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Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin
Abstracts
Mo1584 Differentiating Small Intestinal Crohn’s Disease From Intestinal Tuberculosis: Can Capsule Endoscopy Help? Surinder S. Rana*, Vishal Sharma, Deepak K. Bhasin Post Graduate Institute of Medical Education & Research, Chandigarh, India Background: Differentiation of intestinal tuberculosis (ITB) from Crohn’s Disease (CD) is an important diagnostic challenge. Capsule endoscopy (CE) can effectively diagnose subtle small intestinal (SI) lesions missed by other modalities. CD may involve large areas of gastrointestinal tract whereas ITB is usually characterised by limited small bowel involvement and therefore we hypothesised that CE may be able to differentiate between CD and ITB by evaluating the extent of involvement of SI. Objective: Prospectively evaluate utility of small bowel CE in differentiating CD from ITB. Methods: Patients with suspected ITB or CD with terminal ileal involvement on ileocolonoscopy were prospectively enrolled. After confirming the patency of the gastrointestinal tract by ingestion and subsequent passage of patency capsule or by Barium enteroclysis or CT Enterography, the patients underwent CE. Results: Thirty two patients (20M; age range: 18-42 years) with ITB and 20 patients (14M; age range 20-54 years) with CD were prospectively studied.The patency of gastrointestinal tract was confirmed with patency capsule in 16 patients with CD and 9 patients with ITB respectively. Remaining patients underwent barium enteroclysis or CT Enterography prior to CE. The patency capsule did not pass out in 2 patients with CD and 4 patients with ITB. Sixteen patients with ITB had a tight stricture on radiological evaluation and 4 patients had confirmatory histopathology with presence of acid fast bacilli (AFB) and therefore CE was not done in these 20 patients. After exclusion, CE was done in 18 patients with CD and 8 patients with ITB respectively. Complete examination was possible in all patients with ITB and 15 (83%) patients with CD. All patients with ITB had terminal ileal involvement along with involvement of ileocecal area in the form of ulceration and nodularity. Six patients had large ulcers and two had aphthous ulcers. Rest small bowel was normal. All patients with CD also had terminal ileal involvement but ileocecal valve involvement was seen in 5 (27.7%) patients. Large ulcers were observed in 7 (39%) patients and aphthous ulcers were observed in 15 (83%) patients. Jejunal involvement as aphthous ulcers and nodularity was seen 4 (22%) and 1 (5%) patients respectively. On comparison with CD, patients with ITB had increased frequency of ileocecal valve involvement (pZ0.001) and lesser frequency of aphthous ulcers (pZ0.007). Asymptomatic involvement of other segments of small bowel was observed in one third of patients with CD in contrast to none of the patients with ITB. Conclusion: CE can help in differentiating CD from ITB with ileocecal valve involvement being more common in ITB and aphthous ulcers as well as multi-segment involvement of small bowel being seen more frequently in CD.
Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin Gladys Bravo Velez, Jesenia Ospina, Hannah P. Lukashok, Miguel Soria Alcívar, Carlos A. Robles-Jara, Raquel S. Del Valle, Carlos Robles-Medranda* Endoscopy, Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador Introduction: Capsule endoscopy (CE) is a diagnostic method that enables visualization of intraluminal bowel, diagnosing disorders not diagnosed effectively. Objectives: To demonstrate the utility and diagnostic effectiveness of CE in patients with diarrhea and initially diagnosed and treated as irritable bowel syndrome and abdominal pain. Methods: Retrospective study (03-2012 / 03-2014) in patients who underwent CE for abdominal pain and / or diarrhea , normal studies: gastroscopy, colonoscopy and laboratory; patients without improvement, previously treated as IBS according to Rome III criteria. We used 2 type of capsules: Mirocam (Intromedic) and SB2 (Given-Imaging).Readings were performed by a single physician who is blinded for the study. Results: 216 CE were reveiwed. 65 (30%) subjects met the criteria. (35/65) or 53.8% were women. Median age was 50 years. Diarrhea was present in 33.8% (22/65) and abdominal pain in 66.1% (43/65). CE with diarrhea subjects showed: atrophy of the villi in 18.1% (4/22), and ulcers compatible with inflammatory bowel disease (IBD) 36.3% (n Z 8/22), normal study in 45.4% (n Z 10/22). CE in -abdominal pain subjects detected: ascaridiasis 2.3% (nZ1/43), atrophy of villi in 23.2% (nZ10/43), IBD in 25.5% (nZ11/43), gastroparesis in 6.9% (n Z 3/ 43), submucosal tumor 2.3% (n Z 1/43), nonspecific erythema 4.65% (nZ2).In total, the CE detected 48% more lesions that had a clinical impact of 100%. Conclusions: The CE showed an important role in managing IBS patients with no response to treatment.
