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P.178 PILLCAM COLON CAPSULE ENDOSCOPY (PCCE): THE QUALITY OF PREPARATION MAKES THE DIFFERENCE!
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192 developed by a Chinese manufacturer (Jinshan Science & Technology Company, Chongqing, China) and has obtained the CE mark for its marketing in Europe. The main differences between the OMOM CE and the other currently available systems are a slightly bigger size (13x28 mm) and the use of an antenna-carrying jacket. Also, unique features of the OMOM system are the possibility of modulating the speed of frame recording and a significantly low cost. Thus, the aim of the present study was to assess the feasibility, safety and diagnostic yield of the OMOM CE. Material and methods: 36 patients (17 males, 19 females, mean age 56 years, range 19-85) with suspected small bowel disease underwent OMOM CE in 3 Gastroenterology Units. Indications to the exam consisted of the following: obscure gastrointestinal bleeding in 15 patients, diarrhea in 14, known or suspect Crohn’s disease in 4, neuroendocrine tumor in 1, familial adenomatous polyposis in 2. All patients ingested the capsule very easily. Results: Visualization of the entire small bowel was achieved in 35 patients (97%) and capsule retention without obstruction occurred in 1 patient (3%) due to a previously undiagnosed Crohn’s disease stricture in a patient with diarrhea. This patient underwent surgical treatment of the stricture and capsule recovery. In 1 patient a delay in the start of recording was due to a temporary malfunctioning of the system. All videos were classified by a gastroenterologist as: diagnostic, suspicious or negative. Results of CE are shown in the table. Indication
N
Positive
Suspicious
Negative
Obscure GI bleeding Diarrhea Crohn’s disease FAP Neuroendocrine tumor Total
15 14 4 2 1 36
7 (47%) 5 (36%) 3 (75%) 1 (50%) 0 (0%) 16 (44%)
2 (13%) 3 (21%) 1 (25%) 0 (0%) 0 (0%) 6 (17%)
6 (40%) 6 (43%) 0 (0%) 1 (50%) 1 (100%) 14 (39%)
Conclusions: OMOM CE is easy to perform and provides a diagnostic yield similar to other systems in typical indications of CE; in this preliminary series, it reached the ileo-cecal valve in 97% of the patients, a percentage higher than that usually reported for other systems. Thus, OMOM CE appears a very useful and cost-effective endoscopic tool for the evaluation of small bowel diseases. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.177 ILEAL CROHN’S DISEASE (CD) DILATATION WITH SINGLE BALLOON ENTEROSCOPY (SBD) A. Andreoli ∗ ,1 , M. Marrollo 2 , S. Ciletti 2 , A. Tesi 2 , C. Prantera 2 1 Epatology
Unit Azienda Ospedaliera S. Camillo Forlanini, Roma; Unit Azienda Ospedaliera S. Camillo Forlanini, Roma
2 Gastroenterology
Background and aim: Up to 90% of all patients with CD will undergo an operation during the course of their illness. Up to 50% even need further surgical procedures. The most common indication for a surgical treatment is stenosis. Strictureplasty is a safe and effective procedure for jejunoileal CD. Although the small bowel is the predominant site of strictures in CD, endoscopic access is often limited. With Double balloon enteroscopy (DBE), visualization of small intestinal stenosis has become possible and endoscopic balloon dilation has been described. Material and methods: We present a case of hydrostatic balloon dilatation with a SBD with retrograde approach. A 33 yrs old woman with a greater than 10 yrs history of jejunoileal CD treated with multiple bowel resections and stricturoplasty, presented with symptomatic and radiographically confirmed intestinal short stenosis 30 cm far from the ileo-cecal valve proximally. The patient underwent SBE with retrograde approach under general anaesthesia. The stenosis was reached and a TTS balloon passed across the stricture. The balloon was than inflated for one minute, followed by deflation and re-inflation for a further minute. After that it was possible the endoscopic passage. The procedure required 60 min, was well tolerated and there were no complications. Results: DBE is an endoscopic technique that can be used safely and effectively to provide complete examination of the small bowel and offer therapeutic intervention. SBE seems to have similar characteristic to DBE regarding ballon dilatation. One of the most important applications of DBE or
S165
