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32 P Successful diagnosing of a gastrointestinal stromal tumor (GIST) by wireless capsule enteroscopy in a patient with a history of obscure gastrointestinal bleeding: A case report
Diagnostic endoscopy
29 OP
31 P
CLlNlCAI USEFULNESS OF INTRADUCTAI. ULTRASONOGRAPHY lN PATIENTS WITH BlLIARY STENOSISOF UNKNOWN ORIGIN C. De Angels #, P. CXUCCI #, N Leone#, S. Caronna#,F Cuni #, N Pagano#, A RepictP, C Barlet #,G. Saracco# , A. Foco =,A. Garbanni ‘, M Rirzetto 4 WDrpanmentof Gastmentemlogy.Mohnetw Hosp”al, Tur,” (Italy): ~Departmentof Emergency Surgery, Molinetlc Haspd Turin (Italy). Backmound and aim: some studiesfrom Jaoanereand tierma” zrouos have statedthe accuracy of intraductalultrasonogmphy(IDUS) m pancrcato-biliary diseasesbut usefulness and climcal impact ofthis “cw diagnostictool IS stdl debated We try to evaluateif IDUS can add useful i”fo~&utio” I” patients61s) with biliary strictures of”“& origin in which the results ofother “xagtng techniquesand brushingcytology were doubttil. Material and methods I4 pts (I I men,mean age62 +I I years) suspectedofhawng strictures of the extraheoaticbile duct (BD). not diaroosed bv other technioues.underwentIDUS with a thrncahber &asonic probe (Aioka, 6 Fy, 20 MIiz) insertedin& Su throughthe worklng channel of the duodenoscopeduring ERCP. In 2 pts further information were achxved by concomitant pancreaticIDUS. Six ptr underwent surgery so that histologIcaldatacould be comparedto IDUS results Results: IDUS could seethe presenceandthe level of the strictore in all the pts In 8 of them a BD cancer was dugnosed; in 1 IDUS was doubtful about a BD cancer invading the pancreasor a pancreatic cancer intiltrating the BD, in 2 an ampullomawas diagnosed,in the remaining 3 pts the stenosisseenon IDUS was defined ah benign. I” 6 pts IDUS results were confirmed by surgery (1 pancreaticcancer infiltrating the BD, I papillary cancer; 2 biliary cancer and2 inflammata~strictures) One pt supposedto have biliary cancer developedhepaticMTS. Two pts with suspectedBD cancer on IDUS did “01 undergosugery becauseover 75 years but the deseaseis in progress and the diarmoslshas bee” confirmed bv TC and ERCP: I ot wth susoectedBD cancer o” IDUS has be& lost at follow-up; 2 pti with suspectedbilia{tumor are’witing for surgery One pt with suspectedxnflammatotystrictwe is still well after 6 months follow up; I pt wth a susoectedoaoillarv adenomahas beenfollowinn “o andis well uo to now. US oerformed m all bts showedjwi i”tia and extrahepaticBD di?atl’o”,without an; infonnation’abautthe nature andthe level of the stricture The nature ofthe stenosis could be definedjw in 211I pts studiedby CT (I was doubtful and I showedhepaucMTS), in Z/4 by RMN and3114 by ERCP. Brushing cytology was negativem 811I, includedthe pt with pancreaticcancer mliltmting the RD. while it was doubtful m I pt wth a benign smctore hystologically confirmed; finally I papdIary biopsy was positive Conclusions: IDUS proved useful in assessmgthe nature of the blbary stenosisand in showing the level and theexact extensionof the stricture and shouldprove of value in the assessmentoftomor invasioninto the pancreas,portal vein and hepatr away, so definangthe most appropriatetrcatmcntpk,“. I
I
PATIENTS’ PSYCHOLOGICAL DISTRESS AND TOLERABILITY DURING GIVENM2A CAPSULE ENDOSCOPY FOR SMALL BOWEL EXAMINATION M De Bona, A Bellumat, M De Boni U 0 Gastroentemlogia,Ospedaledi F&e (BI) The GIVEN M2A @is a new diagnostic tool for small bowel exa,m~nationThe system consists on a swallowable caps&de(30x11 mm), a recorder (I 5 kg) worn on patient’sbelt and a workstation The capsule takes 2 video imagesper secondduring GI tract natural peristaltic activity and transmits them to B recorder, which is connected to an antetmaarray applied to the abdominal wall AAer examination, data are transferred to the workstation for interpretation AIMS of this stody were 1 to evaluate patients’tolerabihty of this new procedure, 2 to evaluate psychological distress associated to capsule endoscopy compared with other endoxopic preocedures METHODS- Fifteen oatients were referred to capsule endoscoov for some&d small bowel bleeding or neoplastic lesion All but two of them were outpat&s ARei the examination each patientcompleted a questionnare which evaluated compliance to overnight fastine. bowel prepuatioh with saline solution, swallow and ova&o” of the caps& weight if the recorder and any other difficulty related to the procedure Before and after the exam patients’ distress and anxiety were evaluated using a s&quantitative score and they were compared with a control group representedby patients attending endoscopic precedures (upper GI endoscopv and/or colonosw~~) RESUL’&: All patients c&&ted the exam without any complication Capsuleendoscopy was considered a well tolerated procedure, wthout any problems relatedto bowel preparationor fasting. As for the equipment is concemeh, patients had no problems either for the recorder weight or in swallowing the capsule, two patientsonly referred a feeling of anxiety m swallowing a” intemtittent light device None ofthe patientsexperienced side effects during the exam Psychological distress and anxiety in patients before and during capsule endoscopy were significantly lower than 1” patientswho underwent upper Gl endoscopy amVor colonoscopy CONCLUSIONS Capsuleendorcopy is a safe and painlessprocedure All patients ingested the capsuleeasily andevacuated it without any complication The exam is associatedwith less psychological distress than other endoscopic procedures
30 P THE OUTCOME OF EUS-NEGATIVE PATIENTS WITH SUSPECTED CHOLEDOCHOLITHlASIS L Lodi, E L&&go, F Rocca
Introduction: The value of endoscopic ultrasonography (EUS) in detecting common bile duct (CBD) stone has been reported in many studies. I” a previous prospective series of 143 pts we assessedthe diagnostic usefulness bf EUS for ch&docho~thi&is and proved that th’e accuracy was similar to ERCP The aim of thts study was to evaluate the outcome of patients rvlth suspected choledocholithiasis in whom EUS WBSnegatwe for CBD stones Methods: We searched our EUS-database for pts with suspected choledocholithiasis in whom EUS was negative for CBD stones after the introduction of EUS as diagnostic tool for choledocholitbiasis instead of ERCP. For follow up. the patients were contacted and asked to answer a questionnaire about new symptoms. Results: Between January 2000 and July 2001 164pts underwatt EUS for suspected choledocholitbiasis at our Institution. EUS showed CBD stones in 68 (41%) Forty-three (56%) pts (24 males, mean age 64) with normal EUS may be contacted by phone and all~wer a questionnaire. Mean follow up was 15.8 months (range 5,5-24,9) Only two pts (0.4%). either with gallstones had new symptoms before colecistectomy In this pts EUS was negative for CBD stones yet Twenty-four pts underwent colecistectomy, all without mtraopaative cholangiography and nobody had symptoms before andafter surgery (mea” follow up 16 months) Seventeenpts do not have colecistectomy yet and no one experienced symptoms during the follow up (mea” follow up I4 month) Twelve pts without gallbladder remain all asymptomatic Conclusion EUS IS a vahd method for ~dentificatlonofCBD stones, wth h!gh sensmwty and high specificity yet
SUCCESSFULDIAGNOSING OF A GASTROTNTESTINAL STROMAL TUMOR (GIST) BY WIRELESS CAPSULE ENTEROSCOPY IN A PATIENT WITH A HISTORI OF OBSCUKE GASTROINTESTINAL BLEEDING: A CASE REPORT. R. de Franchis $, C Abbiatl 5, G. Beccarl 5, E. Kondonotb$,L. Beretta#, M. Pnmlgnani 5, M “etch, $ BSewizlo dl Gastraenterologiaed EndoscoplaDtgestiva, Universita degh Stud,dl Mdano, IRCCS OspedaleMaggiore Policlinico, Milana; #Sewizio di EndoscopmDigestiva, Dipammento di Medicina lntema, Anenda OspedalieraS.Gerardo,Mona The GIVEN 0 wrelcss capsule endoscopicsystem is a new tool for thedmgnosis of small bowel lessons.We report a caseof an ileal lesionmissed by other diagnostictools tind identified by meansofthe GIVEN b system m a 44-year-old ma”, with a” history of won deticlency anemia andfecal occult bleeding. Medical history Over the past 2 years the patienthad had recurrent episodesof athralgia and fatigue,associatedwith iron deticxncy anemia (Hb 7.3 gidl) andpositive stool guaiac test. For this reason,hehad beensubmittedto 3 upper GI endorcopies,2 colonoscopics, I push enteroscopyand 1 abdominalCT scan with negative results Only a ““clear scan with labeledred cells had shown a possiblebleedingsite in the terminalileum. The patlentwas receivmg chmmc ro” therapy. Methods: The GIVEN @ system comprisesa swallowable capsule,a recorder, anda workstation. The capsuletransmm video imagesacqwed during “atoral propulno” through the digestive system to the recorder. Atier exammatio”, dataare transferredto the workstation for interpretation. Results: Passagethroughthe pylons occurred 7 ‘IO ’ after ingestion.At lh52 ‘I3 ’ ’ after ingestlon,apolypaid whltlsh lesionwith a red strip was seea about 1cm in diameter Downstreamfrom th,s w,“t. coffee moundsmaterialwas sea, throwho”, the small bowel The causeof bleeding&as interpretei as a possiblelypoma. neoplasmor inverted divert~culum.Locab~t~o” by meansof a dcdxatcd sot&x indtcatedthe distal ieiunum/oroximal ileum as the sateof the bleeding lesson ~&lo& The patientunderwentlaparotomy:at-2 m 50 cm beyond theligament ofTrcit/, 8 3.cm, predominantlyextrinsic ileal nodule was found. A segmentalbowel resectionwas done. Histopathologyreport describeda 4 cm ulceratedGIST, infiltrating the whole mtestinalwall, with focal necrosis, a mitotic count of 2110HPF. Margins of resection were Ike of tumor The patienthada” uneventful recovery andhadnormal red cells co”“, smce the operation.Conclusions: The GIVEN D system could Ident,@a “eoplastic lesion (GIST) that hadbee” m,ssedby other dmgnostictools such asabdom,“al CT scan, andwas not reachedby push enteroscopy.
All7
29 OP
31 P
CLlNlCAI USEFULNESS OF INTRADUCTAI. ULTRASONOGRAPHY lN PATIENTS WITH BlLIARY STENOSISOF UNKNOWN ORIGIN C. De Angels #, P. CXUCCI #, N Leone#, S. Caronna#,F Cuni #, N Pagano#, A RepictP, C Barlet #,G. Saracco# , A. Foco =,A. Garbanni ‘, M Rirzetto 4 WDrpanmentof Gastmentemlogy.Mohnetw Hosp”al, Tur,” (Italy): ~Departmentof Emergency Surgery, Molinetlc Haspd Turin (Italy). Backmound and aim: some studiesfrom Jaoanereand tierma” zrouos have statedthe accuracy of intraductalultrasonogmphy(IDUS) m pancrcato-biliary diseasesbut usefulness and climcal impact ofthis “cw diagnostictool IS stdl debated We try to evaluateif IDUS can add useful i”fo~&utio” I” patients61s) with biliary strictures of”“& origin in which the results ofother “xagtng techniquesand brushingcytology were doubttil. Material and methods I4 pts (I I men,mean age62 +I I years) suspectedofhawng strictures of the extraheoaticbile duct (BD). not diaroosed bv other technioues.underwentIDUS with a thrncahber &asonic probe (Aioka, 6 Fy, 20 MIiz) insertedin& Su throughthe worklng channel of the duodenoscopeduring ERCP. In 2 pts further information were achxved by concomitant pancreaticIDUS. Six ptr underwent surgery so that histologIcaldatacould be comparedto IDUS results Results: IDUS could seethe presenceandthe level of the strictore in all the pts In 8 of them a BD cancer was dugnosed; in 1 IDUS was doubtful about a BD cancer invading the pancreasor a pancreatic cancer intiltrating the BD, in 2 an ampullomawas diagnosed,in the remaining 3 pts the stenosisseenon IDUS was defined ah benign. I” 6 pts IDUS results were confirmed by surgery (1 pancreaticcancer infiltrating the BD, I papillary cancer; 2 biliary cancer and2 inflammata~strictures) One pt supposedto have biliary cancer developedhepaticMTS. Two pts with suspectedBD cancer on IDUS