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Su1236 Capsule Endoscopy With PillCam SB2 Versus PillCam SB3: Did Technological Improvement Grant a Step Forward in Clinical Practice?
Abstracts
based on clinical assessment and further diagnostic procedures, including SBCE. Results: Included 137 patients, 60,6% women, with mean age 43 (range 18-66) years. Anemia was found in 18% of the patients, leukocytosis in 8%, thrombocytosis in 12%, hypoalbuminemia in 8%, and elevated ESR and CRP in 27% and 53% of the patients, respectively. Small bowel inflammatory activity was observed in 40,6% of the patients (nZ56), and diagnosis of CD during follow-up was established in 53 patients (39,7%). In a combined-analysis model, including elevated CRP, anemia, thrombocytosis and hypoalbuminemia, there was a statistically significant correlation with the diagnosis of CD, from 27% incidence of CD diagnosis when none of these factors was present to 83% when all four were present (pZ0,016). The combination of thrombocytosis and either CRP or anemia were highly predictive of a subsequent diagnosis of CD, demonstrating a specificity of 98% and 97% and a predictive positive value of 83% and 77%, respectively. Conclusions: In our study, there was a significant correlation between the frequency of laboratorial markers (elevated CRP, anemia, thrombocytosis and hypoalbuminemia) and a higher likelyhood of diagnosing CD (pZ0,012), but even in the cases where none of these markers are present, up to 27% will be diagnosed with CD. Thrombocytosis, together with CRP or anemia, demonstrated an excellent predictive power for diagnosing CD, with specificity of 97-98% and positive predictive value of 77-83%. In these patients, further investigation, namely with SBCE, should be warranted for confirmation of CD.
Su1236 Capsule Endoscopy With PillCam SB2 Versus PillCam SB3: Did Technological Improvement Grant a Step Forward in Clinical Practice? Sofia Xavier*1, Sara Monteiro1, Joana Magalhães1, Bruno Rosa1, Maria João Moreira1, José Cotter1,2 1 Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal; 2 Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal Introduction: Small bowel capsule endoscopy (SBCE) is a diagnostic tool with increasing relevance. PillcamÒ SB3 has better image resolution than PillCamÒ SB2 and adaptive frame rate technology, rendering it potentially more effective. Objectives: Compare findings detection and completion rate between PillCamÒ SB2 and SB3. Methods: Retrospective single-center study including 357 consecutive SBCE, 173 SB2 and 184 SB3. Videos were reviewed and findings were recorded and classified as relevant or not. Results: Patients had a mean age of 48 years with 66,9% females. The two main indications were suspicion/staging of inflammatory bowel disease (IBD) and obscure gastrointestinal bleeding (OGIB), (43,7% and 40,3%, respectively). Median small-bowel (SB) transit time was 261 minutes (IQR 122) and overall completion rate was 95% (339/357). Endoscopic findings were reported in 76,2% of the examinations, while relevant findings corresponded to 53,5%. The most frequently reported findings were SB ulcers, in 29,4% of patients. Findings in gastrointestinal segments other than the SB were reported in 20,4% of SBCE, most frequently in the stomach (16,8%). No significant differences were found when comparing SB2 with SB3 regarding completion rate (93,6% vs 96,2%, pZ0,27), overall endoscopic findings (73,4% vs 78,8%, pZ0,23), relevant findings (54,3% vs 52,7%, pZ0,76), first tercile findings (43,9% vs 48,9%, pZ0,35), extra-SB findings (23,7% vs 17,3%, pZ0,14), after-8 hours findings (8,1% vs 8,2%, pZ0,99), Z line and papilla detection rate (35,9% vs 35,7%, pZ0,97 and 27,1% vs 32,6%, pZ0,32, respectively). Regarding the subgroup of patients with suspicion/staging of IBD, a significant difference was found in the detection of villous edema and 3rd tercile findings, favoring SB3 (26% vs 44%, pZ0,02 and 47% vs 66%, p<0,02, respectively). No differences were found on Lewis score classification and 3rd tercile ulcer detection. In patients with OGIB, mucosal atrophy was significantly more frequently diagnosed with the PillCam Ò SB3 (0% vs 8%, pZ0,03). Conclusions: Overall, PillCam Ò SB3 didn’t improve diagnostic yield nor the completion rate compared with SB2. Nevertheless, when particular indications were analyzed, significant differences in detection of villi alteration, such as atrophy and segmental villous edema, were found, which may eventually be attributable to SB3 better image resolution.