SBE could be the management of small intestinal strictures in CD particularly in patients with the risk of short bowel syndrome. Conclusions: Future studies are now needed to show feasibility, safety and long term outcome of this procedure. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.178 PILLCAM COLON CAPSULE ENDOSCOPY (PCCE): THE QUALITY OF PREPARATION MAKES THE DIFFERENCE! C. Spada ∗ , M. Riccioni, C. Hassan, L. Petruzziello, P. Cesaro, F. De Vincentis, G. Costamagna Digestive Endoscopy Unit, Catholic University, Rome Background and aim: PCCE has been shown feasible and able to demonstrate colonic polyps and cancers. As with other colon imaging techniques the performance of PCCE is dependent on the preparation (prep) quality. Aim is to assess the relation between PCCE diagnostic yield and the quality of prep. PCCE-related adverse events were evaluated. Material and methods: A single Centre experience with PCCE is reported. Patients prospectively enrolled in 2 different clinical trials (MA-53, MA-109) are re-evaluated. The indications for endoscopy included suspected or known colonic diseases. Pts underwent a colonic preparation specifically designed for PCCE and then ingested the capsule on the morning of the examination. Standard colonoscopy (SC) was performed on the same day, after PCCE excretion or, at latest, 10-12 hours post ingestion. PCCE and SC were performed by independent physicians blinded to the results. The colonic cleansing level was graded using a 4 grade scale (excellent, good, fair, poor). Pts with an excellent-to-good prep were considered having an adequate cleansing level. Pts with a fair-to-poor prep were considered having an inadequate cleansing level. Significant findings were defined as at least 1 polyp ≥ 6 mm. Results: 93 pts, with a mean age of 59 (26-83) years were considered for this analysis. One pt was excluded from the efficacy analysis since the capsule remained in the cecum during the entire procedure. Therefore, 92 pts were included in the final analysis. Quality of colon prep in PCCE was evaluated as adequate in 40 pts (43.5%). Overall, PCCE diagnosed a significant finding in 22 out of 92 pts (23.9%). SC diagnosed a significant finding in 32 out of 92 pts (34.8%). When compared with SC, PCCE showed an overall sensitivity, specificity, PPV and NPV of 56.2%, 93.3%, 81.8% and 80%, respectively. The accuracy parameters in relation to the quality of colon prep are listed in Table 1. No PCCE-related adverse were reported. Table 1. Accuracy parameters for polyps ≥6 mm, in relation to the quality of preparation
Adequate colonic cleansing level Inadequate colonic cleansing level p
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
91 38 <0.05
97 90 NS
91 73 NS
97 68 <0.05
Conclusions: Our experience confirms that PCCE represents a safe non invasive-method to explore the colon. There is a strong relation between the quality of cleansing level and sensitivity. When an adequate prep is obtained, accuracy of PCCE tends to be higher and comparable with that of SC. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.179 SINGLE BALLOON ENTEROSCOPY: A SINGLE CENTRE 2-YEAR EXPERIENCE M. Manno ∗ , E. Dabizzi, R. Manta, H. Bertani, V.G. Mirante, C. Barbera, R. Conigliaro Gastroenterology and Digestive Endoscopy Unit, Baggiovara Hospital, Baggiovara di Modena Background and aim: Single-balloon enteroscopy (SBE) is a new technique that enables deep intubation of the endoscope into the small bowel. Through a channel of the endoscope, invasive procedures such as biopsy, polypectomy
N
Positive
Suspicious
Negative
Obscure GI bleeding Diarrhea Crohn’s disease FAP Neuroendocrine tumor Total
15 14 4 2 1 36
7 (47%) 5 (36%) 3 (75%) 1 (50%) 0 (0%) 16 (44%)
2 (13%) 3 (21%) 1 (25%) 0 (0%) 0 (0%) 6 (17%)
6 (40%) 6 (43%) 0 (0%) 1 (50%) 1 (100%) 14 (39%)
Conclusions: OMOM CE is easy to perform and provides a diagnostic yield similar to other systems in typical indications of CE; in this preliminary series, it reached the ileo-cecal valve in 97% of the patients, a percentage higher than that usually reported for other systems. Thus, OMOM CE appears a very useful and cost-effective endoscopic tool for the evaluation of small bowel diseases. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.177 ILEAL CROHN’S DISEASE (CD) DILATATION WITH SINGLE BALLOON ENTEROSCOPY (SBD) A. Andreoli ∗ ,1 , M. Marrollo 2 , S. Ciletti 2 , A. Tesi 2 , C. Prantera 2 1 Epatology
Unit Azienda Ospedaliera S. Camillo Forlanini, Roma; Unit Azienda Ospedaliera S. Camillo Forlanini, Roma
2 Gastroenterology