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Mo1586 Assessment Tool to Evaluate Competency of Capsule Endoscopy Pre-Reader Tamotsu Sagawa*1, Hidetoshi Ohta2, Yasushi Sato3, Yasuhiro Sato1, Tsuyoshi Hayashi3, Tokiko Nakamura1, Koshi Fujikawa1, Yasuo Takahashi1 1 Division of Gastroenterology, National Hospital Organization HOKKAIDO Cancer Center, Sapporo, Japan; 2Division of Gastroenterology, Sapporo Orthopedics and Cardiovascular Hospital, Sapporo, Japan; 3Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan Background: Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. A major problem of CE is that it is time consuming to read one case. One way to overcome this issue is interpretation support by CE “Pre-Readers”. However, the quality assurance and quality control of the CE procedure can be difficult to maintain, if CE data are not interpreted by qualified “PreReaders”. On the other hand, there is no validated assessment tool to evaluate CE competency. Aim: The aim of this study was to evaluate by Pre-Reader Assessment Form whether, following adequate training, Pre-Readers are capable of detecting all significant lesions without reducing the diagnostic accuracy of the procedure. Materials and Methods: We created a CE Pre-Reader Assessment Form with listings of potential findings in the small bowel. Before the study, trainees as Pre-Readers received education about RAPIDÒ for PillCam Software. Pre-Readers were 3 endoscopy technicians who received a lecture on e-learning by JACE (The Japanese Association for Capsule Endoscopy) and 2 medical engineers who did not receive. The 15 educational cases including three categories (vascular lesions, ulcerative lesions, neoplastic lesions, each 5 cases) in this study were selected from our hospital. PreReaders reviewed 15 cases and completed the assessment form from January 2014 to March 2014. The physician reviewer (T.S.) individually reviewed as the gold standard and then evaluated the assessment form. Critique was provided on the same form, agreement, missed lesion, overcalled. Results: Agreement(A)/missed lesion(M)/ overcalled(O) were observed in 73.3%/22.7%/4.0%, respectively. A/M/O were 88.9%/ 11.1%/0% in endoscopy technicians, 50%/40%/10% in medical engineers. The diagnostic competency of endoscopy technicians who received a lecture on e-learning was superior to the diagnostic competency of medical engineers who did not receive. The agreement rate was high in vascular and ulcerative lesions. Even if trainees had received e-learning, it was difficult for them to accurately diagnose neoplastic lesions. Conclusion: In this study, we have demonstrated that Pre-Reader Assessment Form can be used to evaluate diagnostic competency of Pre-Readers. Our findings confirmed that endoscopy technicians, after an adequate training, was highly accurate in detecting the significant lesions. However, based on our results, feedback should be required for the improvement of diagnostic accuracy in neoplastic lesions.
