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A New Biomimetic Adhesive for Therapeutic Capsule Endoscope Applications in the Gastrointestinal Tract
Abstracts
337 Long-Term Impact of Capsule Endoscopy in Patients with Iron Deficiency Anemia Barrett Levesque, Sarah Sheibani, Jennifer Roost, Lauren B. Gerson Background: Capsule endoscopy (CE) is a valuable imaging modality for patients with iron-deficiency (Fe-def) anemia. We aimed to determine the long-term impact of CE in patients with Fe-def anemia and to compare outcomes to a control group with overt bleeding. Methods: Patients with Fe-def anemia (n Z 80) and overt GI bleeding (n Z 81) who underwent CE between 2/2002-11/05 were invited to participate. A standardized telephone interview was conducted to inquire about need for subsequent diagnostic or therapeutic interventions and resolution of anemia. Results: 48 Fe-def patients (67% male, mean ( SD) age 65 5 yrs) and 27 patients with overt GI bleeding (78% male, mean age 67 14 yrs) were enrolled. 40% (19/48) of Fe-def patients, compared to 97% (26/27) of overt bleeders required transfusions post-CE. (p ! 0.001) CE findings did not differ between cases and controls. (Table) Average follow-up times post-CE were 23 15 months (range 456) for the Fe-def group and 24 14 months (range 2-55) for controls. Post-CE, 75% (36/48) of Fe-def patients underwent procedures including EGD (n Z 19), double balloon enteroscopy (DBE) (n Z 14), push enteroscopy (n Z 2), or repeat CE (n Z 1). Findings included: 1) DBE - normal 50% (7/14), AVM 43% (6/14), Ulcer (1/14); 2) EGD/Colonoscopy - normal 63%(13/19), AVM 10% (2/19), Varices (1/19), gastritis/erosion (1/19), Zenker’s (1/19), and GAVE (1/19); 3) enteroscopy - normal 50%(1/2), ulcer 50%(1/2). 44% (16/36) had therapeutic interventions including cautery (n Z 12) and surgery (n Z 3). Post-CE, 9 (19%) Fe-def and 12 (44%) controls died due to non-bleeding causes over a mean time of 13 7 and 20 9 months. (p Z 0.01) 75% (9/12) of patients in the Fe-def cohort with significant follow-up findings and subsequent therapeutic interventions were no longer anemic. Among iron-deficient patients with positive CE but without significant follow-up findings, and in those with normal CE, 14% (2/24) and 17% (2/12) were still anemic. Conclusions: The diagnostic yield on CE was equivalent for patients with iron-deficiency or overt bleeding. Most Fe-def patients with normal CE were no longer anemic after an average of two years of follow-up. Positive findings on CE, when confirmed by additional diagnostic studies such as DBE, often led to successful therapeutic interventions. CE findings) Fe-deficient (n Z 48))) AVM 20 (42%) Ulcer 3 (6%) Gastritis 4 (8%) Normal 20 (42%) )p values not significant for any categories ))1 additional patient had GAVE þ 1 patient had Dieulafoy and 1 stricture
Overt (n Z 27)D 11 (41%) 0 (0%) 5 (18%) 9 (30%)
338 Endoscopic Balloon Dilation Therapy for Small Intestinal Strictures with Crohn’s Disease Using Double Balloon Endoscopy Keijiro Sunada, Hironori Yamamoto, Hiroto Kita, Tomonori Yano, Michiko Iwamoto, Tomohiko Miyata, Masayuki Arashiro, Yoshikazu Hayashi, Nobuhiro Minami, Yoshimasa Miura, Hiroki Taguchi, Kenichi IDO, Kentaro Sugano Background: Strictures are an important issue in patients with Crohn’s disease and small intestinal strictures have often been indicated for surgical resection or strictureplasty. Recent development of endoscopic balloon dilation therapy for colonic strictures has been reported to avoid surgical procedures successfully. Double balloon endoscopy (DBE) enabled balloon dilation therapy of the strictures even in the small intestine. Aim: To evaluate the clinical outcomes of endoscopic balloon dilation therapy using DBE for small intestinal strictures with Crohn’s disease. Patients: Seven hundred forty-nine procedures of DBE were performed in 383 patients between Sep. 2000 and Oct. 2006 at Jichi Medical University Hospital, Tochigi, Japan and 18 patients (14 men, 4 women; median age 37.5, range 20-57), with obstructive symptoms or evidence of small intestinal stenoses, have undertaken endoscopic balloon dilation therapy. Methods: CRE wire guided balloon dilator (Boston Scientific, USA) was used. Dilation therapy was performed under direct observation when therapeutic DBE (EN-450T5) with 2.8 mm channel was used. Precise evaluation of the stricture, by both endoscopic observation and a selective radiographic contrast imaging at endoscopy, was requisite right before the dilation. In difficult cases, we used small caliber-tip transparent hood in localizing the orifice of the stricture. Results: We have performed 27 dilation procedures in 18 patients. The site of the strictures indicated for balloon dilation
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therapy included the duodenum (1 patient), jejunum (2 patients), mid intestine (2 patients), ileum (12 patients), ileocolonic anastomosis (2 patients), and ileoileal anastomosis (1 patient). Diameter of the balloon for dilation was up to 10 to 20 mm. Additional dilation procedure was necessary in 5 patients, and two more procedures were required in 2 patients, respectively. Perforation requiring surgery occurred during dilation therapy in 1 patient. Two patients required surgical procedure, despite that dilatation therapy was successful, due to the recurrence of complicated strictures in one patient and development of ileal bladder fistula in the other patient. The remaining 15 patients were free from surgical intervention for 11 months on the average (maximum 48 months) after dilatation therapy. Conclusions: We have successfully performed endoscopic balloon dilation therapy for small intestinal strictures in most of the patients with Crohn’s disease by using DBE. This retrospective study demonstrates that endoscopic balloon dilation therapy is a safe and effective method to postpone or avoid surgery for strictures associated with Crohn’s disease.