Background and aim: Up to 90% of all patients with CD will undergo an operation during the course of their illness. Up to 50% even need further surgical procedures. The most common indication for a surgical treatment is stenosis. Strictureplasty is a safe and effective procedure for jejunoileal CD. Although the small bowel is the predominant site of strictures in CD, endoscopic access is often limited. With Double balloon enteroscopy (DBE), visualization of small intestinal stenosis has become possible and endoscopic balloon dilation has been described. Material and methods: We present a case of hydrostatic balloon dilatation with a SBD with retrograde approach. A 33 yrs old woman with a greater than 10 yrs history of jejunoileal CD treated with multiple bowel resections and stricturoplasty, presented with symptomatic and radiographically confirmed intestinal short stenosis 30 cm far from the ileo-cecal valve proximally. The patient underwent SBE with retrograde approach under general anaesthesia. The stenosis was reached and a TTS balloon passed across the stricture. The balloon was than inflated for one minute, followed by deflation and re-inflation for a further minute. After that it was possible the endoscopic passage. The procedure required 60 min, was well tolerated and there were no complications. Results: DBE is an endoscopic technique that can be used safely and effectively to provide complete examination of the small bowel and offer therapeutic intervention. SBE seems to have similar characteristic to DBE regarding ballon dilatation. One of the most important applications of DBE or
S165
SBE could be the management of small intestinal strictures in CD particularly in patients with the risk of short bowel syndrome. Conclusions: Future studies are now needed to show feasibility, safety and long term outcome of this procedure. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.178 PILLCAM COLON CAPSULE ENDOSCOPY (PCCE): THE QUALITY OF PREPARATION MAKES THE DIFFERENCE! C. Spada ∗ , M. Riccioni, C. Hassan, L. Petruzziello, P. Cesaro, F. De Vincentis, G. Costamagna Digestive Endoscopy Unit, Catholic University, Rome Background and aim: PCCE has been shown feasible and able to demonstrate colonic polyps and cancers. As with other colon imaging techniques the performance of PCCE is dependent on the preparation (prep) quality. Aim is to assess the relation between PCCE diagnostic yield and the quality of prep. PCCE-related adverse events were evaluated. Material and methods: A single Centre experience with PCCE is reported. Patients prospectively enrolled in 2 different clinical trials (MA-53, MA-109) are re-evaluated. The indications for endoscopy included suspected or known colonic diseases. Pts underwent a colonic preparation specifically designed for PCCE and then ingested the capsule on the morning of the examination. Standard colonoscopy (SC) was performed on the same day, after PCCE excretion or, at latest, 10-12 hours post ingestion. PCCE and SC were performed by independent physicians blinded to the results. The colonic cleansing level was graded using a 4 grade scale (excellent, good, fair, poor). Pts with an excellent-to-good prep were considered having an adequate cleansing level. Pts with a fair-to-poor prep were considered having an inadequate cleansing level. Significant findings were defined as at least 1 polyp ≥ 6 mm. Results: 93 pts, with a mean age of 59 (26-83) years were considered for this analysis. One pt was excluded from the efficacy analysis since the capsule remained in the cecum during the entire procedure. Therefore, 92 pts were included in the final analysis. Quality of colon prep in PCCE was evaluated as adequate in 40 pts (43.5%). Overall, PCCE diagnosed a significant finding in 22 out of 92 pts (23.9%). SC diagnosed a significant finding in 32 out of 92 pts (34.8%). When compared with SC, PCCE showed an overall sensitivity, specificity, PPV and NPV of 56.2%, 93.3%, 81.8% and 80%, respectively. The accuracy parameters in relation to the quality of colon prep are listed in Table 1. No PCCE-related adverse were reported. Table 1. Accuracy parameters for polyps ≥6 mm, in relation to the quality of preparation
Adequate colonic cleansing level Inadequate colonic cleansing level p
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
91 38 <0.05
97 90 NS
91 73 NS
97 68 <0.05
Conclusions: Our experience confirms that PCCE represents a safe non invasive-method to explore the colon. There is a strong relation between the quality of cleansing level and sensitivity. When an adequate prep is obtained, accuracy of PCCE tends to be higher and comparable with that of SC. # N. Diagnostic endoscopy - 2. Video-capsule/enteroscopy
P.179 SINGLE BALLOON ENTEROSCOPY: A SINGLE CENTRE 2-YEAR EXPERIENCE M. Manno ∗ , E. Dabizzi, R. Manta, H. Bertani, V.G. Mirante, C. Barbera, R. Conigliaro Gastroenterology and Digestive Endoscopy Unit, Baggiovara Hospital, Baggiovara di Modena Background and aim: Single-balloon enteroscopy (SBE) is a new technique that enables deep intubation of the endoscope into the small bowel. Through a channel of the endoscope, invasive procedures such as biopsy, polypectomy