Steroid-sparing strategies in the management of ulcerative colitis

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Online Submissions: http://www.wjgnet.com/esps/ wjg@wjgnet.com doi:10.3748/wjg.v18.i41.6003 Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems Anastasios Koulaouzidis Anastasios Koulaouzidis, Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh EH10 4QU, United Kingdom Author contributions: Koulaouzidis A wrote the paper, analysed data and revised. Correspondence to: Dr. Anastasios Koulaouzidis, MD, MRCP, FEBG, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH10 4QU, United Kingdom. akoulaouzidis@hotmail.com Telephone: +44-131-2421126 Fax: +44-131-2421618 Received: June 16, 2012 Revised: August 21, 2012 Accepted: August 25, 2012 Published online: November 7, 2012 Abstract Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models. A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE) systems (PillCam ® and MiroCam ® ) was performed. The oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis) was captured/identified in almost all (99%) of PillCam ® videos but in none of MiroCam ® cases, P < 0.0001. Furthermore, oesophageal images (i.e., from the upper oesophageal sphincter to the Z-line were captured in 99% of PillCam ® videos (mean ± SD, 60.5 ± 334.1 frames, range: 0-3329 frames) and in 66% of MiroCam ® cases (mean ± SD, 11.1 ± 46.5 frames, range: 0-382 frames), P < 0.0001. The Z-line was identified in 42% of PillCam ® videos and 17% of MiroCam ® , P = 0.0002. This information might be useful when performing SBCE in patients with high risks for aspiration. © 2012 Baishideng. All rights reserved. Key words: Capsule endoscopy; PillCam; MiroCam; Oesophagus; Aspiration; Detection; Z line; Transmission Peer reviewers: Benito Velayos, PhD, Department of Gastroenterology, Hospital Clínico de Valladolid, Av Ramón y Cajal 3, 47003 Valladolid, Spain; Edward J Ciaccio, PhD, Research Scien- WJG|www.wjgnet.com World J Gastroenterol 2012 November 7; 18(41): 6003-6004 ISSN 1007-9327 (print) ISSN 2219-2840 (online) © 2012 Baishideng. All rights reserved. tist, Department of Medicine, HP 804, Columbia University, 180 Fort Washington Avenue, New York, NY 10032, United States Koulaouzidis A. Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems. World J Gastroenterol 2012; 18(41): 6003-6004 Available from: URL: http://www.wjgnet.com/1007-9327/full/v18/i41/6003.htm DOI: http://dx.doi.org/10.3748/wjg.v18.i41.6003 TO THE EDITOR LETTERS TO THE EDITOR Small-bowel capsule endoscopy (SBCE) is likely one of the safest procedures in every day gastroenterology practice. Aside acute small-bowel obstruction from retained capsules [1,2] , aspiration of capsule endoscopes has also been reported [3-5] . Albeit rare -and likely associated with spontaneous resolution-, capsule aspiration is a potentially life-threatening complication and a single fatality has been reported to date [6] . We have previously noted that the MiroCam ® SBCE system (IntroMedic ® Co, Seoul, Korea) has a theoretical advantage, over other SBCE systems, of being smaller in size (11 mm × 24 mm), as well as lighter (3.25 g) [5,7] . The fact that to date there are no reported cases of tracheal aspiration involving MiroCam ® capsules concurs to this. Conversely, PillCam ® is 10.8 mm × 26 mm and weighs 3.45 g. Furthermore, the 2 capsule systems have different centre of gravity and that may have some role in determining the direction of propagation in the small-bowel [7] . The transmission of oesophageal images though may vary between different SBCE models and it is our experience that it fails more frequently with MiroCam ® . In our hospital, a tertiary-care referral centre for capsule endoscopy for the East of Scotland, we have simultaneously operated two SBCE systems (MiroCam ® and PillCam ® SB, Given ® Imaging Ltd, Yokneam, Israel) since May 2009 [8] . We retrospectively reviewed the last 100 examinations performed with each SBCE system in order to check the performance of the 2 systems in capturing images of 6003 November 7, 2012|Volume 18|Issue 41|
Koulaouzidis A. Oesophageal images with 2 capsule systems the upper most part of the gastrointestinal (GI) tract. Procedures involving endoscopic capsule placement (n = 2) and those where a capsule stayed for > 30 min in the oesophagus were excluded (one for each SBCE system). MiroCam ® was used in 51 males/49 females (age: 55.3 ± 16.9 years) with the following indications: suspected/established Crohn’s disease: 25; overt/occult GI bleeding: 64; other indication/s: 11. PillCam ® was used in 34 M/66 F (age: 56.3 ± 14.9 years) of which, 32 had suspected/ established Crohn’s disease, 62 overt/occult GI bleeding and 6 other indication/s. A single, experienced capsule endoscopist (> 1000 SBCE reviews) re-evaluated the SBCE videos for confirmation of capture of oropharyngeal images, number of oesophageal frames and detection of Z-line. Any frame that included a part of Z-line, was calculated as positive for the latter. The Fisher’s exact test, mean ± SD were used; P values of < 0.05 are considered statistically significant. All analyses were performed with GraphPad InStat (GraphPad Software, Inc, La Jolla, United States). Interestingly, the oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis) was captured/identified in almost all (99%) of PillCam ® videos but in none of MiroCam ® cases, P < 0.0001. Furthermore, oesophageal images (i.e., from the upper oesophageal sphincter to the Z-line were captured in 99% of PillCam ® videos (mean ± SD, 60.5 ± 334.1 frames, range: 0-3329 frames) and in 66% of MiroCam ® cases (mean ± SD, 11.1 ± 46.5 frames, range: 0-382 frames), P < 0.0001. The Z-line was identified in 42% of PillCam ® videos and 17% of MiroCam ® , P = 0.0002. MiroCam ® uses electric field propagation rather than radiofrequency, with a single skin electrode, two external contact plates on the capsule and the body as a conductor for signal transmission [9] . This effectively means that a water interface would offer a better conductive surface area and it might explain the scarcity of images from the higher part of the GI tract and -potentially- the lack of documentation of a capsule aspiration. In a recent retrospective study, Hong