Introduction

Gastric cancer have a high prevalence worldwide, and early diagnosis and management are essential for better oncological outcomes. Conventional gastroscopies have limitations due to possible complications, patient discomfort, poor tolerance and the need for sedation. Magnetic-controlled capsule endoscopy (MCCE) is a painless and non-invasive diagnostic tool that can explore the gastric mucosal abnormalities.

Aims & Methods

The aim of the present prospective single centre study is to compare the diagnostic accuracy and patient satisfaction of MCCE and gastroscopy.
We examined a total of 89 consecutive young patients referred for uninvestigated functional dyspepsia between 2018 August and 2023 April to our endoscopy unit who preferred MCCE as an initial diagnostic test. 80 (90%) patients underwent same-day MCCE and gastroscopy examinations, while the remaining 10% underwent the procedures within a 2-week interval. All patients underwent MCCE as the first diagnostic procedure. Gastroscopy was performed using an HD Fujifilm 700 series gastroscope. The urea breath test (UBT) was administered to detect Helicobacter pylori infection in patients who were not receiving proton pump inhibitor (PPI). After the procedures, we evaluated and compared the capsule endoscopy and gastroscopy reports and videos. After both diagnostic procedures, our patients were asked to accomplish a patient satisfaction questionnaire to evaluate the tolerability of each examination, regarding patient discomfort, pain, and anxiety levels during the procedures.

Results

A total of 89 patients were examined (53 males, 36 females, mean age 45). Urea breath test was performed in 43 cases: and detected 18 (41.9%) Helicobacter positive results, and the histology was consistent in 35 cases (81.4%). MCCE and gastroscopy were highly sensitive to detect any focal lesions 1 vs 0 hyperplastic polyp, 3 vs. 3 ulcers, 1 vs. 1 submucosal tumour, 2 vs. 2 early gastric cancer, 1 vs. 1 early gastric B cell lymphoma, and 9 vs. 2 foveolar hyperplasia, respectively. For gastritis, we found 4 vs. 1 proximal gastritis, 53 vs 56 distal gastritis, and 16 vs 16 pangastritis. MCCE had higher diagnostic yield and accuracy than gastroscopy for detecting minimal foveolar hyperplasia (MCCE 9, gastroscopy 2, p=0.01) and upper gastritis (MCCE 4, gastroscopy 1, p=0.02), meanwhile gastroscopy was more accurate in the detection of antral gastritis (MCCE 53, gastroscopy 66, p=0.03). There were no significant differences between the two tests for detecting polyps, ulcers, submucosal tumours, early gastric cancer, lymphoma and pangastritis. All the patients reported that MCCE was a more tolerable diagnostic test than gastroscopy with Propofol sedation based on the questionnaire.

Conclusion

In conclusion, both MCCE and gastroscopy are comparably sensitive diagnostic methods for detecting focal and diffuse lesions, with MCCE offering the advantage of higher patient tolerability and acceptance. The study results suggest that MCCE can be a useful alternative to gastroscopy in young patients (under age 50) referred for uninvestigated functional dyspepsia, to select those patients who really needs gastroscopy and biopsy and therefore it can shorten the waiting lists for routine upper GI endoscopy.

Introduction

MACE is a new, non-invasive technology which approaches the diagnostic sensitivity of OGD in gastric focal lesion detection in patients with dyspepsia. [Li et al., CGH 2016] This study compared the two in the detection of focal and diffuse lesions in patients referred for the investigation of anaemia.

Aims & Methods

MACE was performed within one week before OGD using the AnX Robotica magnet system and Navicam capsule (single camera capsule, frame rate 6/sec: Wuhan, China). Following a fast, simethicone and gastric distension using 0.5-1L water, patients swallowed the capsule semi-recumbent on the left lateral side before lying supine to allow approximation of the magnet to the chest. The examination protocol included a sequence of magnet movements and patient position changes. Inspection of an anatomical location was considered complete if sufficient to exclude any significant pathology. Endoscopists performing OGD were blinded to the MACE outcome and all findings were recorded from a pre-identified diagnostic list. Data was analysed using SPSS.

Results

45 of 81 (55.5%; median age 63 (IQR 45.5- 72), 60% male) patients had pathology identified by MACE, OGD or both. Complete views were obtained by MACE in the oesophagus (72.4%), proximal stomach (93.8%), distal stomach (93.8%) and duodenum(79.6%, p<0.001) and mean examination time was 22 minutes. Findings were concordant in 17 (37.8%: gastric erosions (n=6), ulcers (n=5), oesophagitis (n=2), eroded polyps (n=2) and gastric antral vascular ectasia (n=2)). MACE alone identified pathology in 24 (53.3%: gastric erosions (n=17), angioectasia (n=4), ulcers (n=2, oesophageal and duodenal), eroded polyp (n=1) and both angioectasia and erosions (n=1). OGD identified a distal body ulcer (n=1), small (n=1) and large (n=1) oesophageal varices and oesophageal ulcers (n=1) missed by MACE and in one patient MACE identified only an oesophageal ulcer and OGD only a duodenal ulcer, each missing the pathology detected by the other. Diagnostic yield was higher for MACE than OGD (P<0.001).

Conclusion

The improved diagnostic yield of MACE compared to OGD is accounted for mainly by minor mucosal abnormalities which could, nonetheless, contribute to occult bleeding and anaemia. Although speculative this could be because of better tolerance of MACE and a longer examination time. An increased frame capture rate, with or without a second camera, is needed to improve oesophageal visualisation.

Disclosure

I herwith declare that the magnetic capsules for the study were provided by Ankon

Introduction

Sedation during upper gastrointestinal endoscopies (UGIEs) is a common practice aimed at improving patient comfort and procedural tolerance. However, the necessity of sedation remains a subject of debate, particularly regarding its impact on patient safety and experience. This prospective study aimed to compare the outcomes of sedated and non-sedated UGIEs, focusing on patient safety, procedural experience, and post-procedural comfort.

Aims & Methods

From January 1st, 2023, to December 31st, 2023, 150 patients undergoing diagnostic UGIEs were prospectively enrolled. Indications for endoscopy included dyspepsia, dysphagia, unexplained iron deficiency anemia, weight loss, and diarrhea. Patients were randomly assigned to one of three groups: Group 1 received local pharyngeal spray (lidocaine), Group 2 received pharyngeal spray with midazolam, and Group 3 received pharyngeal spray with nalbuphine. Parameters assessed included patient safety, procedural experience, technical safety, pharyngeal sensitivity, and post-procedural comfort.

Results

Out of 150 patients, 90 were male and 60 were female. In Group 1 (pharyngeal spray only), 12 out of 50 patients reported mild throat irritation. In Group 2 (pharyngeal spray with midazolam), 9 out of 50 patients experienced increased sleepiness during the procedure, with reduced discomfort. In Group 3 (pharyngeal spray with nalbuphine), 6 out of 50 patients reported post-procedural anxiety. The mean ages in Groups 1, 2, and 3 were 38.5 ± 2.25, 41.25 ± 3.45, and 45.5 ± 2.14 years, respectively.

Conclusion

This study sheds light on the feasibility and outcomes of non-sedated UGIEs using pharyngeal spray alone. While sedation can enhance procedural tolerance, it may also introduce risks and post-procedural effects. The findings suggest that UGIEs with pharyngeal spray alone may be well-tolerated, particularly for select patient populations. Further research on a larger scale is warranted to validate these findings and refine guidelines for sedation strategies in UGIEs.

Introduction

Functional Dyspepsia (FD), a common disorder of gut-brain interaction [1], is associated with alterations in gastric accommodation, gastric emptying, gastric sensitivity, gastroduodenal permeability, and the gut microbiome. Resilience, the ability to maintain function under personal or physical stress, may play a role in the development of FD, although no studies have evaluated this theory. We hypothesize that FD patients have lower resilience than the general population, which may lead to a new therapeutic target.

Aims & Methods

This prospective questionnaire study compared patients with FD (Rome IV criteria) with internal medicine clinic patients without dyspepsia at a tertiary referral center. Participants completed the FD symptom severity score [2], Brief Resilience Scale (BRS) [3], Connor-Davidson Resilience Scale (CDRS) [4], hospital anxiety and depression scale (HADS) [5], early childhood adverse life event questionnaire [6], and perceived stress score [7]. Questionnaires were distributed to clinic patients meeting inclusion/exclusion criteria.

Results

38 FD (mean age 43 years old, 87% female) and 31 control (mean age 57 years old, 39% female) patients completed the survey. FD patients exhibited lower resilience on the CDRS (96.83 vs. 90.26, P<0.04, CI -12.93 to -0.21) but not on the BRS (3.018 vs. 3.022, P<0.96, CI -0.15 to 0.13). FD patients and controls scored no different on the HADS anxiety index (17.05 vs. 18.38, P<0.064, CI -2.74 to 0.08) and depression scores (P<0.14, CI -0.21 to 1.5). The FD group reported "high" perceived psychological stress while the control group reported a “moderate” level (P<0.004, CI 2.002 to 9.827). In childhood, FD patients had significantly more adverse childhood events (29.3% vs. 15%, P<0.004, CI 0.05 to 0.25). FD patients were more likely to have been exposed to a household member suffering from a psychiatric illness compared to control patients (47% vs. 20%, P<0.049, CI 0.001 to 0.5). FD patients were also more likely to report psychological abuse in childhood (53% vs. 17%, P<0.03, CI 0.034 to 0.67). No other significant differences were found in types of early childhood trauma including physical abuse, familial substance abuse, witnessed maternal violence, or criminal behavior by a household member.

Conclusion

This novel, prospective questionnaire pilot study shows that FD patients have lower resilience compared to the general outpatient population on the CDRS. The long-term symptoms of FD may further decrease resilience. While anxiety and psychological stress are not strongly associated with FD, the significant exposure to childhood household members with a psychiatric diagnosis and significantly higher prevalence of self reported psychological abuse may explain the higher prevalence of antidepressant use in this population, especially considering the significantly higher level of self perceived psychological stress [8]. Otherwise, early childhood trauma appears similar between FD patients and patients without FD and is thus not likely to influence resilience markers. Understanding the contribution of resilience to development of FD may lead to therapies enhancing resilience, improving symptoms, and patient well-being.

References

1. El-Serag HB, Talley NJ. Systemic review: The prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004;19:643-654.
2. Taylor F, Higgins S, Carson RT, et al. Development of a symptom-focused patient-reported outcome measure for functional dyspepsia: the functional dyspepsia symptom diary (FDSD). Am J Gastroenterol. 2018 Jan,113(1):39-48.
3. Smith BW, Dalen J, Wiggins K, et al. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194-200
4. Connor KM & Davidson JR. 2003. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress. Anxiety, 18; 76-82
5. Zigmond AS & Snaith RP. 1983. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67: 361-370
6. Felitti VJ, Andra RF, Nordenburg D, et al. Relationship of childhood abuse and household dysfunction to many of the causes of death in adults. The adverse childhood experiences (ACE) study. Am J Prev Med. 1998 May;14(4):245-58
7. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96.
8. Esterita T, Dewi S, Suryatenggara FG, Glenardi G, et al. Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review. J Gastrointestin Liver Dis. 2021 Jun 18;30(2):259-266.

Introduction

The acid-suppressive drug such as proton pump inhibitor (PPI) is one of treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid blockers(P-CABs) for treating FD is not established. This study aimed to assess the efficacy and safety of tegoprazan in patients with FD in a prospective, multicenter clinical trial.

Aims & Methods

Investigated FD was diagnosed using the Rome IV criteria. All patients received tegoprazan 50mg once daily for 8 weeks. Dyspeptic symptoms were assessed by a dyspepsia symptom questionnaire (5-point Likert scale, NDI-K, and GERD-HRQL). The main outcome was the rate of satisfactory relief of dyspeptic symptoms at 8weeks.

Results

A total of 173 patients were enrolled in this study. The rate of satisfactory relief of dyspeptic symptoms at 4 and 8weeks was 74.6% and 86.7%, respectively. The complete symptom relief rate at 4 and 8weeks was 15.0% and 24.9%, respectively. The symptom resolution rate was significantly higher at 8weeks than at 4weeks. (86.7% vs. 74.6%, p<0.001; 24.9% vs. 15.0%, p=0.003). The mean score of NDI-K and GERD-HRQL also significant decreased at 8weeks. The efficacy was not influenced by subtypes of FD or Helicobacter pylori status. There was no serious adverse event or death during the study.

Conclusion

Tegoprazan 50mg once daily significantly provides satisfactory symptom relief for FD. (International clinical trial registry number: KCT0005600)

Introduction

Capsule endoscopy screening for pangastrointestinal tumours during a single procedure is expected. Here, we developed a handheld guiding device using a neodymium magnet through which a conventional colon capsule endoscope without an internal magnet can be manipulated.