340 A New Biomimetic Adhesive for Therapeutic Capsule Endoscope Applications in the Gastrointestinal Tract Paul Glass, Metin Sitti, Ragunath Appasamy In this work, we present a new type of material that shows promise for use as a repeatable adhesive for robotic pill cameras in the GI tract. These adhesives are inspired by those found on the feet of certain beetles capable of adhering to surfaces by the secretion of oil from foot micro-fibers. Patterned micro-pillar polymer arrays manufactured by optical lithographic techniques are coated with a viscous oil to stick to the micro-villi of the small intestine lining. Laboratory testing on freshly-harvested porcine small intestine has shown more than five times better adhesive ability over similar non-patterned materials. Currently, this material is being tested for use in pads that could be incorporated into existing capsule endoscopes, as shown in Fig. 1. An actuator presses the pads into the intestinal wall where the adhesives clamp the capsule in place. With new devices incorporated into the capsule design, this stability would allow a clinician to perform therapeutically useful tasks with the capsule endoscope like applying a heater probe to treat angiectasias or taking biopsy samples at desired locations in a minimally invasive way. These materials can also be used for the development of therapeutic capsule colonoscopes which aim to minimize patient risk and discomfort, and eliminate the need for conscious sedation during routine colonoscopy. These materials demonstrate advantages over other alternatives. Small forces are sufficient for strong adhesion to the intestinal lining, minimizing the energy requirements for actuation, the discomfort for the patient, and the risk of damaging or perforating the intestine wall. By peeling, the adhesion bond can be broken with little energy expenditure.
Fig 1. Actuated capsule endoscope prototype with micro-patterned adhesive feet for adhering to the intestinal lining. Pillars shown in the inset scanning electron microscope image are 100 mm in diameter.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB91
337 Long-Term Impact of Capsule Endoscopy in Patients with Iron Deficiency Anemia Barrett Levesque, Sarah Sheibani, Jennifer Roost, Lauren B. Gerson Background: Capsule endoscopy (CE) is a valuable imaging modality for patients with iron-deficiency (Fe-def) anemia. We aimed to determine the long-term impact of CE in patients with Fe-def anemia and to compare outcomes to a control group with overt bleeding. Methods: Patients with Fe-def anemia (n Z 80) and overt GI bleeding (n Z 81) who underwent CE between 2/2002-11/05 were invited to participate. A standardized telephone interview was conducted to inquire about need for subsequent diagnostic or therapeutic interventions and resolution of anemia. Results: 48 Fe-def patients (67% male, mean ( SD) age 65 5 yrs) and 27 patients with overt GI bleeding (78% male, mean age 67 14 yrs) were enrolled. 40% (19/48) of Fe-def patients, compared to 97% (26/27) of overt bleeders required transfusions post-CE. (p ! 0.001) CE findings did not differ between cases and controls. (Table) Average follow-up times post-CE were 23 15 months (range 456) for the Fe-def group and 24 14 months (range 2-55) for controls. Post-CE, 75% (36/48) of Fe-def patients underwent procedures including EGD (n Z 19), double balloon enteroscopy (DBE) (n Z 14), push enteroscopy (n Z 2), or repeat CE (n Z 1). Findings included: 1) DBE - normal 50% (7/14), AVM 43% (6/14), Ulcer (1/14); 2) EGD/Colonoscopy - normal 63%(13/19), AVM 10% (2/19), Varices (1/19), gastritis/erosion (1/19), Zenker’s (1/19), and GAVE (1/19); 3) enteroscopy - normal 50%(1/2), ulcer 50%(1/2). 44% (16/36) had therapeutic interventions including cautery (n Z 12) and surgery (n Z 3). Post-CE, 9 (19%) Fe-def and 12 (44%) controls died due to non-bleeding causes over a mean time of 13 7 and 20 9 months. (p Z 0.01) 75% (9/12) of patients in the Fe-def cohort with significant follow-up findings and subsequent therapeutic interventions were no longer anemic. Among iron-deficient patients with positive CE but without significant follow-up findings, and in those with normal CE, 14% (2/24) and 17% (2/12) were still anemic. Conclusions: The diagnostic yield on CE was equivalent for patients with iron-deficiency or overt bleeding. Most Fe-def patients with normal CE were no longer anemic after an average of two years of follow-up. Positive findings on CE, when confirmed by additional diagnostic studies such as DBE, often led to successful therapeutic interventions. CE findings) Fe-deficient (n Z 48))) AVM 20 (42%) Ulcer 3 (6%) Gastritis 4 (8%) Normal 20 (42%) )p values not significant for any categories ))1 additional patient had GAVE þ 1 patient had Dieulafoy and 1 stricture
Overt (n Z 27)D 11 (41%) 0 (0%) 5 (18%) 9 (30%)
338 Endoscopic Balloon Dilation Therapy for Small Intestinal Strictures with Crohn’s Disease Using Double Balloon Endoscopy Keijiro Sunada, Hironori Yamamoto, Hiroto Kita, Tomonori Yano, Michiko Iwamoto, Tomohiko Miyata, Masayuki Arashiro, Yoshikazu Hayashi, Nobuhiro Minami, Yoshimasa Miura, Hiroki Taguchi, Kenichi IDO, Kentaro Sugano Background: Strictures are an important issue in patients with Crohn’s disease and small intestinal strictures have often been indicated for surgical resection or strictureplasty. Recent development of endoscopic balloon dilation therapy for colonic strictures has been reported to avoid surgical procedures successfully. Double balloon endoscopy (DBE) enabled balloon dilation therapy of the strictures even in the small intestine. Aim: To evaluate the clinical outcomes of endoscopic balloon dilation therapy using DBE for small intestinal strictures with Crohn’s disease. Patients: Seven hundred forty-nine procedures of DBE were performed in 383 patients between Sep. 2000 and Oct. 2006 at Jichi Medical University Hospital, Tochigi, Japan and 18 patients (14 men, 4 women; median age 37.5, range 20-57), with obstructive symptoms or evidence of small intestinal stenoses, have undertaken endoscopic balloon dilation therapy. Methods: CRE wire guided balloon dilator (Boston Scientific, USA) was used. Dilation therapy was performed under direct observation when therapeutic DBE (EN-450T5) with 2.8 mm channel was used. Precise evaluation of the stricture, by both endoscopic observation and a selective radiographic contrast imaging at endoscopy, was requisite right before the dilation. In difficult cases, we used small caliber-tip transparent hood in localizing the orifice of the stricture. Results: We have performed 27 dilation procedures in 18 patients. The site of the strictures indicated for balloon dilation
www.giejournal.org
therapy included the duodenum (1 patient), jejunum (2 patients), mid intestine (2 patients), ileum (12 patients), ileocolonic anastomosis (2 patients), and ileoileal anastomosis (1 patient). Diameter of the balloon for dilation was up to 10 to 20 mm. Additional dilation procedure was necessary in 5 patients, and two more procedures were required in 2 patients, respectively. Perforation requiring surgery occurred during dilation therapy in 1 patient. Two patients required surgical procedure, despite that dilatation therapy was successful, due to the recurrence of complicated strictures in one patient and development of ileal bladder fistula in the other patient. The remaining 15 patients were free from surgical intervention for 11 months on the average (maximum 48 months) after dilatation therapy. Conclusions: We have successfully performed endoscopic balloon dilation therapy for small intestinal strictures in most of the patients with Crohn’s disease by using DBE. This retrospective study demonstrates that endoscopic balloon dilation therapy is a safe and effective method to postpone or avoid surgery for strictures associated with Crohn’s disease.
340 A New Biomimetic Adhesive for Therapeutic Capsule Endoscope Applications in the Gastrointestinal Tract Paul Glass, Metin Sitti, Ragunath Appasamy In this work, we present a new type of material that shows promise for use as a repeatable adhesive for robotic pill cameras in the GI tract. These adhesives are inspired by those found on the feet of certain beetles capable of adhering to surfaces by the secretion of oil from foot micro-fibers. Patterned micro-pillar polymer arrays manufactured by optical lithographic techniques are coated with a viscous oil to stick to the micro-villi of the small intestine lining. Laboratory testing on freshly-harvested porcine small intestine has shown more than five times better adhesive ability over similar non-patterned materials. Currently, this material is being tested for use in pads that could be incorporated into existing capsule endoscopes, as shown in Fig. 1. An actuator presses the pads into the intestinal wall where the adhesives clamp the capsule in place. With new devices incorporated into the capsule design, this stability would allow a clinician to perform therapeutically useful tasks with the capsule endoscope like applying a heater probe to treat angiectasias or taking biopsy samples at desired locations in a minimally invasive way. These materials can also be used for the development of therapeutic capsule colonoscopes which aim to minimize patient risk and discomfort, and eliminate the need for conscious sedation during routine colonoscopy. These materials demonstrate advantages over other alternatives. Small forces are sufficient for strong adhesion to the intestinal lining, minimizing the energy requirements for actuation, the discomfort for the patient, and the risk of damaging or perforating the intestine wall. By peeling, the adhesion bond can be broken with little energy expenditure.
Fig 1. Actuated capsule endoscope prototype with micro-patterned adhesive feet for adhering to the intestinal lining. Pillars shown in the inset scanning electron microscope image are 100 mm in diameter.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB91