Introduction

Video capsule endoscopy is a diagnostic method for examination of the small intestine. It is completely non-invasive and painless method that ensures complete examination of the small intestine because the video capsule allows a visual examination of the entire small intestine including parts that are difficult to reach with other endoscopic methods. Capsule provide high-quality images of the inner walls of the small intestine. This allows a better detection of pathological changes such as polyps, inflammation or bleeding. In a certain population of patients there is a risk that capsule "get stuck" in the intestine. This especially applies to patients with previous operations in the small intestine, in those who are on long-term therapy with nonsteroidal antirheumatic drugs, in patients who have had radiation to the pelvic region, or in patients where there is a suspicion of stenosis of the small intestine which is possible in patients with Crohn's disease.

Results & Findings

Patient underwent a small bowel video capsule examination. After the patient did not notice that the capsule had come out of the large intestine he come to our department. We performed a radiological evaluation which determined that capsule had remained in the small intestine. It was suggested to try to remove it through a single balloon enteroscope in order to avoid surgery. He was prepared for single balloon enteroscopy under general anesthesia. The endoscope was advanced through the small intestine to the site where the capsule had remained (middle part of jejunum) and with the help of a net loop the capsule was grasped and safely removed.

Summary & Discussion

One of the common risks of the procedure is capsule retention which is defined as a capsule remaining in the gastrointestinal system for longer than two weeks. Capsule retrieval is not emergent in asymptomatic retainers. In this case, the patient had no symptoms but was concerned because the capsule did not come out as expected. Considering the passage of time since installation and the type of capsule itself it was not possible to see online where the capsule is located. We used a radiological methods to detect capsule retention. Because we gave the patient clear instructions on what to expect after the capsule was placed so the retention condition was recognized in time and the extraction procedure was performed which ultimately resulted in avoiding patient surgery.

Conclusion

In order to avoid potential complications in the form of retention of the capsule in the small intestine in patients with Crohn's disease, before the actual placement of the capsule, the patient can be given a capsule to check the patency of the small intestine. A successful patency test minimizes the risk of retention and allows the safe administration of a capsule. On the other hand single baloon enteroscopy provides us possibility of therapeutic action in the small intestine and using of this endoscopic method spare patient from other invasive solutions.

References

1. Boysen M and Ritter M, Small Bowel Obstruction from Capsule Endoscopy, West J Emerg Med. 2010 Feb;11(1):71–73.
2. Mitselos IV, Katsanos KH, Tsianos, Eliakim R, Christodoulou DK, Clinical Use of Patency Capsule: A Comprehensive Review of the Literature, Inflammatory Bowel Diseases, Volume 24, Issue 11, November 2018, Pages 2339–2347

Introduction

Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic gastrointestinal disorder characterized by relapsing inflammation and significant psychological burden [1]. Patients with IBD often experience depression, anxiety, and reduced quality of life [2]. However, emerging research highlights posttraumatic growth (PTG)—positive psychological transformation following trauma—as a potential outcome in chronic illness [3].
PTG arises from cognitive restructuring after traumatic events, with rumination playing a key role [4]. Rumination includes intrusive rumination (unwanted, distressing thoughts) and deliberate rumination (purposeful reflection). While deliberate rumination typically fosters PTG, findings on intrusive rumination are inconsistent, with some studies reporting negative, positive, or null effects [5].

Results & Findings

A cross-sectional survey of 237 Chinese IBD patients. Intrusive rumination was negatively associated with PTG (β = -0.33; 95% CI: -0.61, -0.04), with education level impacting this effect (P for interaction < 0.05). Deliberate rumination showed a positive linear relationship with PTG (β = 0.87; 95% CI: 0.57, 1.17). Above a threshold of 17, intrusive rumination had a stronger negative impact (β = -1.01; 95% CI: -1.73, -0.30).