Aims & Methods

We aimed to determine its effectiveness and safety. In a randomized controlled trial, 96 patients harboring superficial oesophageal carcinomas, gastric tumours, or colorectal polyps or tumours (CRTs) were enrolled; 47 and 49 patients were allocated to the S group using a nonmagnetic sham device and the M group using this magnetic device, respectively. The primary outcomes were the per-patient diagnostic yields for the representative tumours or polyps and the per-lesion yields. The secondary outcomes were the observation rate at each gastric site, adverse events, and acceptability using a subjectively categorized questionnaire survey.

Results

Although the per-patient sensitivity and specificity of the representative gastric tumours in the S and M groups were 95.2% and 100.0%, respectively (P=.4773); and 96.2% and 92.3%, respectively (P>.9999), the per-lesion sensitivity of gastric polyps was significantly greater in the M group (P < 0.0001), especially those localized in the upper and middle portions and <5 mm in size. There were significantly distinct observation rates of total gastric sites in the S and M groups (87% vs. 98%, P <0.0001). In both groups, the per-patient sensitivity and specificity of CRTs ≥6 mm and ≥10 mm were 90.9% and 96.7%, respectively; 92.5% and 98.2%, respectively; and 77.8% and 71.4%, respectively, for superficial oesophageal carcinoma. There were no adverse events associated with magnetic guidance. The proportions of patients who reported “not at all” and “almost none” or “quite easy” and “fairly easy” for embarrassment, abdominal pain, and fear were higher than 80% and who desired CE at the next examination were 62.5% (60/96) in total.

Conclusion

This study provides evidence supporting the effectiveness, safety, and acceptability of magnetically assisted CE for pangastrointestinal cancer screening.
Japan Registry of Clinical Trials, jRCTs042180150.

References

1. Tashiro K, Kutsuna S, Wakiwaka H, and Ohmiya N. Design of the Magnetic Guide Magnet for Magnetic Guide of a Capsule Endoscope. Journal of the Japan Society of Applied Electromagnetics and Mechanics 2017;25:100-105.
2. Matsuhashi K, Ozawa Y, Tashiro K, Wakiwaka H, Mizuno T, and Ohmiya N. Design of Planar Array Magnet for Magnetic Guide of a Capsule Endoscope. Journal of the Japan Society of Applied Electromagnetics and Mechanics 2021;29:13-18.

Introduction

Current guidelines suggest upper and lower GI endoscopy to investigate iron deficiency anaemia (IDA) because of a perceived low risk of small bowel pathology. This is the first study to investigate the entire gastrointestinal tract to localise lesions suspected of causing blood loss in patients with IDA.

Aims & Methods

Patients referred to three centres (Sheffield, Hong Kong and Szekesfehervar, Hungary) for the investigation of IDA underwent small bowel (SB) capsule endoscopy (Navicam, AnX Robotica, Plano, US) a week prior to upper and lower gastrointestinal endoscopy. All lesions were described using terms selected from a predetermined diagnostic list and according to the perceived likelihood of bleeding (P0: unlikely; P1: suspected; P2: likely. Saurin et al., Endoscopy 2003).

Results

Assuming a true prevalence of small bowel lesions of 10% in patients with IDA, a sample size required to have 80% power of getting a 95% confidence interval for the prevalence no wider than 10 percentage points is 160 patients. 164 patients (median age 61 years (IQR 48.2-72); 50.6% male) had a median haemoglobin of 102.0 g/L (IQR 90.0-116.0), ferritin 11(IQR 7- 18). Completion rates for gastroscopy, colonoscopy and capsule endoscopy were 99.3%, 95.7% and 85.9% respectively. Diagnostic yield of P1/P2 lesions by SB capsule (49.3%) was higher than gastroscopy (25.7%) and colonoscopy (26.8%); p<0.0001. Four patients had fresh blood seen on capsule the source of which was unclear. Four additional patients were given new diagnoses of coeliac disease at capsule endoscopy which was subsequently confirmed following duodenal biopsy. All lesions were defined by a three-person expert panel review by consensus with a 99.1% agreement.

Table-1: Number of patients with P1/P2 pathology identified at gastroscopy, SB capsule and colonoscopy.

Conclusion

Pathology suspected of, or likely to be, causing blood loss in patients with IDA appears to be commoner in the small bowel than the proximal GI tract or colon. Small bowel examination should be performed routinely to maximise diagnostic yield.

Disclosure

Capsules for the study were provided by AnX robotica