Su1237 Effect of Proton Pump Inhibitor Therapy and Healing Effect of Irsogladine on Nonsteroidal Anti-Inflammatory Drug-Induced Small-Intestinal Lesions in Healthy Volunteers Yuichi Kojima*, Toshihisa Takeuchi, Shinpei Kawaguchi, Yoshiaki Takahashi, Kazuhiro Ota, Satoshi Harada, Sadaharu Nouda, Kazuhide Higuchi second department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
sogladine (IG), using capsule endoscopy (CE) in healthy volunteers. Methods: As a short-term study (Study 1), diclofenac sodium (DS) at 75 mg and a PPI at a standard dose, omeprazole (OP) at 20 mg or lansoprazole (LP) at 30 mg, were orally administered for 2 weeks (nZ20). DS and the PPI at a 2-fold dose, OP at 40 mg or LP at 60 mg, were orally administered for 2 weeks (nZ10). CE was performed before and after drug administration. As a long-term study (Study 2), 32 subjects were divided into the following 2 groups: Group A, in which DS and OP at 10 mg were orally administered for 6 weeks, and combined with IG at 4 mg from Week 6 until Week 10, and Group B, in which combination therapy with DS and IG was continued for 6 weeks. CE was performed in Weeks 0, 2, 6, and 10. In the small intestine, the presence of adaptation to NSAIDs was suggested, as reported for the stomach. DS and OP at 10 mg were orally administered to 5 subjects for 10 weeks as a control group (Group C). Results: In Study 1, when examining the influence of standarddose PPIs, erythema significantly exacerbated after administration in the OP group, but there was no exacerbation in the LP group. There were no significant differences in erosion, ulcers, or edema between the two groups. When investigating the influence of PPIs at a 2-fold dose, in the LP group, NSAIDs-induced small intestinal mucosal injury was less marked than in the OP group. In Study 2, the extent of mucosal break (MB) in Week 2 was significantly greater than in Week 0 in Group A. However, in Week 6, there was no further increase. In Group B, there was no increase in the number of lesions in Weeks 2 or 6. In Group A, combination therapy with IG from Week 6 until Week 10 decreased the extent of MB. In Group C, the extent of MB in Week 2 was greater than in Week 0. There were no significant changes between Weeks 2 and 10. Conclusion: The results suggest that, for combination therapy with NSAIDs and PPIs, the influence of PPIs, which are used to prevent upper GI disorder, on small intestinal lesions depends on the type and dose of PPI. However, long-term combination therapy with NSAIDs and OP did not show any inhibitory effects. Furthermore, long-term follow-up suggested small intestinal adaptation. IG exhibited both preventive and curative effects on small intestinal mucosal injury related to the long-term administration of NSAIDs.
Su1238 The Necessity of Bowel Preparation With Purgative in Small Intestinal Capsule Endoscope Examination Keiji Ozeki*, Hiromi Kataoka, Takashi Joh Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan Background & Aims: Recently the usefulness of small bowel capsule endoscopy (SBCE) in the examination of small bowel disease has become clear. But the poor visualization with bubbles, intraluminal fluid or debris often disturbs exactly diagnosis. And so the bowel preparation of different dose of purgatives (polyethylene glycol (PEG), sodium phosphate solution or sennoside A/B) or prokinetics(metoclopramide or domperidon and so on) and anti-bubble agents(simethicone) before SBCE were reported to assess the efficacy of small bowel clearing quality. However the efficacy of both purgatives and prokinetics on capsule endoscopy pretreatment is still controversial. The aim of this study was to compare the quality of visualization, as well as diagnostic yield and rate of complete small bowel exploration with cecum visualization, using three different small bowel clearing protocol including no bowel preparation of purgative. Methods: Between June 2008 and November 2014, one hundred forty-eight patients (male: female, 91:57, the mean age was 58.820.0 years old) were conducted SBCE in our hospital. They were divided into three groups with bowel preparation of SBCE. Group A was included 32 patients followed 24h (whole one day) fasting without any bowel preparation. Group B was included 56 patients followed 11h (overnight) fasting without any bowel preparation. And group C was included 60 patients followed bowel pretreatment with purgatives prior to SBCE regardless of the time of fasting. The quality of visualization with SBCE was assessed with according to the proportion of mucosal visible by 5-points (The score of 0 indicates 0-20% mucosal visible with residual materials, 1 indicates 20-40% mucosal visible, 2 indicates 40-60% mucosal visible, 3 indicates 60-80% mucosal visible, 4 indicates 80-100% mucosal visible). And the diagnostic yields, the rate of complete small bowel exploration were also examined. Results: The mean values of visible score in ileum were 2.60.7, 2.40.7 and 2.40.7 in Group A, B, and C. The rates of any findings on SBCE were 84.8%, 75.4% and 78.1%, and the rates of complete small bowel examination were 84.8%, 86.9% and 82.2% in Group A, B and C, respectively. And so these were no significant differences among three groups. Conclusions: In this study, the bowel preparation with purgative on SBCE was not necessary. The procedure without any bowel pretreatment will be tolerated with the patients. The limitation of this study was only single center retrospective examination, so further exploration should be needed.
Purpose: As therapy for NSAID-induced upper gastrointestinal (GI) disorder, proton pump inhibitors (PPIs) are used as standard treatment. However, a basic experiment showed that PPIs deteriorated NSAIDs-induced small intestinal mucosal injury through dysbiosis; their influence on the human small intestine remains to be clarified. In this study, we examined changes in small intestinal lesions after short-/ long-term combination therapy with NSAIDs and PPIs, as well as the effects of ir-
AB322 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
www.giejournal.org
based on clinical assessment and further diagnostic procedures, including SBCE. Results: Included 137 patients, 60,6% women, with mean age 43 (range 18-66) years. Anemia was found in 18% of the patients, leukocytosis in 8%, thrombocytosis in 12%, hypoalbuminemia in 8%, and elevated ESR and CRP in 27% and 53% of the patients, respectively. Small bowel inflammatory activity was observed in 40,6% of the patients (nZ56), and diagnosis of CD during follow-up was established in 53 patients (39,7%). In a combined-analysis model, including elevated CRP, anemia, thrombocytosis and hypoalbuminemia, there was a statistically significant correlation with the diagnosis of CD, from 27% incidence of CD diagnosis when none of these factors was present to 83% when all four were present (pZ0,016). The combination of thrombocytosis and either CRP or anemia were highly predictive of a subsequent diagnosis of CD, demonstrating a specificity of 98% and 97% and a predictive positive value of 83% and 77%, respectively. Conclusions: In our study, there was a significant correlation between the frequency of laboratorial markers (elevated CRP, anemia, thrombocytosis and hypoalbuminemia) and a higher likelyhood of diagnosing CD (pZ0,012), but even in the cases where none of these markers are present, up to 27% will be diagnosed with CD. Thrombocytosis, together with CRP or anemia, demonstrated an excellent predictive power for diagnosing CD, with specificity of 97-98% and positive predictive value of 77-83%. In these patients, further investigation, namely with SBCE, should be warranted for confirmation of CD.
