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Capsule endoscopy in clinical practice: concise up-to-date overview
Anastasios Koulaouzidis, Sarah Douglas
Clinical and Experimental Gastroenterology , 2009, DOI: http://dx.doi.org/10.2147/CEG.S4758
Abstract: psule endoscopy in clinical practice: concise up-to-date overview Review (6164) Total Article Views Authors: Anastasios Koulaouzidis, Sarah Douglas Published Date November 2009 Volume 2009:2 Pages 111 - 116 DOI: http://dx.doi.org/10.2147/CEG.S4758 Anastasios Koulaouzidis, Sarah Douglas Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK Abstract: Until recently, the small bowel was considered a ‘no man’s land’ as the imaging modalities available for its investigation were laborious, invasive, costly, or involve significant radiation exposure. Wireless capsule endoscopy (WCE) has changed the field dramatically, over the last eight years. The established indications for small bowel WCE are obscure gastrointestinal bleed/anemia, Crohn’s disease, hereditary polyposis syndromes, and to a lesser extent, evaluation of side effects of nonsteroidal anti-inflammatory medications and coeliac disease. We herein present an overview of the capsule examination, which seems to be a quickly improving area.
Capsule endoscopy in clinical practice: concise up-to-date overview
Anastasios Koulaouzidis,Sarah Douglas
Clinical and Experimental Gastroenterology , 2009,
Abstract: Anastasios Koulaouzidis, Sarah DouglasCentre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UKAbstract: Until recently, the small bowel was considered a ‘no man’s land’ as the imaging modalities available for its investigation were laborious, invasive, costly, or involve significant radiation exposure. Wireless capsule endoscopy (WCE) has changed the field dramatically, over the last eight years. The established indications for small bowel WCE are obscure gastrointestinal bleed/anemia, Crohn’s disease, hereditary polyposis syndromes, and to a lesser extent, evaluation of side effects of nonsteroidal anti-inflammatory medications and coeliac disease. We herein present an overview of the capsule examination, which seems to be a quickly improving area.Keywords: capsule, imaging, small bowel, Crohn’s, celiac, GI bleed
Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems
Anastasios Koulaouzidis
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i41.6003
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.
Comments on the editorial by Riggio & Ageloni on the ascitic fluid analysis
Anastasios Koulaouzidis
World Journal of Gastroenterology , 2009,
Abstract: Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis (SBP) diagnosis. Riggio and Angeloni have recently published an editorial on the ascitic fluid analysis in diagnosis and monitoring of SBP. Herein, some points of interest are discussed.
Diagnosis of spontaneous bacterial peritonitis: An update on leucocyte esterase reagent strips
Anastasios Koulaouzidis
World Journal of Gastroenterology , 2011,
Abstract: Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or an intra-abdominal inflammatory focus. An AF polymorphonuclear (PMN) leucocyte count ≥ 250/mm3 -irrespective of the AF culture result- is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. However, this is a crucial step in SBP management. Since 2000, 26 studies (most of them published as full papers) have checked the validity of using leukocyte esterase reagent strips (LERS) in SBP diagnosis. LERS appear to have low sensitivity for SBP, some LERS types more than others. On the other hand, though, LERS have consistently given a high negative predictive value (> 95% in the majority of the studies) and this supports the use of LERS as a preliminary screening tool for SBP diagnosis. Finally, an AF-tailored dipstick has been developed. Within the proper setting, it is set to become the mainstream process for handling AF samples.
Three-dimensional image reconstruction in capsule endoscopy
Anastasios Koulaouzidis,Alexandros Karargyris
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i31.4086
Abstract: To date, limited research has been carried out in developing methods and materials that offer three-dimensional (3-D) representation of the digestive tract. In the field of capsule endoscopy (CE), hardware approaches have been developed that provide real time both 3-D information and texture using an infrared projector and a complementary metal oxide semiconductor camera. The major drawbacks of this system are its size, power consumption and packaging issues. A software approach to approximate a 3-D representation of digestive tract surface utilising current CE technology has been proposed. The algorithm utilizes the Shape from Shading technique and seem to provide promising results for polypoid structures and angioectasias. Further clinical evaluation is currently under way.
Distinct colonoscopy findings of microscopic colitis: Not so microscopic after all?
Anastasios Koulaouzidis,Athar A Saeed
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i37.4157
Abstract: Microscopic colitis (MC) is considered an “umbrella term”, comprising two subtypes, i.e., collagenous colitis (CC) and lymphocytic colitis (LC). They are classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC, especially CC. A systematic electronic and manual search of PubMed and EMBASE (to December 2010), for publications on distinct endoscopic findings in MC, resulted in 42 relevant reports for inclusion in this review. Eighty eight patients with collagenous colitis were presented. Only one publication describing a distinct endoscopic pattern in LC was found. Typical findings in CC are alteration of the vascular mucosal pattern, mucosal nodularity, a sequence of change from mucosal defects to mucosal cicatricial lesions, and perhaps (although of doubtful relevance) mucosal pseudomembranes. A causal connection of mucosal defects with the use of lansoprazole seems to exist. Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.
Spontaneous bacterial peritonitis
Anastasios Koulaouzidis, Shivaram Bhat, Athar A Saeed
World Journal of Gastroenterology , 2009,
Abstract: Since its initial description in 1964, research has transformed spontaneous bacterial peritonitis (SBP) from a feared disease (with reported mortality of 90%) to a treatable complication of decompensated cirrhosis, albeit with steady prevalence and a high recurrence rate. Bacterial translocation, the key mechanism in the pathogenesis of SBP, is only possible because of the concurrent failure of defensive mechanisms in cirrhosis. Variants of SBP should be treated. Leucocyte esterase reagent strips have managed to shorten the ‘tap-to-shot’ time, while future studies should look into their combined use with ascitic fluid pH. Third generation cephalosporins are the antibiotic of choice because they have a number of advantages. Renal dysfunction has been shown to be an independent predictor of mortality in patients with SBP. Albumin is felt to reduce the risk of renal impairment by improving effective intravascular volume, and by helping to bind pro-inflammatory molecules. Following a single episode of SBP, patients should have long-term antibiotic prophylaxis and be considered for liver transplantation.
Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy
Anastasios Koulaouzidis,Sarah Douglas,John N Plevris
World Journal of Gastrointestinal Endoscopy , 2012, DOI: 10.4253/wjge.v4.i2.33
Abstract: AIM: To check the usefulness of blue mode (BM) review in lewis score (LS) calculation, by comparing it with respective LS results obtained by white light (WL) small-bowel capsule endoscopy (SBCE) review and mucosal inflammation as reflected by faecal calprotectin (FC) levels, considered as ‘gold standard’ for this study. METHODS: Computational analysis of our SBCE database to identify patients who underwent SBCE with PillCam and had FC measured within a 30-day period from their test. Only patients with prior colonoscopy were included, to exclude any colon pathology-associated FC rise. Each small bowel tertile was reviewed (viewing speed 8 fps) with WL and BM, in a back-to-back mode, by a single experienced reviewer. LS were calculated after each WL and BM reviews. Pearson rank correlation (rho, r) statistic was applied. RESULTS: Twenty-seven (n = 27, 20F/7M) patients were included. Thirteen (n = 13) had SBCE with PillCam SB1, and the remainder (n = 14) with PillCam SB2. The median level of FC in this cohort was 125 μg/g. LS (calculated in WL SBCE review) correlation with FC levels was r = 0.490 (P = 0.01), while for BM review and LS correlation with FC was r = 0.472 (P = 0.013). CONCLUSION: Although BM is believed to enhance mucosal details i.e., small mucosal breaks, it did not perform better than WL in the calculation of LS in our cohort.
Malignant peritoneal mesothelioma as a rare cause of ascites: a case report
Iftikhar Ahmed, Anastasios Koulaouzidis, Javaid Iqbal, Wong C Tan
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-121
Abstract: We report a case of malignant peritoneal mesothelioma in a 75-year-old woman who presented with ascites which, in the absence of inhalational exposure to asbestos, caused diagnostic confusion, and evaded radiological detection.We concluded from this case that Peritoneal Mesothelioma although rare but should be considered among the differential diagnosis of Ascites.Malignant mesothelioma of the peritoneum is rare but rapidly fatal malignancy. The median survival rang from 5 to 12 months, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000; approximately one fifth to one third of all mesotheliomas are peritoneal. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40–45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. Because of its unusual nature, the disease has not been clearly defined in terms of its natural history, diagnosis, or management. Treatment options with intravenous chemotherapy are far from satisfactory. However, because malignant peritoneal mesothelioma usually remains confined to the peritoneal cavity for most of its natural history, regional chemotherapy is an attractive option.A 75-year-old woman was admitted with a five-week history of progressive dyspnoea, ascites, leg edema and lethargy. She had a previous history of pulmonary tuberculosis 50 years earlier and hypertension which was well controlled with atenolol. She had never smoked and had no known previous exposure to asbestos. She had a family history of lung and large bowel cancer but no history of mesothelioma.Clinical examination revealed bilateral pedal pitting edema but no signs of chronic liver disease. She had moderate ascites but normal cardiovascular and respirat
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