Summary & Discussion

This finding aligns with cognitive theories of trauma processing, which suggest that excessive intrusive thoughts may overwhelm an individual's cognitive and emotional resources, impeding adaptive meaning-making [6]. Below this threshold, intrusive rumination may serve as an initial, albeit distressing, step in cognitive processing, whereas higher levels may entrench negative thought patterns[9].This non-linear association helps reconcile conflicting findings in the literature [7]. Future research should explore whether interventions (e.g., mindfulness, cognitive restructuring) facilitate a transition toward deliberate rumination and subsequent PTG.
In contrast to intrusive rumination, deliberate rumination demonstrated a robust positive association with PTG across all models[8]. For IBD patients, who often experience fluctuating symptoms and emotional distress, facilitating deliberate cognitive processing may help them reframe their illness narrative, enhancing resilience and adaptive coping.
Individuals with lower education levels may lack the cognitive resources and flexibility needed to transform intrusive rumination into constructive meaning-making, making them more susceptible to negative emotional cycles that hinder PTG [9].

Conclusion

In conclusion, a nonlinear relationship between intrusive rumination and PTG in patients with IBD was found. When intrusive rumination exceeded a threshold of 17, it was negatively correlated with PTG. Additionally, deliberate rumination was positively associated with PTG, highlighting its potential as a facilitator of psychological growth.

References

1. Barberio B, Zamani M, Black CJ, et al. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370.
2. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.
3. Joseph S, Murphy D, Regel S. An affective-cognitive processing model of post-traumatic growth. Clin Psychol Psychother. 2012;19(4):316-325.
4. Allen N, Hevey D, Cogley C, et al. A meta-analysis of the association between event-related rumination and posttraumatic growth: the event-related rumination inventory and the posttraumatic growth inventory. J Trauma Stress. 2022;35(6):1575-1585. https://doi.org/10.1002/jts.22875
5. Jones SR, Fernyhough C. Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model. Behav Res Ther. 2009;47(1):54-59.
6. Hill EM, Watkins K. Women with ovarian cancer: Examining the role of social support and rumination in posttraumatic growth, psychological distress, and psychological well-being. J Clin Psychol Med Settings. 2017;24(1):47-58
7. Tedeschi RG, Shakespeare-Finch J, Taku K, et al. Posttraumatic growth: Theory, research, and applications. Routledge. 2018.
8. Niemeyer H, Bieda A, Michalak J, et al. Education and mental health: Do psychosocial resources matter? SSM Popul Health. 2019;7:100392.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Introduction

The legal responsibility of nurses is a key element in the healthcare sector, especially in complex areas such as digestive endoscopy. This role requires advanced technical skills and a deep understanding of legal implications. Nurses must follow protocols, ethical standards, and laws to ensure patient safety and prevent complications. Despite adherence to protocols, unusual complications can occur. Nurses have an autonomous position of guarantee towards the patient, based on their professional autonomy, which implies an essential task of health protection.

Results & Findings

The systematic literature review examined documented clinical cases in the field of digestive endoscopy, consulting clinical databases for situations where nursing responsibility was crucial. Precise data were obtained to provide specifics on nursing responsibility in endoscopy. However, from the analysis of collected clinical cases and available data, it emerges that about 50%-60% of the responsibilities are attributable to non-compliance with good care practices. Ineffective communication, both within the healthcare team and with patients, represents about 20%-30% of the issues in particularly complex contexts. Finally, suboptimal management of a complex environment, including organizational and technological factors, contributes to the remaining 10%-20% of difficulties.

Summary & Discussion

The results of this review highlight the importance of nursing responsibility in digestive endoscopy. The main cause of liability is the failure to adhere to good care practices, indicating the need to improve training and adherence to protocols. Ineffective communication represents a significant portion of the issues, emphasizing the importance of developing effective communication skills. Finally, suboptimal management of complex environments requires attention to organizational and technological factors to improve the quality of care.

Conclusion

From the clinical cases considered, common issues emerge, including the failure to apply good practices, inadequate consideration of the complex environment in which nurses work, and communication difficulties. These factors impact the quality of care and highlight the need to invest in tools and training. Focusing on effective communication strategies and appropriate protocols could improve nursing responsibility.

References

Endoscopia digestiva e responsabilità dell'infermiere-http//www.Nurse24.it;Endoscopia digestiva e responsabilità dell'infermiere-http//wwwDocsity.com;Survey Nazionale di Anote-Anigea -infermiere online;Irti G, L'infermiere di endoscopia oggi: compiti e responsabilità. Ipasvi Roma 2000; studio centrato sulla letteratura della responsabilità in endoscopia –http//tesi.univpm.it