Su1236 Capsule Endoscopy With PillCam SB2 Versus PillCam SB3: Did Technological Improvement Grant a Step Forward in Clinical Practice? Sofia Xavier*1, Sara Monteiro1, Joana Magalhães1, Bruno Rosa1, Maria João Moreira1, José Cotter1,2 1 Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal; 2 Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal Introduction: Small bowel capsule endoscopy (SBCE) is a diagnostic tool with increasing relevance. PillcamÒ SB3 has better image resolution than PillCamÒ SB2 and adaptive frame rate technology, rendering it potentially more effective. Objectives: Compare findings detection and completion rate between PillCamÒ SB2 and SB3. Methods: Retrospective single-center study including 357 consecutive SBCE, 173 SB2 and 184 SB3. Videos were reviewed and findings were recorded and classified as relevant or not. Results: Patients had a mean age of 48 years with 66,9% females. The two main indications were suspicion/staging of inflammatory bowel disease (IBD) and obscure gastrointestinal bleeding (OGIB), (43,7% and 40,3%, respectively). Median small-bowel (SB) transit time was 261 minutes (IQR 122) and overall completion rate was 95% (339/357). Endoscopic findings were reported in 76,2% of the examinations, while relevant findings corresponded to 53,5%. The most frequently reported findings were SB ulcers, in 29,4% of patients. Findings in gastrointestinal segments other than the SB were reported in 20,4% of SBCE, most frequently in the stomach (16,8%). No significant differences were found when comparing SB2 with SB3 regarding completion rate (93,6% vs 96,2%, pZ0,27), overall endoscopic findings (73,4% vs 78,8%, pZ0,23), relevant findings (54,3% vs 52,7%, pZ0,76), first tercile findings (43,9% vs 48,9%, pZ0,35), extra-SB findings (23,7% vs 17,3%, pZ0,14), after-8 hours findings (8,1% vs 8,2%, pZ0,99), Z line and papilla detection rate (35,9% vs 35,7%, pZ0,97 and 27,1% vs 32,6%, pZ0,32, respectively). Regarding the subgroup of patients with suspicion/staging of IBD, a significant difference was found in the detection of villous edema and 3rd tercile findings, favoring SB3 (26% vs 44%, pZ0,02 and 47% vs 66%, p<0,02, respectively). No differences were found on Lewis score classification and 3rd tercile ulcer detection. In patients with OGIB, mucosal atrophy was significantly more frequently diagnosed with the PillCam Ò SB3 (0% vs 8%, pZ0,03). Conclusions: Overall, PillCam Ò SB3 didn’t improve diagnostic yield nor the completion rate compared with SB2. Nevertheless, when particular indications were analyzed, significant differences in detection of villi alteration, such as atrophy and segmental villous edema, were found, which may eventually be attributable to SB3 better image resolution.
Su1237 Effect of Proton Pump Inhibitor Therapy and Healing Effect of Irsogladine on Nonsteroidal Anti-Inflammatory Drug-Induced Small-Intestinal Lesions in Healthy Volunteers Yuichi Kojima*, Toshihisa Takeuchi, Shinpei Kawaguchi, Yoshiaki Takahashi, Kazuhiro Ota, Satoshi Harada, Sadaharu Nouda, Kazuhide Higuchi second department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
sogladine (IG), using capsule endoscopy (CE) in healthy volunteers. Methods: As a short-term study (Study 1), diclofenac sodium (DS) at 75 mg and a PPI at a standard dose, omeprazole (OP) at 20 mg or lansoprazole (LP) at 30 mg, were orally administered for 2 weeks (nZ20). DS and the PPI at a 2-fold dose, OP at 40 mg or LP at 60 mg, were orally administered for 2 weeks (nZ10). CE was performed before and after drug administration. As a long-term study (Study 2), 32 subjects were divided into the following 2 groups: Group A, in which DS and OP at 10 mg were orally administered for 6 weeks, and combined with IG at 4 mg from Week 6 until Week 10, and Group B, in which combination therapy with DS and IG was continued for 6 weeks. CE was performed in Weeks 0, 2, 6, and 10. In the small intestine, the presence of adaptation to NSAIDs was suggested, as reported for the stomach. DS and OP at 10 mg were orally administered to 5 subjects for 10 weeks as a control group (Group C). Results: In Study 1, when examining the influence of standarddose PPIs, erythema significantly exacerbated after administration in the OP group, but there was no exacerbation in the LP group. There were no significant differences in erosion, ulcers, or edema between the two groups. When investigating the influence of PPIs at a 2-fold dose, in the LP group, NSAIDs-induced small intestinal mucosal injury was less marked than in the OP group. In Study 2, the extent of mucosal break (MB) in Week 2 was significantly greater than in Week 0 in Group A. However, in Week 6, there was no further increase. In Group B, there was no increase in the number of lesions in Weeks 2 or 6. In Group A, combination therapy with IG from Week 6 until Week 10 decreased the extent of MB. In Group C, the extent of MB in Week 2 was greater than in Week 0. There were no significant changes between Weeks 2 and 10. Conclusion: The results suggest that, for combination therapy with NSAIDs and PPIs, the influence of PPIs, which are used to prevent upper GI disorder, on small intestinal lesions depends on the type and dose of PPI. However, long-term combination therapy with NSAIDs and OP did not show any inhibitory effects. Furthermore, long-term follow-up suggested small intestinal adaptation. IG exhibited both preventive and curative effects on small intestinal mucosal injury related to the long-term administration of NSAIDs.
Su1238 The Necessity of Bowel Preparation With Purgative in Small Intestinal Capsule Endoscope Examination Keiji Ozeki*, Hiromi Kataoka, Takashi Joh Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan Background & Aims: Recently the usefulness of small bowel capsule endoscopy (SBCE) in the examination of small bowel disease has become clear. But the poor visualization with bubbles, intraluminal fluid or debris often disturbs exactly diagnosis. And so the bowel preparation of different dose of purgatives (polyethylene glycol (PEG), sodium phosphate solution or sennoside A/B) or prokinetics(metoclopramide or domperidon and so on) and anti-bubble agents(simethicone) before SBCE were reported to assess the efficacy of small bowel clearing quality. However the efficacy of both purgatives and prokinetics on capsule endoscopy pretreatment is still controversial. The aim of this study was to compare the quality of visualization, as well as diagnostic yield and rate of complete small bowel exploration with cecum visualization, using three different small bowel clearing protocol including no bowel preparation of purgative. Methods: Between June 2008 and November 2014, one hundred forty-eight patients (male: female, 91:57, the mean age was 58.820.0 years old) were conducted SBCE in our hospital. They were divided into three groups with bowel preparation of SBCE. Group A was included 32 patients followed 24h (whole one day) fasting without any bowel preparation. Group B was included 56 patients followed 11h (overnight) fasting without any bowel preparation. And group C was included 60 patients followed bowel pretreatment with purgatives prior to SBCE regardless of the time of fasting. The quality of visualization with SBCE was assessed with according to the proportion of mucosal visible by 5-points (The score of 0 indicates 0-20% mucosal visible with residual materials, 1 indicates 20-40% mucosal visible, 2 indicates 40-60% mucosal visible, 3 indicates 60-80% mucosal visible, 4 indicates 80-100% mucosal visible). And the diagnostic yields, the rate of complete small bowel exploration were also examined. Results: The mean values of visible score in ileum were 2.60.7, 2.40.7 and 2.40.7 in Group A, B, and C. The rates of any findings on SBCE were 84.8%, 75.4% and 78.1%, and the rates of complete small bowel examination were 84.8%, 86.9% and 82.2% in Group A, B and C, respectively. And so these were no significant differences among three groups. Conclusions: In this study, the bowel preparation with purgative on SBCE was not necessary. The procedure without any bowel pretreatment will be tolerated with the patients. The limitation of this study was only single center retrospective examination, so further exploration should be needed.
Purpose: As therapy for NSAID-induced upper gastrointestinal (GI) disorder, proton pump inhibitors (PPIs) are used as standard treatment. However, a basic experiment showed that PPIs deteriorated NSAIDs-induced small intestinal mucosal injury through dysbiosis; their influence on the human small intestine remains to be clarified. In this study, we examined changes in small intestinal lesions after short-/ long-term combination therapy with NSAIDs and PPIs, as well as the effects of ir-
AB322 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
www.giejournal.org