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Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding

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World Journal of Gastroenterology 2017年第4期23卷 697-702页

作者： Carlo Maria Girelli Marco Soncini emanuele rondonotti Gastroenterology and Digestive Endoscopy Unit Hospital of Busto Arsizio(VA) Gastroenterology S.Carlo Hospital Gastroenterology Valduce Hospital

AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2(significant findings) and P0-1(normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance(outpatients vs inpatients), bowel cleanliness, and center volume.RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records(62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815(57%) were males. In comparison with patients in the P0-1 group, those in the P2 group(n = 776, 54%) were older(P < 0.0001), had a longer small-bowel transit time(P = 0.0015), and were more frequently examined in low-volume centers(P < 0.001). Age and smallbowel transit time were correlated(P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations(54.5%), inflammatory(23.6%) and protruding(10.4%) lesions, and luminal blood(11.5%).CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.

关键词：囊内视镜检查法小肠的运输时间察觉率诊断产量小肠遮住胃肠的流血 Prokinetics 怀疑小肠的流血

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Capsule endoscopy in neoplastic diseases

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World Journal of Gastroenterology 2008年第34期14卷 5245-5253页

作者： Marco Pennazio emanuele rondonotti Roberto de Franchis Division of Gastroenterology 2 Department of Gastroenterology and Clinical Nutrition S. Giovanni A.S. Hospital University of Milan IRCCS Policlinico MangiagalliRegina Elena Foundation Gastroenterology and Gastrointestinal Endoscopy Unit University of Milan IRCCS Policlinico MangiagalliRegina Elena Foundation Gastroenterology and Gastrointestinal Endoscopy Unit

Until recently, diagnosis and management of small-bowel tumors were delayed by the diffi culty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High- quality images of the small-bowel mucosa may be captured and small and ? at lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion’s endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push- and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings,remains to be determined through carefully-designed studies.

关键词：胶囊内窥镜检查法消化道出血消化系统疾病息肉病

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Small-bowel capsule endoscopy: A ten-point contemporary review

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World Journal of Gastroenterology 2013年第24期19卷 3726-3746页

作者： Anastasios Koulaouzidis emanuele rondonotti Alexandros Karargyris Centre for Liver and Digestive Disorders the Royal Infirmary of EdinburghEdinburgh EH16 4SA Scotland United Kingdom Gastroenterology Unit Ospedale Valduce 22100 Como Italy National Library of Medicine National Institutes of HealthBethesda MD 20814 United States

The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure,is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e. , by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflam-mation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attem

关键词： Capsule endoscopy Calprotectin Meta- analysis Review Preparation Reading software Complication Indications

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Evaluation of 4 three-dimensional representation algorithms in capsule endoscopy images

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World Journal of Gastroenterology 2013年第44期19卷 8028-8033页

作者： Alexandros Karargyris emanuele rondonotti Giovanna Mandelli Anastasios Koulaouzidis National Library of Medicine National Institutes of Health Bethesda MD 20892 United States Gastroenterology Unit Ospedale Valduce 22100 Como Italy Centre for Liver and Digestive Disorders The Royal Infirmary of Edinburgh Edinburgh EH16 4SAScotland United Kingdom

AIM:To evaluate the three-dimensional(3-D)representation performance of 4 publicly available Shapefrom-Shading(SfS)algorithms in small-bowel capsule endoscopy(SBCE).METHODS:SfS techniques recover the shape of objects using the gradual variation of shading.There are4 publicly available SfS algorithms.To the best of our knowledge,no comparative study with images obtained during clinical SBCE has been performed to date.Three experienced reviewers were asked to evaluate 54 twodimensional(2-D)images(categories:protrusion/inflammation/vascular)transformed to 3-D by the aforementioned SfS 3-D algorithms.The best algorithm was selected and inter-rater agreement was calculated.RESULTS:Four publicly available SfS algorithms were compared.Tsai’s SfS algorithm outperformed the rest(selected as best performing in 45/54 SBCE images),followed by Ciuti’s algorithm(best performing in 7/54images)and Torre o’s(in 1/54 images).In 26/54 images;Tsai’s algorithm was unanimously selected as the best performing 3-D representation SfS software.Tsai’s 3-D algorithm superiority was independent of lesion category(protrusion/inflammatory/vascular;P=0.678)and/or CE system used to obtain the 2-D images(MiroCam/PillCam;P=0.558).Lastly,the interobserver agreement was good(kappa=0.55).CONCLUSION:3-D representation software offers a plausible alternative for 3-D representation of conventional capsule endoscopy images(until optics technology matures enough to allow hardware enabled-"real"3-D reconstruction of the gastrointestinal tract).

关键词： Capsule endoscopy Small-bowel Threedimensional Software Algorithm Reconstruction Technology Advance

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Wireless endoscopy in 2020:Will it still be a capsule?

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World Journal of Gastroenterology 2015年第17期21卷 5119-5130页

作者： Anastasios Koulaouzidis Dimitris K Iakovidis Alexandros Karargyris emanuele rondonotti The Royal Infirmary of Edinburgh Endoscopy UnitEH16 4SA EdinburghScotlandUnited Kingdom Department of Computer Engineering Technological Educational Institute of Central Greece35100 LamiaGreece The National Institute of Health BethesdaMD 20810United States Gastroenterology Department Ospedale Valduce22100 ComoItaly

Currently,the major problem of all existing commercial capsule devices is the lack of control of movement.In the future,with an interface application,the clinician will be able to stop and direct the device into points of interest for detailed inspection/diagnosis,and therapy delivery.This editorial presents current commerciallyavailable new designs,European projects and delivery capsule and gives an overview of the progress required and progress that will be achieved-according to the opinion of the authors- in the next 5 year leading to 2020.

关键词： Capsule endoscopy Hardware Future Development

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Small bowel capsule endoscopy in 2007:Indications,risks and limitations

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World Journal of Gastroenterology 2007年第46期13卷 6140-6149页

作者： emanuele rondonotti Federica Villa Chris JJ Mulder Maarten AJM Jacobs Roberto de Franchis Università degli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy VU University Medical Centre Department of Gastroenterology and HepatologyBoelelaan 11171081 HV AmsterdamThe Nederlands Universitàdegli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy

囊内视镜检查法有 revoluzionized 由提供一个可靠方法评估的小肠的学习，内视镜的联盟者，全部小肠。在最后六年里，几份报纸被出版了处于不同临床的条件探索这考试的可能的角色。在现在的时间囊，内视镜检查法通常被推荐为第三考试，... 详细信息

囊内视镜检查法有 revoluzionized 由提供一个可靠方法评估的小肠的学习，内视镜的联盟者，全部小肠。在最后六年里，几份报纸被出版了处于不同临床的条件探索这考试的可能的角色。在现在的时间囊，内视镜检查法通常被推荐为第三考试，在否定双向内视镜检查法以后，在有阴暗胃肠的流血的病人。证据的成长身体也处于象 Crohn 的疾病，乳糜泻，小肠息肉病症候群或小肠肿瘤那样的另外的临床的条件为这考试建议一个重要角色。这考试的主要复杂并发症是在以前未知的小肠苛评的地点的设备的保留。然而，也由于这个工具的技术限制主要有一些另外的开的问题(它没从遥控被驾驶，是不能的拿活体检视到 insufflate 空气，正确地缩放并且定位损害到 suck 液体或碎片并且到有时) 。最近发达的双汽球肠脓毒病，尽管侵略、耗时，由于它的能力指向了活体检视探索小肠的大部分并且拿，能克服囊内视镜检查法的一些限制。在现在预定，在临床的条件的多数(即阴暗官方补给的流血)，赢的策略似乎是联合这二种技术探索小肠在一无痛苦，安全、完全的方法(与囊内视镜检查法)并且识别了定义并且对待损害(与两倍汽球肠寄生物)。

关键词：内窥镜检查小肠肠膜诊断临床医学

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Imaging of the small bowel in Crohn's disease: A review of old and new techniques

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World Journal of Gastroenterology 2007年第24期13卷 3279-3287页

作者： Simone Saibeni emanuele rondonotti Andrea Iozzelli Luisa Spina Gian Eugenio Tontini Flaminia Cavallaro Camilla Ciscato Roberto de Franchis Francesco Sardanelli Maurizio Vecchi Gastroenterology and Gastrointestinal Endoscopy Service IRCCS Fondazione Ospedale Maggiore Policlinico Mangiagalli and Regina Elena Milan Italy Gastroenterology and Gastrointestinal Endoscopy Unit IRCCS Policlinico San Donato University of Milan School of Medicine Milan Italy Radiology Unit IRCCS Policlinico San Donato San Donato Milanese University of Milan School of Medicine Milan Italy Departments of Medical and Surgical Sciences University of Milan School of Medicine Milan Italy Gastroenterology and Gastrointestinal Endoscopy Unit University of Milan School of Medicine Milan Italy Gastroenterology and Gastrointestinal Endoscopy Unit IRCCS Policlinico San Donato University of Milan School of Medicine Milan Italy