et al [10] compared the diagnostic yield of MiroCam ® and PillCam ® SB capsules using the detection rates of the Z-line and the duodenal ampulla in a cohort of 141 individuals who under- WJG|www.wjgnet.com went SBCE for various clinical indications. In this cohort, the Z-line was detected in 36.9% of PillCam ® videos and 47.7% of MiroCam ® examinations (P = 0.227). It is useful to remember that the advent of real-time viewers allows us to follow the procedure from the very first steps of capsule ingestion, providing of course that images are captured during this phase. This may have clinical implications, especially when the procedure is performed in unfit, elderly patients or individuals with known swallowing difficulties, since a number of capsule aspiration cases are relatively asymptomatic [4,5] . REFERENCES 1 Höög CM, Bark LÅ, Arkani J, Gorsetman J, Broström O, Sjöqvist U. Capsule retentions and incomplete capsule endoscopy examinations: an analysis of 2300 examinations. Gastroenterol Res Pract 2012; 2012: 518718 2 Lee MM, Jacques A, Lam E, Kwok R, Lakzadeh P, Sandhar A, Segal B, Svarta S, Law J, Enns R. Factors associated with incomplete small bowel capsule endoscopy studies. World J Gastroenterol 2010; 16: 5329-5333 3 Lucendo AJ, González-Castillo S, Fernández-Fuente M, De Rezende LC. Tracheal aspiration of a capsule endoscope: a new case report and literature compilation of an increasingly reported complication. Dig Dis Sci 2011; 56: 2758-2762 4 Despott EJ, O’Rourke A, Anikin V, Davison C, Panter S, Bromley J, Plaice J, Corbett M, Fraser C. Tracheal aspiration of capsule endoscopes: detection, management, and susceptibility. Dig Dis Sci 2012; 57: 1973-1974 5 Koulaouzidis A, Pendlebury J, Douglas S, Plevris JN. Aspiration of video capsule: rare but potentially life-threatening complication to include in your consent form. Am J Gastroenterol 2009; 104: 1602-1603 6 Parker C, Davison C, Panter S. Tracheal aspiration of a capsule endoscope: not always a benign event. Dig Dis Sci 2012; 57: 1727-1728 7 Koulaouzidis A, Douglas S, Plevris JN. Heads or tail orientation in small-bowel capsule endoscopy: 2 capsule models with 2 reviewers. Dig Dis Sci 2012; 57: 1102-1103; author reply 1102-1103 8 Koulaouzidis A, Douglas S, Plevris JN. The Edinburgh experience with two small-bowel capsule endoscopy systems. Gastrointest Endosc 2011; 74: 941; author reply 941-942 9 Fisher LR, Hasler WL. New vision in video capsule endoscopy: current status and future directions. Nat Rev Gastroenterol Hepatol 2012; 9: 392-405 10 Hong SP, Cheon JH, Kim TI, Song SY, Kim WH. Comparison of the diagnostic yield of “MiroCam” and “PillCam SB” capsule endoscopy. Hepatogastroenterology 2012; 59: 778-781 S- Editor Gou SX L- Editor A E- Editor Zhang DN 6004 November 7, 2012|Volume 18|Issue 41|
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Phillip S Oates, Perth Ross C Smith
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Deepak N Amarapurkar, Mumbai Abhiji
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S Contents EDITORIAL TOPIC HIGHLIGH
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Contents ACKNOWLEDGMENTS APPENDIX A
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Shiraki M et al . Steroid-sparing e
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Műzes G et al . Cytokine profile c
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Day AS et al . Crohn’s disease an
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A B C Iida H et al . Popping predic
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Impedance (Ω) Iida H et al . Poppi
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Iida H et al . Popping prediction d
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Iida H et al . Popping prediction d
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Tsubota A et al . Prediction of rib
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Hemoglobin decline (g/dL) 4.0 2.0 0
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Chen DP et al . Deslanoside induced
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A B C g 3.0 2.0 1.0 g 3.0 NCS 2.0 1
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A Chen DP et al . Deslanoside induc
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Chen DP et al . Deslanoside induced
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added and incubated for 1 h at 37
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Zhang HJ et al . Annexin A2 in HCC
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A D colonic mucosa. All polyps dete
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diagnostic efficacy of i-SCAN and H
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sner L, Schaab C, Frieling T, Medve
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the presence of oesophageal varices
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haemorrhage [13] . Endoscopic treat
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and O-ring ligation. J Gastroentero
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abdominal symptoms in symptomatic u
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A Percentage of patients B Percenta
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it has been shown that vegetarians
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Weight gain (%) 200 150 100 50 0 SA
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Ventola H et al . Lactobacillus rha
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Mello CS et al . Methane and small
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A H2 concentration (ppm) B H2 conce
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Mello CS et al . Methane and small
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Tokudome K et al . Efficacy of ELGP
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A FSSG score 5 4 3 2 1 0 3 mo 12 mo
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Tokudome K et al . Efficacy of ELGP
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Lim HC et al . Electrogastrography
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Steroid-sparing strategies in the management of ulcerative colitis

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