the main indications (27%) for referral to the SBCE service of our centre with the majority of referrals coming from the >40 age group. In our cohort, the overall DY of SBCE for IDA is 30.7% and the commonest finding small-bowel angioectasias. The detection rate of significant small-bowel pathology for those >40 yr is low decreasing to zero in the >80 age group. In contrast, 25% of patients ≤40 yr had a significant or sinister diagnosis made with SBCE.
Esophageal capsule endoscopy (ECE) is considered to be an alternative to conventional esophagogastroduodenoscopy (EGD); however, its indications continue to expand. This report presents results from the use of ECE in patients with hemophilia at a tertiary referral academic center over a 7-year period. A total of 16 patients with hemophilia, who were all at risk of new-variant Creutzfeldt-Jakob disease due to previous treatment with UK plasma-derived pooled blood products, underwent a total of 28 ECE examinations. Main outcomes were the diagnostic yield of ECE, requirement for subsequent conventional EGD, and any variceal bleeding episodes during the follow-up period. The overall diagnostic yield was 67.8 % (19 /28 ECEs). Only one patient underwent conventional EGD, for esophageal biopsies. There were no variceal hemorrhage events in any of the patients on variceal screening follow-up. ECE is a useful and acceptable alternative to conventional endoscopy in selected patient groups (i. e. patients with hemophilia). In this group, ECE can eliminate the need for prior administration of clotting factors.
This multicenter study aimed to create and validate a scoring system for survival of patients with metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC). The entire cohort of 356 patients was divided in a test group (N = 178) and a validation group (N = 178). In the test group, nine pre-treatment factors including age, gender, Eastern Cooperative Oncology Group performance status (ECOG-PS), number of involved vertebrae, pre-radiotherapy ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and the time developing motor were retrospectively analyzed. On multivariate analysis, survival was significantly associated with ECOG-PS, pre-radiotherapy ambulatory status, visceral metastases, and the time developing motor deficits. These factors were included in the scoring system; the score for each factor was determined by dividing the 6-month survival rate (in %) by 10. The risk score represented the sum of the scores for each factor. According to the risk scores, which ranged from 6 to 19 points, three prognostic groups were designed. The 6-month survival rates were 6% for 6–10 points, 29% for 11–15 points, and 78% for 16–19 points (p < 0.001). In the validation group, the 6-month survival rates were 4%, 24%, and 76%, respectively (p < 0.001). Since the survival rates of the validation group were similar to those of the test group, this score can be considered reproducible. The scoring system can help when selecting the individual treatment for patients with MSCC from NSCLC. A prospective confirmatory study is warranted.
Based on an analysis of 1852 retrospectively evaluated patients with metastatic spinal cord compression (MSCC), a scoring system was developed to predict survival. This study was performed to validate the scoring system in a new data set.The score included 6 prognostic factors: tumor type, interval between tumor diagnosis and MSCC, other bone or visceral metastases, ambulatory status, and duration of motor deficits. Scores ranged between 20 and 45 points, and patients were initially divided into 5 groups: those with 20 to 25 points, those with 26 to 30 points, those with 31 to 35 points, those with 36 to 40 points, and those with 41 to 45 points. To facilitate the clinical use of the score, the patients were regrouped into 3 groups: those with 20 to 30 points, those with 31 to 35 points, and those with 36 to 45 points. In this study, data of 439 new patients were included who were divided into the same prognostic groups as in the preceding study.In this study, the 6-month survival rates were 7% (for those with 20-25 points), 19% (for those with 26-30 points), 56% (for those with 31-35 points), 73% (for those with 36-40 points), and 90% (for those with 41-45 points), respectively (P<.0001). After regrouping, the 6-month survival rates were 14% (for those with 20-30 points), 56% (for those with 31-35 points), and 80% (for those with 36-45 points), respectively, in this study (P<.0001).In the current study, the difference in 6-month survival between the prognostic groups was found to be as significant as in the preceding study. Thus, this scoring system was considered valid to estimate survival of MSCC patients. The system could have been simplified by including only 3 instead of 5 prognostic groups.
There are only few reports on the diagnostic yield (DY) of small bowel capsule endoscopy (SBCE) in patients with chronic kidney disease (CKD). We aim to report our SBCE experience in patients with CKD.Retrospective study; case notes of patients with low estimated glomerular filtration rate (eGFR) who underwent SBCE (March 2005-August 2012) for anemia and/or obscure gastrointestinal bleeding (OGIB) were retrieved and abstracted. Severity of CKD was defined according to Renal Association recommendations as: stage 3 (eGFR: 30-59); stage 4 (eGFR: 15-29); and stage 5 (eGFR <15 or on dialysis).In the aforementioned period, 69 patients with CKD [stage 3: 65/69 (92.8%), stage 4 or 5:4/69 (7.2%)] had SBCE. 51/65 (78.5%) patients with stage 3 CKD had SBCE due to unexplained anemia and/or OGIB [43 (66.1%) and 8 (12.3%), respectively]. In 25/51 (49%), the SBCE was normal and in 17/51 (33.3%) showed small-bowel angiectasias. Other findings were active bleeding (n=2), fold edema (n=2), ileal erosions (n=1), adenocarcinoma (n=1), and inconclusive/videos not available (n=3). All patients (n=4) with CKD grade 4 or 5 were referred due to unexplained anemia; 3/4 (75%) had angiectasias and 1 normal SBCE. Fecal calprotectin (FC) was measured in 12 patients with CKD stage 3 and unexplained anemia prior to their SBCE; no significant small-bowel inflammation was found in this subgroup.SBCE has limited DY in CKD patients referred for unexplained anemia. Sinister SB pathology is rare, while the most common finding is angiectasias. Furthermore, FC measurement prior to SBCE -in this cohort of patients- is not associated with increased DY.
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