Introduction

Video capsule endoscopy(VCE) is an useful and safe examination in diagnosis of small bowel disease. VCE is composed of one wide-view front lens, flashlight and 8 hour battery to take small bowel images.. In early models, the relative short battery time lead to a modest completion rate about 83.5% in meta-analysis. The battery time of new generation VCE increased to at least 12 hour and even up to 18 hours in real-world practice which made extended examination possible. The effect of prolonged VCE examination time on VCE performance was less explored.

Aims & Methods

This study is aimed to evaluate the completeness and diagnostic yield in patients receiving prolonged VCE examinations. From year 2016 we started to perform an overnight protocol for VCE examination in our hospital using Olympus endocapsule 10, EC-10; Olympus Corp., Japan). After 10 ml simethicone ingestion, the patient swallowed the capsule endoscope. The doctors checked the capsule endoscopy 2-3 hours after capsule endoscope for confirmation of small bowel entering. The patient kept capsule endoscope recording overnight until the coming morning when patients came back to clinic. For some inpatients with active bleeding, VCE was checked at least after 12 hours at midnight. The VCE recording was stopped earlier if colon arrival is confirmed. All the CE procedures were read by experienced endoscopist. We reviewed consecutive VCE examination records from Jan 2016 to Dec 2020. VCE Completeness was defined as the capsule endoscopy reached the cecum within recording time. We subcategorized the VCE records into within 8 hours, within 12 hours and whole procedure and compared VCE complete rate and diagnostic yield between groups. The Cochran’s Q test was used for statistical analysis. P values less than .05 were considered significant.

Results

Total 88 patients aged 20-90 years old received VCE in the study period. Their median age was 69 years old and 46 patients(52.3%) were male. 69 patients(78.4%) were inpatient and 84 patients(95%) were suspected with small bowel bleeding. The small bowel transit time was 342 minutes(91-1134minutes) with total exam time measuring 1031 minutes (452 to 1273 minutes). 58% of patients completed small bowel evaluation within 8 hours since capsule endoscope ingestion, significantly lower than 79.5% within 12 hours(p<0.001), and 93.2 %(p<0.001) in whole course overnight study. The diagnostic yield was 71.6% within 8 hours, also significantly lower than 81.8% within 12 hours(p<0.001) and 83% in whole course overnight study(<0.001%).(Table) No capsule retention was encountered in this study.

Conclusion

1. Prolonged overnight VCE examination can improve complete rate and diagnostic yield using capsule endoscope whose battery life over 12 hours. 2. Prolonged overnight VCE examination should be considered to be routine practice, especially for inpatients.

Disclosure

None

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a common liver condition, and liver biopsy is considered the gold standard to diagnose and stage the disease [1]. However, the risks associated with the invasive procedure limit its widespread use, making noninvasive methods for assessing the severity and progression of fibrosis essential in pediatric NAFLD cohorts [2].

Aims & Methods

To investigate the levels of transforming growth factor-beta 1 (TGF-β1) and glycosaminoglycans (GAGs) in obese children with NAFLD and assess their diagnostic accuracy.
94 children aged 9 to 17 years (average age 12.15 ± 2.51 years) were examined. According to the transient elastography data (FibroScan®502touch, Echosence, France) and body mass index, children were divided into four groups:1 group - 27 obese NAFLD children with fibrosis ≥F1, group 2 - 35 obese NAFLD children without fibrosis, group 3 - 18 obese children without NAFLD and fibrosis. Group 4 (control) comprised 14 children with normal weight without NAFLD and liver fibrosis. Serum transforming growth factor-beta 1 (TGF-β1) levels were evaluated by enzyme-linked immunosorbent assay (ELISA) using the IBL International (Germany) test system, and glycosaminoglycans (GAG) levels were determined spectrophotometrically. ROC analysis was performed for cut-off values calculation.

Results

The highest level of TGF-β1 was found in 1 group children –up to 153.4 (99.7; 189.1) pg/ml, which was significantly higher than in 2 group- 72.4 (53.1; 111.3) pg/ml (p˂0,05), 3 group - 74.0 (50.6; 99.4) pg/ml (p˂0,05) and 4 group - 56.1 (46.0; 77.4) pg/ml (p˂0,05). Moreover, 1 group of children demonstrated increased GAG content up to 4.50 (3.21; 4.60) mmol/L (p˂0,05). ROC analysis revealed that cut-off serum TGF-β1 96.8 pg/ml predicted liver fibrosis in NAFLD children. The area under the curve (AUROC) was 0.787 (p<0.001), the sensitivity of the test was 80.0%, and the specificity was 65.7%. The threshold GAG value for fibrosis was 4.24 mmol/L (sensitivity 70.6%, specificity 69.6%, AUROC 0.743 (p<0.01)).

Conclusion

TGF-β1 and GAG are reliable noninvasive fibrosis markers in children with NAFLD, allowing for their use in liver fibrosis screening.

References

1. Gawrieh S, Harlow KE, Pike F, et al. Relationship of Enhanced Liver Fibrosis Score with Pediatric Nonalcoholic Fatty Liver Disease Histology and Response to Vitamin E or Metformin. J Pediatr. 2021;239:161-167.e5. doi:10.1016/j.jpeds.2021.08.012.
2. Draijer L, Benninga M, Koot B. Pediatric NAFLD: an overview and recent developments in diagnostics and treatment. Expert Rev Gastroenterol Hepatol. 2019;13(5):447-461. doi:10.1080/17474124.2019.1595589

Introduction

Colon capsule endoscopy (CCE) may be recommended as a screening test for individuals under the age of 50 with low familial risk, diagnosed with irritable bowel syndrome (IBS) but lacking alarming symptoms and showing no fecal immunochemical test (FIT) positivity.

Aims & Methods

In the present study, our aim was to assess the efficacy, feasibility and acceptance of CCE in IBS patients with low risk of CRC, and our secondary aim was to assess polyp detection rates, transit times, cleanliness level and patient satisfaction. From April 2022 to April 2024, we conducted a prospective study at our institution involving 196 patients with IBS under the age of 50 (130 (66%) males, 66 (44%) females). We applied first in the literature, the recently developed colon capsule endoscopy technology of the Anx Robotics (USA) Navicam dual-camera CCE for this comprehensive assessment. The new first generation Navicam CCE measures 31mm in length and 11.6mm in diameter, weighing approximately 3 grams. The two cameras operate at adaptive frame rate of 0.5 to 16 pic/sec, with adaptive focus of 0-30 mm, providing an image resolution of 480x480 pixels. The minimum battery time is 12h, and this is a fully functional panenteric capsule. Colonoscopy under anaesthesia was offered to all patients, and after detailed information and signing the consent form, they chose CCE as the first examination method. We identified and addressed the incomplete cases, recorded capsule transit times, and calculated the polyp detection rates. If polyps were detected, patients underwent subsequent colonoscopy with Propofol sedation for polyp removal and histological analysis.

Results

Out of the total cases, 8.7% (n=17) were incomplete. The average colon and total transit time was 201.95 and 360.55 mins, respectively. Our study revealed a remarkable 14.8% (n=29) polyp detection rate (PDR) among the participants. PDR varied across age groups (18-30yo: 12.5%, 31-40yo: 14.04%, 41-50yo: 17.39%). Polyp sizes were categorized as <5mm (n=20), 5-7mm (n=6), and >7mm (n=3). The majority of polyps were located in the sigmoid colon (n=12), followed by the unspecified left colon (n=10) and the right colon (n=7). Subsequent colonoscopy due to positive CCE performed in all patients and detected an additional 6 small polyps (<3mm). In 4 cases, colonoscopy yielded negative results. However, upon conducting a back-to-back colonoscopy all of the previously undetected polyps were eventually found. Histology results revealed one high-grade dysplastic polyp. The average cleanliness level of the colon was assessed using the CCE Cleansing Score (CC-CLEAR). For the coecum, the right and left colon, the average scores were 5.5-7-8, respectively. Impressively, 95% of participants reported high tolerance, and 91% of respondents expressed a preference for CCCE as the next screening procedure too and colonoscopy only after a positive CCE result.

Conclusion

Navicam colon capsule endoscopy emerges as a useful and feasible screening tool, demonstrating unparalleled promise in detecting polyps among asymptomatic individuals. Its polyp detection rate, cost-effectiveness, patient-friendly nature, and agreement with colonoscopy findings position it as a potent complementary method for advancing colorectal screening in low CRC risk individuals.

Clinical Case Summary

A 34 year old female attended electively for liver biopsy for investigation of deranged liver function tests (LFTs).
Ultrasound guided percutaneous liver biospy was complicated by immediate abdominal pain with computed tomography (CT) abdomen revealing right subphrenic intracapsular fluid contained within the liver capsule in keeping with post biopsy haemorrhage. This was managed conservatively with overnight admission for observation.
The patient represented within 48h hours with worsening jaundice and severe abdominal pain. LFTs had significantly worsened with a hyperbilirubinaemia of 153 umol/L with a cholestatic pattern. Repeat CT abdomen showed new intrahepatic and extrahepatic bile duct dilation with common bile duct (CBD) measuring up to 16 mm in diameter. In the lower CBD, there was an obstructing opacity measuring approximately 7 mm in diameters by 24 mm longitudinal and given the clinical history, a blood clot was to be the most felt likely be the underlying aetiology.
Urgent endoscopic retrograde cholangiopancreatography (ERCP) was performed. An initial cholangiogram revealed a dilated biliary system with ill-defined opacity distally. Following sphincterotomy a large clot was extracted with a 12 millimetre balloon. Final cholangiogram showed clearance of bile ducts with no post procedural complications. The next day updated imaging with CT abdomen showed complete resolution of the biliary duct dilatation and LFTs had improved to pre-liver biopsy baseline. The patient was discharged with no further complications.
Discussion: Haemobilia is recognised as a rare complication from percutaneous liver biopsy with incidence rate of less than 1% (1). The management of haemobilia may be conservative in minor cases with transcatheter arterial embolization usually recommended as first line intervention and ERCP used for biliary drainage (2). In this case we demonstrated a successful outcome in biliary decompression following clot extraction with ERCP.