did “01 undergosugery becauseover 75 years but the deseaseis in progress and the diarmoslshas bee” confirmed bv TC and ERCP: I ot wth susoectedBD cancer o” IDUS has be& lost at follow-up; 2 pti with suspectedbilia{tumor are’witing for surgery One pt with suspectedxnflammatotystrictwe is still well after 6 months follow up; I pt wth a susoectedoaoillarv adenomahas beenfollowinn “o andis well uo to now. US oerformed m all bts showedjwi i”tia and extrahepaticBD di?atl’o”,without an; infonnation’abautthe nature andthe level of the stricture The nature ofthe stenosis could be definedjw in 211I pts studiedby CT (I was doubtful and I showedhepaucMTS), in Z/4 by RMN and3114 by ERCP. Brushing cytology was negativem 811I, includedthe pt with pancreaticcancer mliltmting the RD. while it was doubtful m I pt wth a benign smctore hystologically confirmed; finally I papdIary biopsy was positive Conclusions: IDUS proved useful in assessmgthe nature of the blbary stenosisand in showing the level and theexact extensionof the stricture and shouldprove of value in the assessmentoftomor invasioninto the pancreas,portal vein and hepatr away, so definangthe most appropriatetrcatmcntpk,“. I
I
PATIENTS’ PSYCHOLOGICAL DISTRESS AND TOLERABILITY DURING GIVENM2A CAPSULE ENDOSCOPY FOR SMALL BOWEL EXAMINATION M De Bona, A Bellumat, M De Boni U 0 Gastroentemlogia,Ospedaledi F&e (BI) The GIVEN M2A @is a new diagnostic tool for small bowel exa,m~nationThe system consists on a swallowable caps&de(30x11 mm), a recorder (I 5 kg) worn on patient’sbelt and a workstation The capsule takes 2 video imagesper secondduring GI tract natural peristaltic activity and transmits them to B recorder, which is connected to an antetmaarray applied to the abdominal wall AAer examination, data are transferred to the workstation for interpretation AIMS of this stody were 1 to evaluate patients’tolerabihty of this new procedure, 2 to evaluate psychological distress associated to capsule endoscopy compared with other endoxopic preocedures METHODS- Fifteen oatients were referred to capsule endoscoov for some&d small bowel bleeding or neoplastic lesion All but two of them were outpat&s ARei the examination each patientcompleted a questionnare which evaluated compliance to overnight fastine. bowel prepuatioh with saline solution, swallow and ova&o” of the caps& weight if the recorder and any other difficulty related to the procedure Before and after the exam patients’ distress and anxiety were evaluated using a s&quantitative score and they were compared with a control group representedby patients attending endoscopic precedures (upper GI endoscopv and/or colonosw~~) RESUL’&: All patients c&&ted the exam without any complication Capsuleendoscopy was considered a well tolerated procedure, wthout any problems relatedto bowel preparationor fasting. As for the equipment is concemeh, patients had no problems either for the recorder weight or in swallowing the capsule, two patientsonly referred a feeling of anxiety m swallowing a” intemtittent light device None ofthe patientsexperienced side effects during the exam Psychological distress and anxiety in patients before and during capsule endoscopy were significantly lower than 1” patientswho underwent upper Gl endoscopy amVor colonoscopy CONCLUSIONS Capsuleendorcopy is a safe and painlessprocedure All patients ingested the capsuleeasily andevacuated it without any complication The exam is associatedwith less psychological distress than other endoscopic procedures
30 P THE OUTCOME OF EUS-NEGATIVE PATIENTS WITH SUSPECTED CHOLEDOCHOLITHlASIS L Lodi, E L&&go, F Rocca
Introduction: The value of endoscopic ultrasonography (EUS) in detecting common bile duct (CBD) stone has been reported in many studies. I” a previous prospective series of 143 pts we assessedthe diagnostic usefulness bf EUS for ch&docho~thi&is and proved that th’e accuracy was similar to ERCP The aim of thts study was to evaluate the outcome of patients rvlth suspected choledocholithiasis in whom EUS WBSnegatwe for CBD stones Methods: We searched our EUS-database for pts with suspected choledocholithiasis in whom EUS was negative for CBD stones after the introduction of EUS as diagnostic tool for choledocholitbiasis instead of ERCP. For follow up. the patients were contacted and asked to answer a questionnaire about new symptoms. Results: Between January 2000 and July 2001 164pts underwatt EUS for suspected choledocholitbiasis at our Institution. EUS showed CBD stones in 68 (41%) Forty-three (56%) pts (24 males, mean age 64) with normal EUS may be contacted by phone and all~wer a questionnaire. Mean follow up was 15.8 months (range 5,5-24,9) Only two pts (0.4%). either with gallstones had new symptoms before colecistectomy In this pts EUS was negative for CBD stones yet Twenty-four pts underwent colecistectomy, all without mtraopaative cholangiography and nobody had symptoms before andafter surgery (mea” follow up 16 months) Seventeenpts do not have colecistectomy yet and no one experienced symptoms during the follow up (mea” follow up I4 month) Twelve pts without gallbladder remain all asymptomatic Conclusion EUS IS a vahd method for ~dentificatlonofCBD stones, wth h!gh sensmwty and high specificity yet
SUCCESSFULDIAGNOSING OF A GASTROTNTESTINAL STROMAL TUMOR (GIST) BY WIRELESS CAPSULE ENTEROSCOPY IN A PATIENT WITH A HISTORI OF OBSCUKE GASTROINTESTINAL BLEEDING: A CASE REPORT. R. de Franchis $, C Abbiatl 5, G. Beccarl 5, E. Kondonotb$,L. Beretta#, M. Pnmlgnani 5, M “etch, $ BSewizlo dl Gastraenterologiaed EndoscoplaDtgestiva, Universita degh Stud,dl Mdano, IRCCS OspedaleMaggiore Policlinico, Milana; #Sewizio di EndoscopmDigestiva, Dipammento di Medicina lntema, Anenda OspedalieraS.Gerardo,Mona The GIVEN 0 wrelcss capsule endoscopicsystem is a new tool for thedmgnosis of small bowel lessons.We report a caseof an ileal lesionmissed by other diagnostictools tind identified by meansofthe GIVEN b system m a 44-year-old ma”, with a” history of won deticlency anemia andfecal occult bleeding. Medical history Over the past 2 years the patienthad had recurrent episodesof athralgia and fatigue,associatedwith iron deticxncy anemia (Hb 7.3 gidl) andpositive stool guaiac test. For this reason,hehad beensubmittedto 3 upper GI endorcopies,2 colonoscopics, I push enteroscopyand 1 abdominalCT scan with negative results Only a ““clear scan with labeledred cells had shown a possiblebleedingsite in the terminalileum. The patlentwas receivmg chmmc ro” therapy. Methods: The GIVEN @ system comprisesa swallowable capsule,a recorder, anda workstation. The capsuletransmm video imagesacqwed during “atoral propulno” through the digestive system to the recorder. Atier exammatio”, dataare transferredto the workstation for interpretation. Results: Passagethroughthe pylons occurred 7 ‘IO ’ after ingestion.At lh52 ‘I3 ’ ’ after ingestlon,apolypaid whltlsh lesionwith a red strip was seea about 1cm in diameter Downstreamfrom th,s w,“t. coffee moundsmaterialwas sea, throwho”, the small bowel The causeof bleeding&as interpretei as a possiblelypoma. neoplasmor inverted divert~culum.Locab~t~o” by meansof a dcdxatcd sot&x indtcatedthe distal ieiunum/oroximal ileum as the sateof the bleeding lesson ~&lo& The patientunderwentlaparotomy:at-2 m 50 cm beyond theligament ofTrcit/, 8 3.cm, predominantlyextrinsic ileal nodule was found. A segmentalbowel resectionwas done. Histopathologyreport describeda 4 cm ulceratedGIST, infiltrating the whole mtestinalwall, with focal necrosis, a mitotic count of 2110HPF. Margins of resection were Ike of tumor The patienthada” uneventful recovery andhadnormal red cells co”“, smce the operation.Conclusions: The GIVEN D system could Ident,@a “eoplastic lesion (GIST) that hadbee” m,ssedby other dmgnostictools such asabdom,“al CT scan, andwas not reachedby push enteroscopy.
All7