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A primer in capsule endoscopy

Uwe Seitz

Summary

AI Generated

This online course provides a comprehensive introduction to capsule endoscopy, covering technique, reporting software, complications, and clinical applications through eight illustrative cases.

  • Capsule endoscopy allows visualisation of the entire small intestine and is generally safe, well tolerated, and less invasive than traditional endoscopy
  • Common indications for capsule endoscopy include occult bleeding and iron-deficiency anaemia
  • The course covers use of capsule reporting software, management of common complications, and interpretation of common pathologies encountered during capsule endoscopy
  • Learning objectives emphasise the importance of thorough patient history knowledge when interpreting findings and understanding the interface between capsule endoscopy and other diagnostic procedures including upper digestive endoscopy and enteroscopy
  • The course is designed for accredited gastroenterologists, gastroenterologists in training, radiologists, and gastrointestinal surgeons
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

Capsule endoscopy (also known as wireless capsule endoscopy or video capsule endoscopy) allows visualisation of the entire small intestine. The procedure has gained popularity because it is not invasive in the same way as traditional endoscopy and it is generally safe and well tolerated. Common indications for the use of capsule endoscopy include occult bleeding and iron-deficiency anaemia, among others.

This online course aims to provide a full introduction to capsule endoscopy, capsule reporting software and the potential complications that may be encountered. Eight cases are used to illustrate the role of capsule endoscopy.  The course is based on a presentation (with 35 accompanying slides) given by Uwe Seitz as part of a practical skills training session recorded in June 2015 at the United European Gastroenterology Summer School in Prague, Czech Republic.

Learning objectives

  • Understand the basics of how to use capsule reporting software.
  • Know how to deal with the most common complications of capsule endoscopy.
  • Be aware of the most common indications for capsule endoscopy.
  • Understand the common pathologies encountered at capsule endoscopy.
  • Be aware of further investigations that may be recommended following the identification of small-bowel lesions.
  • Appreciate the need for a thorough knowledge of the patient’s history when interpreting capsule findings.
  • Know the role of capsule endoscopy in the investigation of patients with iron-deficiency anaemia of unknown origin (both obscure occult bleeding and overt occult bleeding).
  • Understand the interface between capsule endoscopy and upper digestive endoscopy and enteroscopy.

Target audience

Accredited Gastroenterologists, Gastroenterologists in training, Radiologists and GI surgeons. 

Event

A primer in capsule endoscopy

Topics

Endoscopy

Accreditation status

not accredited

Duration

1 hour

Published

2015

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UEG Podcast Episode
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Best of UEG Week - Nursing with Mary Phillips and Leigh Donnelly

Mary Phillips, Leigh Donnelly

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Primary Care

Published

2025

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IMPACT OF NEW TIMING RECOMMENDATIONS FOR CAPSULE ENTEROSCOPY IN THE SETTING OF OVERT DIGESTIVE BLEEDING

Maria Manuela Estevinho 1, Rolando Pinho 1, Adélia Rodrigues 1, Unknown Unknown 1, Joao Paulo Laranjeira Correia 1, Pedro Silva Mesquita 1, Teresa Freitas 1

Affiliations

1 Centro Hospitalar Vila Nova de Gaia Espinho, Vila Nova de Gaia, Porto, Portugal

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Capsule endoscopy is the first-line examination for digestive bleeding with likely origin in the small bowel, in hemodynamically stable patients. In the 2022 update, ESGE guidelines recommend that, in the context of overt bleeding, capsule enteroscopy should be performed as soon as possible, ideally within the first 48 hours. In the previous guidelines, published in 2015, the recommended window was 14 days.

Aims & Methods

This study aimed to evaluate the improvement in yield offered by the new recommendations regarding the timing of urgent capsule enteroscopy. Patients with suspected overt middle gastrointestinal bleeding between January 2005 and November 2022 were retrospectively analyzed. Diagnostic and therapeutic yield, rebleeding rate, and mortality were compared when capsule enteroscopy was performed within the first 48 hours, within the first 14 days, or between the 3rd and 14th day after admission.

Results

A total of 138 patients were included (58.7% men, median age 66 years), 87 of whom (63.0%) underwent capsule enteroscopy within the first 48 hours after hospital admission. The median follow-up was 55 months (5-180). The diagnostic yield (presence of blood or lesions with bleeding potential) was slightly higher when capsule enteroscopy was performed within the first 48 hours (81.6% versus 76.5%, p=0.349). On the other hand, capsule enteroscopy within the first 48 hours was significantly associated with higher therapeutic yield (endoscopic, radiologic, or surgical treatment) - 54.0% versus 39.2%, p=0.02. The rebleeding rate was significantly lower in patients undergoing enteroscopy within 48 hours after admission (19.5% versus 29.4%, p=0.04). On the other hand, overall mortality at 36 months did not differ between strategies (21.8% and 25.5%, p=0.401).

Conclusion

Performing capsule endoscopy within the first 48 hours, as recommended by recently published guidelines, is associated with favourable short- and long-term clinical outcomes.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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THE ECONOMIC IMPACT OF USTEKINUMAB IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASE: A TARGETED LITERATURE REVIEW

Kunal Shastri 1, Kerise Clarke 2, Margaret Ainslie-Garcia 2, Nicole Ferko 2

Affiliations

1 Fresenius Kabi SwissBioSim Gmbh, Eysins, Switzerland

2 EVERSANA, Burlington, Canada

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Ustekinumab, an interleukin (IL) 12/23 inhibitor is a biologic used to treat inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Clinical and real-world evidence has demonstrated its ability to provide a clinically meaningful response and remission among patients; however, the economic impact of its use may not be favourable from the payer perspective. The objective of this targeted literature review was to understand the economic impact of ustekinumab reference product in the treatment of patients with IBD.

Aims & Methods

A literature search was conducted in MEDLINE for economic publications that evaluate the economic impact of ustekinumab or include ustekinumab within their analyses. Search terms included “budget impact model”, “budget impact analysis”, “cost-utility”, “cost-effect”, “ulcerative colitis”, “Crohn’s disease” and “ustekinumab” from database inception until Feb 8th, 2024. Only studies published in English were eligible for inclusion.

Results

A total of 30 hits were screened for inclusion, yielding 12 relevant studies that discussed economic implications of ustekinumab. Five articles were conducted from the US payer perspective, two from the Japanese payer perspective, and one each from the Canadian, Swedish, Polish, French, and German perspectives. The economic models included budget impact models (n = 2), cost-effectiveness models (n = 8), and cost per responder/remitter analyses (n = 2). Five studies used a CD patient population, six studies focused on UC, and one study included a mixed population of CD and UC. In CD studies, two found ustekinumab was cost-effective: these studies were conducted from the perspective of Polish and Swedish payers in CD patients who failed anti-TNF therapy. Both studies used a Markov based model to assess cost-effectiveness of treatments. In the remaining CD studies, ustekinumab was associated with the highest cost per responder/remitter (Japanese payer perspective) and was dominated by other treatments in cost-effectiveness analyses (US payer perspective). The studies conducted in the UC patient population also found that, although clinically effective, ustekinumab was dominated (based on the incremental cost effectiveness ratio [ICER]) by other biologics included in the analyses (eg, vedolizumab and infliximab). Similar to the CD patient population, the cost per responder/remitter was highest for ustekinumab compared to five other therapies including tofacitinib and golimumab (US payer perspective). However, in two UC studies, ustekinumab was observed to be more effective than the most cost-effective treatment option (from the Japanese and US payer perspectives), highlighting that its price negatively affected its ICER. Moreover, cost-effectiveness analyses conducted by the German and Canadian perspectives, demonstrated that ustekinumab was not a cost-effective therapy at the current willingness to pay threshold (0% probability). Note, that no studies tested the possible cost-effectiveness of an ustekinumab biosimilar which would positively influence the cost associated with ustekinumab treatment.

Conclusion

This literature review demonstrated that, despite its high efficacy, ustekinumab is among the highest costing biologics available for the treatment of IBD with low probabilities of cost-effectiveness across several studies. As the economic burden for IBD is increasing globally, cost-saving therapeutic options such as biosimilars may help to provide savings that can be redistributed in a healthcare system or provide funds to expand patient access.

Disclosure

Kunal Shastri is an employee of Fresenius Kabi a manufacturer of biosimilars. Kerise Clarke, Margaret Ainslie-Garcia, Nicole Ferko are employees of EVERSANA a company who receives consulting fees from Fresenius Kabi.

Conference

UEG Week Vienna 2024

Submission format

Abstract

Session

Other (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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UEG Poster
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SUBTYPES OF GASTRIC ADENOMAS: PREVALENCE, RISK FACTORS AND OUTCOMES OF ENDOSCOPIC MANAGEMENT

Nada El-Domiaty 1, Frédéric Beuvon 2, Marine Carpentier-Pourquier 3, Wafaa Ibrahim 4, Sarra Oumrani 3, Paul Doumbe-Mandengue 2, Juliette Leroux 2, Félix Corre 2, Arthur Belle 3, chaussade stanislas 2, Romain Coriat 2, anna pellat 2, Maximilien Barret 5

Affiliations

1 Cochin Hospital,Assistance Publique - Hôpitaux de Paris, Paris, France|||Faculty of Medicine, Helwan University, Cairo, Egypt

2 Cochin Hospital,Assistance Publique - Hôpitaux de Paris, Paris, France|||Université de Paris, Paris, France

3 Cochin Hospital,Assistance Publique - Hôpitaux de Paris, Paris, France

4 Cairo University, Faculty of Economics and Political Science, Cairo, Egypt

5 Université de Paris, Paris, France|||Cochin Hospital,Assistance Publique - Hôpitaux de Paris, Paris, France

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Gastric adenoma is recognized as a premalignant lesion.1Much of the literature lumps all adenomas together with different classifications. These are few western reports regarding the prevalence, associated risk factors and outcomes of endoscopic management of different subtypes of gastric adenoma.

Aims & Methods

Aims: The aim of this study is to determine the prevalence, potential predictors, and outcomes of endoscopic management of the different subtypes of gastric adenoma.
Methods: Of 162 consecutive patients who underwent endoscopic resection for gastric lesions between 2017 and 2022 at our center, 79 patients were enrolled. All the hyperplastic polyps (n=37) and subepithelial lesions (n=46) were excluded. The patient clinical characteristics, endoscopic and histopathological features of gastric lesions were retrospectively collected. Patients were divided according to the histological types of gastric adenoma into 4 groups: intestinal group (n= 49), foveolar group (n= 23),pyloric group (n= 6) and oxyntic group (n=1). We statistically compared the clinical and endoscopic features of the three groups. In addition to the analysis of the outcomes of endoscopic resection of gastric adenomas.

Results

Of the 79 patients with a mean follow-up of 2622 months, 51 patients were males (65 %) and 28 patients were females (35%). Forty-nine patients (49/79,62%) had intestinal adenoma, 23 patients (29%) showed foveolar adenoma, 6 patients (8%) developed pyloric adenoma and only 1 patient (1%) had oxyntic adenoma. The mean age was significantly older in the intestinal group (71 ± 13 years vs. 64 ± 16 years vs. 58 ± 18 years, p = 0.03). Intestinal adenomas were significantly associated with family history of gastric adenocarcinoma (14% vs. 4% vs. 0%, p = 0.01) and history of statin intake (39% vs. 26% vs. 0%, p = 0.04).Foveolar adenomas were significantly associated with multiple lesions (≥3 lesions) (p < 0.001) and 0-IIa+IIc Paris classification (6/23, 26%). the size of largest polyp was significantly higher among pyloric group (28 ±15, p= 0.00). Among intestinal group, 33/49 patients (67%) had atrophic gastritis. 82% of the adenomas were resected by ESD with histologically complete resection (R0) in 72/79 patients (91%). Although the difference was not statistically significant (p = 0.4), adenocarcinoma was most frequently encountered among the intestinal adenoma group (17/49, 35%). The post endoscopic resection outcome was comparable among 3 groups with overall recurrence rate (group1:8% vs. group 2:17% vs group 3:17%, P = 0.07) with a comparable mean time to recurrence among three groups (21 ± 17 months vs. 20±17months vs. 14 months, p=0.8). Family history of gastric adenocarcinoma (HR=1.33, p< 0.001) and active helicobacter pylori infection (HR=1.14, p < 0.001) were identified as independent predictors of recurrence after endoscopic resection of different gastric adenoma. Among baseline endoscopic characteristics, polyp size ³ 30mm(HR= 2.04, p< 0.001), more than 3 polyps (HR=1.51, p<0.001), lesser curvature as lesion location (HR=1.72, p< 0.001) and morphology as Paris classification IIc are potential predictors of post resection recurrence. In addition to specimen size ³ 15mm (HR=2.19, p< 0.001) and T1b as lesion histology (HR=2.07, p< 0.001), in the histopathological examination.

Conclusion

The present study clarifies the endoscopic and histopathological characteristics of different gastric adenomas, in addition to the potential predictive factors for each subtype. Potential predictors of recurrence after endoscopic resection emphazie the importance of endoscopic follow up.

References

1. Fujiwara, Y. et al. Diagnosis of borderline adenomas of the stomach by endoscopic mucosal resection. Endoscopy 28, 425–430 (1996).

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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UEG Online Course
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Management of early-invasive (T1) colorectal cancer

Alexandra Langers, Jurjen J. Boonstra, James Hardwick

Summary

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Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

With the introduction of population-based screening programs in several countries, the proportion of patients diagnosed with early invasive colorectal cancer (T1 CRC) has been vastly increasing. There are several major challenges in clinical management of this patient group, resulting in significant practice variations among physicians.

This online course covers the most relevant aspects of clinical management of T1 CRC patients, and provides an overview of latest insights and current knowledge gaps. To facilitate the learning process, several questions on real-life patient cases have been included in which learners can bring the acquired knowledge directly into practice.

Learning objectives

  • To systematically assess colorectal lesions and identify those suspicious for submucosally invasive (T1) cancer
  • To learn about local resection techniques for T1 colorectal cancer
  • To gain insight into histological assessment of local en bloc resection specimens of T1 colorectal cancer
  • To be aware of considerations from the oncological and patient perspective in therapeutic decision making after local treatment for T1 colorectal cancer

Target audience

This course is suitable for gastroenterologists, surgeons, pathologists, nurses and any other healthcare professionals interested in, or actively involved in clinical management of T1 CRC patients. 

This course was developed by Alexandra M.J. Langers, Jurjen J. Boonstra, James C.H. Hardwick, Richard (H.) Dang et al. in receipt of an Activity Grant from UEG.

Reviewed & updated December 2022

Event

Management of early-invasive (T1) colorectal cancer

Topics

Digestive Oncology

Accreditation status

accredited

Duration

1 hour

Published

2020

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Arthur Belle Arthur Belle, anna pellat, Romain Coriat, Sarra Oumrani, Maximilien Barret, chaussade stanislas, Félix Corre, Juliette Leroux, Paul Doumbe-Mandengue, Wafaa Ibrahim, Marine Carpentier-Pourquier, Frédéric Beuvon, Nada El-Domiaty

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Mistakes in capsule endoscopy and how to avoid them

Mistakes in capsule endoscopy and how to avoid them

Reena Sidhu Reena Sidhu, Cristina Carretero

UEG Mistakes In Articles
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Mistakes in capsule endoscopy and how to avoid them

Reena Sidhu, Cristina Carretero

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Abstract

Capsule endoscopy is a noninvasive technique intended for studying the small bowel and/or colon. The capsule endoscope consists of a small, wireless, pill-sized camera that can be swallowed and allows direct visualization of the gastrointestinal mucosa. The design of the capsule differs depending on the part of the gastrointestinal tract to be studied. The small-bowel capsule has one optical dome and is generally used in patients who have suspected bleeding or to identify evidence of active Crohn’s disease. By contrast, the colon capsule has two optical domes, a higher frame rate and can be considered as an alternative to conventional colonoscopy, especially for cases when the examination was incomplete. There is also a new capsule with two optical domes that is designed for the panendoscopic study of both the small bowel and colon. 

Topics

Endoscopy

Citation

Carretero C and Sidhu R. Mistakes in capsule endoscopy and how to avoid them. UEG Education 2018; 18: 21-23.

Published

2024

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