References

(1) Thomaides-Brears, H.B., Alkhouri, N., Allende, D. et al. Incidence of Complications from Percutaneous Biopsy in Chronic Liver Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 67, 3366–3394 (2022).
(2) Yilmaz N: Hemobilia Causing Acute Cholecystitis and Pancreatitis after Percutaneous Liver Biopsy: A Case Report and Review of the Literature. Visc Med 2020;36:246-250.

Introduction

Coeliac disease (CeD) is a chronic immune-mediated enteropathy driven by dietary gluten proteins. Previous studies have indicated an increased risk of cardiovascular disease (CVD) in individuals with CeD [1-3]. However, results are inconsistent and specific guidelines on the management of CVD risk and comorbidities for individuals with CeD do not exist. In this study, we aimed to compare the distribution of traditional CVD risk factors in CeD patients and non-CeD controls from a population-based cohort.

Aims & Methods

We performed a CeD screening of 54,541 serum samples by anti-transglutaminase 2 immunoglobulin A and G serology from in total 56,042 adult participants in the fourth wave of the Norwegian Trøndelag Health Study (HUNT4) [4]. All seropositive participants were invited to upper endoscopy with duodenal biopsies to confirm a CeD diagnosis. Seronegative participants with previously diagnosed CeD were identified by linkage to hospital records and the Norwegian Patient Registry. We calculated SCORE2 and SCORE2-OP as predictors for 10-year risk of first-onset CVD [5, 6]. The groups “no CeD”, previously diagnosed CeD (“known CeD”) and CeD diagnosed in HUNT4 (“new CeD”), as well as “CeD” (known + new cases) were examined in this study. To compare group characteristics, we used the Wilcoxon rank sum test. Associations between groups and SCORE2(-OP) were assessed using ordinal logistic regression analysis.

Results

468 (0.80%) individuals received a CeD diagnosis in HUNT4, while 309 (0.57%) seronegative individuals had known CeD. Individuals with newly diagnosed CeD were younger, better educated, and had lower blood lipids compared to controls. Individuals with CeD smoked significantly less, had lower BMI and waist-hip-ratio, glycated hemoglobin levels, serum creatinine, and hsCRP levels compared to controls without CeD (n=52,438; p<0.05 for all variables mentioned, see table). We found a significantly lower SCORE2 for CeD cases (n=589) compared to controls (n=39,747; p<0.05). Adjustment for alcohol consumption did not affect group characteristics. A significantly lower SCORE2 was observed in CeD cases also after adjustment for level of education (OR .84, 95% CI .72-.98), high sensitivity C-reactive protein (hsCRP) and serum creatinine (OR .85, 95% CI .78-.99), but not for the combination of all three variables (OR .90, 95% CI .76-1.05).

Conclusion

Individuals with CeD appear to have a lower cardiovascular risk based on traditional risk factors like smoking habits, body fat, diabetes, renal function and inflammation compared to control individuals without CeD. In line with that, SCORE2 and SCORE2-OP as predictors for 10-year risk of first-onset CVD were lower in individuals with CeD.

References

1. Bathrellou, E., M.D. Kontogianni, and D.B. Panagiotakos, Celiac disease and non-celiac gluten or wheat sensitivity and health in later life: A review. Maturitas, 2018. 112: p. 29-33.
2. Ludvigsson, J.F., et al., Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation, 2011. 123(5): p. 483-90.
3. Figtree, G.A., et al., Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet, 2021. 397(10279): p. 1085-1094.
4. Asvold, B.O., et al., Cohort Profile Update: The HUNT Study, Norway. Int J Epidemiol, 2023. 52(1): p. e80-e91.
5. SCORE2 working group and ESC Cardiovascular risk collaboration, SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J, 2021. 42(25): p. 2439-2454.
6. SCORE2-OP working group and ESC Cardiovascular risk collaboration, SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. European Heart Journal, 2021. 42(25): p. 2455-2467.

Disclosure

None.