Mo1587 The Detection of Small Intestine Lesion Using PillCam SB3. -Has the Efficiency Been Achieved? Teppei Omori*, Tomoko Kuriyama, Ayumi Ito, Hiroyuki Konishi, Shinichi Nakamura, Keiko Shiratori Institute of gastroenterology, Tokyo women’s medical university, Tokyo, Japan Objective: PillCam SB3 is characterized by the automatic conversion of the imaging frame rate and the improvement of the image resolution which are realized by using in combination with the DR3 recorder. In addition, it is considered that the efficiency of detection has been achieved by the improvement of the video processing function using in combination with the interpretation software RAPID Reader8. In this study, we calculated the interpretation time and the diagnostic contribution rate when using SB3 and examined the actual efficiency. Patients and Methods: A total of 64 patients who underwent small intestine capsule endoscopy performed at our hospital, were categorized into the following 2 groups: the SB2 plus group (30 patients) and the SB3 group (34 patients) to compare the gastrointestinal transit time, total testing time, interpretation time, number of the thumbnails, and diagnostic contribution rate of findings of each examination. RAPID Reader8 was used as the radiogram interpretation software for both groups. The interpretation time was defined as the time required from the start of the radiogram interpretation to the completion of the report. Result: There was no significant difference in the patient background between the two groups. The gastrointestinal transit time of the SB2 plus group vs. the SB3 group was as follows: the esophageal transit time: 6.39.2 vs. 6.212.4 seconds, the stomach transit time: 1822.1 vs. 2141.1 minutes, the small intestinal transit time: 262.2170 vs. 233.3134 minutes, the large intestinal sojourn time: 217.3131.7 vs. 176.5109.3 minutes, and the total testing time: 497.7232.3 vs. 431.7118.6 minutes. There was no significant difference between the both groups. The interpretation time of the SB2 plus group vs. the SB3 group was 32.315.1 minutes [95％CI:26.6-37.9 min.] and 15.84.2 minutes [95％CI:14.3-17.3 min.], respectively, which indicated a significant reduction of the interpretation time in the SB3 group (p＜0.0001). The number of the thumbnails in the SB2 plus group vs. the SB3 group was 18.311.8 vs. 14.16.7, which indicated no significance between the two groups (pZ0.32). The diagnostic contribution rate of the SB2 plus group vs. the SB3 group was 56.7% vs. 79.4% (pZ0.0625), which indicated a slightly
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB475
Mo1584 Differentiating Small Intestinal Crohn’s Disease From Intestinal Tuberculosis: Can Capsule Endoscopy Help? Surinder S. Rana*, Vishal Sharma, Deepak K. Bhasin Post Graduate Institute of Medical Education & Research, Chandigarh, India Background: Differentiation of intestinal tuberculosis (ITB) from Crohn’s Disease (CD) is an important diagnostic challenge. Capsule endoscopy (CE) can effectively diagnose subtle small intestinal (SI) lesions missed by other modalities. CD may involve large areas of gastrointestinal tract whereas ITB is usually characterised by limited small bowel involvement and therefore we hypothesised that CE may be able to differentiate between CD and ITB by evaluating the extent of involvement of SI. Objective: Prospectively evaluate utility of small bowel CE in differentiating CD from ITB. Methods: Patients with suspected ITB or CD with terminal ileal involvement on ileocolonoscopy were prospectively enrolled. After confirming the patency of the gastrointestinal tract by ingestion and subsequent passage of patency capsule or by Barium enteroclysis or CT Enterography, the patients underwent CE. Results: Thirty two patients (20M; age range: 18-42 years) with ITB and 20 patients (14M; age range 20-54 years) with CD were prospectively studied.The patency of gastrointestinal tract was confirmed with patency capsule in 16 patients with CD and 9 patients with ITB respectively. Remaining patients underwent barium enteroclysis or CT Enterography prior to CE. The patency capsule did not pass out in 2 patients with CD and 4 patients with ITB. Sixteen patients with ITB had a tight stricture on radiological evaluation and 4 patients had confirmatory histopathology with presence of acid fast bacilli (AFB) and therefore CE was not done in these 20 patients. After exclusion, CE was done in 18 patients with CD and 8 patients with ITB respectively. Complete examination was possible in all patients with ITB and 15 (83%) patients with CD. All patients with ITB had terminal ileal involvement along with involvement of ileocecal area in the form of ulceration and nodularity. Six patients had large ulcers and two had aphthous ulcers. Rest small bowel was normal. All patients with CD also had terminal ileal involvement but ileocecal valve involvement was seen in 5 (27.7%) patients. Large ulcers were observed in 7 (39%) patients and aphthous ulcers were observed in 15 (83%) patients. Jejunal involvement as aphthous ulcers and nodularity was seen 4 (22%) and 1 (5%) patients respectively. On comparison with CD, patients with ITB had increased frequency of ileocecal valve involvement (pZ0.001) and lesser frequency of aphthous ulcers (pZ0.007). Asymptomatic involvement of other segments of small bowel was observed in one third of patients with CD in contrast to none of the patients with ITB. Conclusion: CE can help in differentiating CD from ITB with ileocecal valve involvement being more common in ITB and aphthous ulcers as well as multi-segment involvement of small bowel being seen more frequently in CD.
Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin Gladys Bravo Velez, Jesenia Ospina, Hannah P. Lukashok, Miguel Soria Alcívar, Carlos A. Robles-Jara, Raquel S. Del Valle, Carlos Robles-Medranda* Endoscopy, Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador Introduction: Capsule endoscopy (CE) is a diagnostic method that enables visualization of intraluminal bowel, diagnosing disorders not diagnosed effectively. Objectives: To demonstrate the utility and diagnostic effectiveness of CE in patients with diarrhea and initially diagnosed and treated as irritable bowel syndrome and abdominal pain. Methods: Retrospective study (03-2012 / 03-2014) in patients who underwent CE for abdominal pain and / or diarrhea , normal studies: gastroscopy, colonoscopy and laboratory; patients without improvement, previously treated as IBS according to Rome III criteria. We used 2 type of capsules: Mirocam (Intromedic) and SB2 (Given-Imaging).Readings were performed by a single physician who is blinded for the study. Results: 216 CE were reveiwed. 65 (30%) subjects met the criteria. (35/65) or 53.8% were women. Median age was 50 years. Diarrhea was present in 33.8% (22/65) and abdominal pain in 66.1% (43/65). CE with diarrhea subjects showed: atrophy of the villi in 18.1% (4/22), and ulcers compatible with inflammatory bowel disease (IBD) 36.3% (n Z 8/22), normal study in 45.4% (n Z 10/22). CE in -abdominal pain subjects detected: ascaridiasis 2.3% (nZ1/43), atrophy of villi in 23.2% (nZ10/43), IBD in 25.5% (nZ11/43), gastroparesis in 6.9% (n Z 3/ 43), submucosal tumor 2.3% (n Z 1/43), nonspecific erythema 4.65% (nZ2).In total, the CE detected 48% more lesions that had a clinical impact of 100%. Conclusions: The CE showed an important role in managing IBS patients with no response to treatment.
www.giejournal.org
Mo1586 Assessment Tool to Evaluate Competency of Capsule Endoscopy Pre-Reader Tamotsu Sagawa*1, Hidetoshi Ohta2, Yasushi Sato3, Yasuhiro Sato1, Tsuyoshi Hayashi3, Tokiko Nakamura1, Koshi Fujikawa1, Yasuo Takahashi1 1 Division of Gastroenterology, National Hospital Organization HOKKAIDO Cancer Center, Sapporo, Japan; 2Division of Gastroenterology, Sapporo Orthopedics and Cardiovascular Hospital, Sapporo, Japan; 3Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan Background: Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. A major problem of CE is that it is time consuming to read one case. One way to overcome this issue is interpretation support by CE “Pre-Readers”. However, the quality assurance and quality control of the CE procedure can be difficult to maintain, if CE data are not interpreted by qualified “PreReaders”. On the other hand, there is no validated assessment tool to evaluate CE competency. Aim: The aim of this study was to evaluate by Pre-Reader Assessment Form whether, following adequate training, Pre-Readers are capable of detecting all significant lesions without reducing the diagnostic accuracy of the procedure. Materials and Methods: We created a CE Pre-Reader Assessment Form with listings of potential findings in the small bowel. Before the study, trainees as Pre-Readers received education about RAPIDÒ for PillCam Software. Pre-Readers were 3 endoscopy technicians who received a lecture on e-learning by JACE (The Japanese Association for Capsule Endoscopy) and 2 medical engineers who did not receive. The 15 educational cases including three categories (vascular lesions, ulcerative lesions, neoplastic lesions, each 5 cases) in this study were selected from our hospital. PreReaders reviewed 15 cases and completed the assessment form from January 2014 to March 2014. The physician reviewer (T.S.) individually reviewed as the gold standard and then evaluated the assessment form. Critique was provided on the same form, agreement, missed lesion, overcalled. Results: Agreement(A)/missed lesion(M)/ overcalled(O) were observed in 73.3%/22.7%/4.0%, respectively. A/M/O were 88.9%/ 11.1%/0% in endoscopy technicians, 50%/40%/10% in medical engineers. The diagnostic competency of endoscopy technicians who received a lecture on e-learning was superior to the diagnostic competency of medical engineers who did not receive. The agreement rate was high in vascular and ulcerative lesions. Even if trainees had received e-learning, it was difficult for them to accurately diagnose neoplastic lesions. Conclusion: In this study, we have demonstrated that Pre-Reader Assessment Form can be used to evaluate diagnostic competency of Pre-Readers. Our findings confirmed that endoscopy technicians, after an adequate training, was highly accurate in detecting the significant lesions. However, based on our results, feedback should be required for the improvement of diagnostic accuracy in neoplastic lesions.
Mo1587 The Detection of Small Intestine Lesion Using PillCam SB3. -Has the Efficiency Been Achieved? Teppei Omori*, Tomoko Kuriyama, Ayumi Ito, Hiroyuki Konishi, Shinichi Nakamura, Keiko Shiratori Institute of gastroenterology, Tokyo women’s medical university, Tokyo, Japan Objective: PillCam SB3 is characterized by the automatic conversion of the imaging frame rate and the improvement of the image resolution which are realized by using in combination with the DR3 recorder. In addition, it is considered that the efficiency of detection has been achieved by the improvement of the video processing function using in combination with the interpretation software RAPID Reader8. In this study, we calculated the interpretation time and the diagnostic contribution rate when using SB3 and examined the actual efficiency. Patients and Methods: A total of 64 patients who underwent small intestine capsule endoscopy performed at our hospital, were categorized into the following 2 groups: the SB2 plus group (30 patients) and the SB3 group (34 patients) to compare the gastrointestinal transit time, total testing time, interpretation time, number of the thumbnails, and diagnostic contribution rate of findings of each examination. RAPID Reader8 was used as the radiogram interpretation software for both groups. The interpretation time was defined as the time required from the start of the radiogram interpretation to the completion of the report. Result: There was no significant difference in the patient background between the two groups. The gastrointestinal transit time of the SB2 plus group vs. the SB3 group was as follows: the esophageal transit time: 6.39.2 vs. 6.212.4 seconds, the stomach transit time: 1822.1 vs. 2141.1 minutes, the small intestinal transit time: 262.2170 vs. 233.3134 minutes, the large intestinal sojourn time: 217.3131.7 vs. 176.5109.3 minutes, and the total testing time: 497.7232.3 vs. 431.7118.6 minutes. There was no significant difference between the both groups. The interpretation time of the SB2 plus group vs. the SB3 group was 32.315.1 minutes [95％CI:26.6-37.9 min.] and 15.84.2 minutes [95％CI:14.3-17.3 min.], respectively, which indicated a significant reduction of the interpretation time in the SB3 group (p＜0.0001). The number of the thumbnails in the SB2 plus group vs. the SB3 group was 18.311.8 vs. 14.16.7, which indicated no significance between the two groups (pZ0.32). The diagnostic contribution rate of the SB2 plus group vs. the SB3 group was 56.7% vs. 79.4% (pZ0.0625), which indicated a slightly
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB475