capsule experience - MG Lorenzatto

More documents

Recommendations

Info

74 Chapter 7 diagnostic tools in 31% of obscure bleeding cases. In large studies involving intraoperative enteroscopy angiodysplasias were identified in 34%-40% of patients. We performed capsule endoscopy in 28 patients with obscureoccult or obscure-overt bleeding and we found bleeding sources in 72% of these patients. In 11 cases the capsule found AVMs: one or multiple flat telangiectasias in 10 patients and jejunal varices in one case. 7 patients showed sites of a bleeding source, in these cases AVMs are also a probable origin of bleeding. Many authors have reported on the increased incidence of AVMs in patients with aortic stenosis (Heyde-syndrome), renal failure, von Willebrand’s disease, cirrhosis and pulmonary disease. Association with aortic stenosis and decrease of bleeding after aortic valve replacement is widely described, but because of methodological flaws of these mostly retrospective studies a clear relationship has not yet be confirmed. Three of our 10 patients with small bowel telangiectasias suffered from additional aortic stenosis. Not all of the other associations have been subjected to critical analysis, but available evidence does not support a strong relationship in most instances. Therapeutic options for vascular abnormalities of the GI tract include interventional-endoscopic procedures like electro- or lasercoagulation, argon plasma coagulation, sclerotherapy and ligation. According to a recent multicenter, randomized clinical trial hormonal replacement therapy does not seem to be useful in the prevention of rebleeding from gastrointestinal angiodysplasia. Vascular abnormalities of the small bowel other than acquired AVMs are rare. Some case reports describe phlebectasia or varices of the small bowel, solitary jejunal or ileal vascular abnormalities or jejunal Dieulafoy’s lesions as gastrointestinal bleeding sources. In one of our younger patients (36 years old) with recurrent obscure-overt bleeding capsule examination could reveal a short part of the jejunum with extensive varices. After successful surgery the patient did not bleed any more. Syndromes like Hereditary Hemorrhagic Telangiectasia (HHT), von Willebrand’s disease, the Blue Rubber Bleb Nevus Syndrome or Klippel-Trenaunay syndrome can be associated with gastrointestinal vascular malformations. Hereditary hemorrhagic telangiectasia is transmitted in an autosomal dominant way and is characterized by multiple telangiectasias of the skin, mucous membranes, extremities, lung and brain. The prevalence of typical telangiectases throughout the gastrointestinal tract is estimated to be about 15 to 44% of persons affected with HHT. Intestinal bleeding occurs in 10 - 40% of these patients, mostly in the older patients with this disorder. Epistaxis is found more frequently in the young. CONCLUSION Vascular Abnormalities Vascular abnormalities are important causes of gastrointestinal bleeding, especially obscure bleeding. The lesions can occur throughout the whole intestine and can often not be reached by conventional endoscopic examinations. In these cases visualization of the total intestine as provided by the M2A ® Capsule is a crucial addition to our diagnostic approach to these cases.
Chapter 7 References and Suggested Readings 1 Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:201-221. 2 Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II; etiology, therapy and outcomes. Gastrointest Endosc 1999;49:228-238 3 Boley SJ, Sprayregen S, Sammartano RJ, Adams A, Kleinhaus S. The pathophysiologic basis for the angiographic signs of vascular ectasis of the colon. Radiology 1977;125:615-621 4 Rogers BHG. Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occuring in elderly patients and associated with cardiac, vascular and pulmonary disease. Gastrointest Endosc 1980;26:134-138 5 Foutch PG, Sawyer R, Sanowski RA. Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin. Gastrointest Endosc 1990;36:337-341 6 Landi B, Tkoub M, Gaudric M, Guimbaud R, Cervoni JP, Chaussade S, Couturier D, Barbier JP, Cellier C. Diagnostic yield of push-type enteroscopy in relation to indication. Gut 1998;42:421-425 7 Schmit A, Gay F, Adler M, Cremer M, van Gossum A. Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias. Dig Dis Sci 1996;41:2348-2352 8 Lewis BS, Waye JD. Chronic gastrointestinal bleeding of obscure origin: role of small bowel enteroscopy. Gastroenterology 1998;94:1117-1120 9 Berner JS, Mauer K, Lewis BS. Push and Sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 1994;89:2139- 2142 10 Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding. Am J Surg 1992;163:90-92 11 Ress AM, Benacci JC, Sarr MG. Efficacy of intraoperative enteroscopy in diagnosis and prevention of recurrent, occult gastrointestinal bleeding. Am J Surg 1992;163:94-98 12 Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding and angiodysplasia: is there an association, Gastroenterology 1988;95:1670-1676 13 Sharma R, Gorbien MJ. Angiodysplasia and lower gastrointestinal tract bleeding in elderly patients. Arch Intern Med 1995;155:807-812 14 Krevsky B. Detection and treatment of angiodysplasias. Gastrointest Endosc Clin N Am 1997;7:509-524 Vascular Abnormalities 15 Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM, Saperas E, Piqué JM, Malagelada J-R. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology 2001;121:1073-1079 16 Kumar P, Salcedo J, al-Kawas FH. Enteroscopic diagnosis of bleeding jejunal phlebectasia: a case report and review of literature. Gastrointest Endosc 1997;46:185-7 17 Chen JJ, Changchien CS, Lin CC. Dieulafoy’s lesion of the jejunum. Hepatogastroenterology 1999;46:1699-701 18 Saunders MP. A solitary jejunal vascular abnormality: a source of massive rectal bleeding. Postgrad Med J 1991;67:683-6 19 Baba R, Hashimoto E, Yashiro K. Multiple abdominal telangiectases and lymphangiectases. A limited form of Osler-Weber-Rendu disease, J Clin Gastroenterol 1995;21:154-157 75
Page 1 and 2:
Atlas of Capsule Endoscopy Editors:
Page 3 and 4:
Atlas of Capsule Endoscopy Marisa H
Page 5 and 6:
Acknowledgments We would like to th
Page 7 and 8:
Table of contents Development of th
Page 9 and 10:
4 Development of the Swallowable Vi
Page 11 and 12:
Notes From the Inventor Gavriel J.
Page 13 and 14:
10 Chapter 1 THE OPTICAL DOME The o
Page 15 and 16:
12 Chapter 1 c. Conscious sedation
Page 17 and 18: 16 Chapter 2 Typical timing of a ca
Page 19 and 20: 18 Chapter 2 Figure 1. Intializing
Page 21 and 22: 20 Chapter 2 Figure 5. Time Capsule
Page 23 and 24: 24 Chapter 3 becomes very obvious.
Page 25 and 26: 26 Chapter 3 M2A ® M2A ® Figure 3
Page 27 and 28: 28 Chapter 3 M2A ® Figure 3.5b Nor
Page 29 and 30: 30 Chapter 3 M2A ® M2A ® Figure 3
Page 31 and 32: Chapter 4 Inflammatory Diseases of
Page 33 and 34: Chapter 4 6 Sayek I, Aran O, Uzunal
Page 35 and 36: Chapter 4 M2A ® M2A ® Figure 4.4a
Page 37 and 38: Chapter 4 M2A ® Figure 4.5f Pseudo
Page 39 and 40: Chapter 4 M2A ® Figure 4.6f Extens
Page 41 and 42: Chapter 4 M2A ® M2A ® Figure 4.10
Page 43 and 44: Chapter 4 M2A ® Figure 4.15a Jejun
Page 45 and 46: 48 Chapter 5 with small bowel tumor
Page 47 and 48: 50 Chapter 5 M2A ® Figure 5.4a Lar
Page 49 and 50: 52 Chapter 5 M2A ® Figure 5.7b Sam
Page 51 and 52: 54 Chapter 5 M2A ® Figure 5.11a A
Page 53 and 54: 56 Chapter 5 Figure 5.12c Biopsy of
Page 55 and 56: 58 Chapter 5 M2A ® Figure 5.15a Ad
Page 57 and 58: 60 Chapter 5 M2A ® Figure 5.18a No
Page 59 and 60: Chapter 6 Iatrogenic Diseases David
Page 61 and 62: Chapter 6 Iatrogenic Diseases M2A
Page 67: Chapter 7 Vascular Abnormalities Ma
Page 71 and 72: Chapter 7 M2A ® Figure 7.2 74 year
Page 73 and 74: Chapter 7 M2A ® Figure 7.8a Small
Page 75 and 76: Chapter 8 Malabsorption Gerard Gay,
Page 77 and 78: Chapter 8 References and Suggested
Page 79 and 80: Chapter 8 Endoscopic management of
Page 81 and 82: Chapter 8 M2A ® M2A ® Figure 8.1e
Page 83 and 84: Chapter 8 Figure 8.3a Enteroscopy p
Page 85 and 86: Chapter 8 M2A ® M2A ® Figure 8.3i
Page 87 and 88: Chapter 8 M2A ® Figure 8.4a Celiac
Page 89 and 90: Chapter 8 Figure 8.6e Histological
Page 91 and 92: Chapter 8 Figure 8.7f Higher magnif
Page 93 and 94: Chapter 8 M2A ® Figure 8.9a 38 yea
Page 95 and 96: 104 Chapter 9 Our preliminary data
Page 97 and 98: 106 Chapter 9 M2A ® M2A ® Figure
Page 99 and 100: 108 Chapter 9 M2A ® Figure 9.4a 11
Page 101 and 102: 112 Chapter 10 transplant. Indicati
Page 103 and 104: 114 Chapter 10 M2A ® Figure 10.2b
Page 105 and 106: 116 Chapter 10 M2A ® Figure 10.4c
Page 107 and 108: 120 Chapter 11 CONCLUSION During th
Page 109 and 110: 122 Chapter 11 M2A ® Figure 11.4a
Page 111 and 112: Contributors Carla Abbiati, M.D. Un
Page 113 and 114: 128 Contributors (continued) Sandor
Page 115 and 116: 130 Contributors (continued) Ana Sa
show all

capsule experience - MG Lorenzatto

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?