The investigation of small bowel morphology is often mandatory in many patients with Crohn's disease. Traditional radiological techniques (small bowel enteroclysis and small bowel follow-through) have long been the only suitable methods for this purpose. In recent years, several alternative imaging techniques have been proposed. To review the most recent advances in imaging studies of the small bowel, with particular reference to their possible application in Crohn's disease, we conducted a complete review of the most important studies in which traditional and newer imaging methods were performed and compared in patients with Crohn's disease. Several radiological and endoscopic techniques are now available for the study of the small bowel; each of them is characterized by a distinct profile of favourable and unfavourable features. In some cases, they may also be used as complementary rather than alternative techniques. In everyday practice, the choice of the technique to be used stands upon its availability and a careful evaluation of diagnostic accuracy, clinical usefulness, safety and cost. The recent development ofinnovative imaging techniques has opened a new and exciting area in the exploration of the small bowel in Crohn's disease patients.

关键词：超声波扫描术医学影像学克罗恩氏病磁共振

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Efficacy and tolerability of high and low-volume bowel preparation compared:A real-life single-blinded large-population study

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World Journal of Gastrointestinal Endoscopy 2021年第12期13卷 659-672页

作者： Vincenzo Occhipinti Paola Soriani Francesco Bagolini Valentina Milani emanuele rondonotti Maria Laura Annunziata Flaminia Cavallaro Sara Vavassori Maurizio Vecchi Luca Pastorelli Gian Eugenio Tontini Digestive Endoscopy and Gastroenterology Unit A.Manzoni HospitalASST LeccoLecco 23900Italy Gastroenterology Unit IRCCS Policlinico San DonatoSan Donato Milanese 20097Italy Gastroenterology and Digestive Endoscopy Unit Azienda USL ModenaCarpi HospitalCarpi 41012Italy Scientific Directorate IRCCS Policlinico San DonatoSan Donato Milanese 20097Italy Gastroenterology Unit Ospedale ValduceComo 22100Italy Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilan 20122Italy Gastroenterology and Hepatology Unit ASST Santi Paolo e CarloMilan 20142Italy Department of Pathophysiology and Transplantation University of MilanMilan 20122Italy Department of Biomedical Sciences for Health University of MilanMilan 20122Italy

BACKGROUND Low-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials(RCT).However,most RCTs do not provide data about clinical outcomes including lesions detection rate.Moreover,real-life comparisons are lacking.AIM To compare efficacy(both in terms of adequate bowel preparation and detection of colorectal lesions)and tolerability of a high-volume(HV:4 L polyethylene glycol,PEG)and a low-volume(LV:2 L PEG plus bisacodyl)bowel preparation in a real-life setting.METHODS Consecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016.Patients could choose either LV or HV preparation,with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures.Adequate bowel preparation according to Boston Bowel Preparation Scale(BBPS),clinical outcomes including polyp detection rate(PDR),adenoma detection rate(ADR),advanced adenoma detection rate(AADR),sessile/serrated lesion detection rate(SDR)and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.RESULTS Total 2040 patients were enrolled and 1815(mean age 60.6 years,50.2%men)finally included.LV was chosen by 52%of patients(50.8%of men,54.9%of women).Split-dose schedule was more common with HV(44.7%vs 38.2%,P=0.005).High-definition scopes were used in 33.4%of patients,without difference in the two groups(P=0.605).HV and LV preparations showed similar adequate bowel preparation rates(89.2%vs 86.6%,P=0.098),also considering the two different schedules(HV split-dose 93.8%vs LV split-dose 93.6%,P=1;HV daybefore 85.5%vs LV day-before 82.3%,P=0.182).Mean global BBPS score was higher for HV preparations(7.1±1.7 vs 6.8±1.6,P<0.001).After adjustment for sex,age and indications for colonoscopy,HV preparation resulted higher in PDR[Odds ratio(OR)1.32,95%CI:1.07-1.63,P=0.011]and ADR(OR 1.29,95%CI 1.02–1.63,P=0.038)and comparable to LV in AADR(OR 1.51,95%CI 0.97-2.35,P=0.069),SDR and cancer detecti

关键词： Bowel preparation volume Polyethylene glycol Bisacodyl Colonoscopy Colonic adenomas Tolerability

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