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Tc-HIDA cholescintigraphy in Dubin-Johnson syndrome (DJS) demonstrates intense prolonged homogeneous visualization of the liver, together with delayed visualization of the gall bladder and extrahepatic ducts. Such a cholescintigram has... more
Tc-HIDA cholescintigraphy in Dubin-Johnson syndrome (DJS) demonstrates intense prolonged homogeneous visualization of the liver, together with delayed visualization of the gall bladder and extrahepatic ducts. Such a cholescintigram has not been described for any other hyperbilirubinemic state. Because it is a noninvasive and easy technique, it is recommended for the evaluation of children suspected of having DJS.
Research Interests: Medicine, Humans, Child, Liver, Female, and 6 moreMale, Pediatric, Gallbladder, Technetium, Bile ducts, and Medical and Health Sciences
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The continuing development in computer-based medical simulators provides an ideal platform for simulator-assisted training programs for medical trainees. Computer-based endoscopic simulators provide a virtual reality environment for... more
The continuing development in computer-based medical simulators provides an ideal platform for simulator-assisted training programs for medical trainees. Computer-based endoscopic simulators provide a virtual reality environment for training endoscopic procedures. This study illustrates the use of a comprehensive training model combining the use of endoscopic simulators with simulated (actor) patients (SP). To evaluate the effectiveness of a comprehensive simulation workshop from the trainee perspective. Four case studies were developed with emphasis on communication skills. Three workshops with 10 fellows in each were conducted. During each workshop the trainees spent half of the time in SP case studies and the remaining half working with computerized endoscopic simulators with continuous guidance by an expert endoscopist. Questionnaires were completed by the fellows at the end of the workshop. Seventy percent of the fellows felt that the endoscopic simulator was close or very clos...
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Papillary stenosis is an imprecisely defined clinical syndrome which eludes definitive diagnosis. In this study we evaluated 26 patients with suspected papillary stenosis by manometric examination of the sphincter of Oddi done during ERCP... more
Papillary stenosis is an imprecisely defined clinical syndrome which eludes definitive diagnosis. In this study we evaluated 26 patients with suspected papillary stenosis by manometric examination of the sphincter of Oddi done during ERCP examination. Basal pressure in the sphincter of Oddi was elevated in 14 of the patients. Of these 14 patients, 10 underwent sphincterotomy and all experienced improvement in clinical symptoms after their surgery. We suggest that ERCP manometry is a useful procedure for identifying patients with papillary stenosis who may benefit from sphincterotomy.
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Research Interests: Nutrition and Dietetics, Biology, Inflammation, Medicine, Cell line, and 15 moreClinical Nutrition, Humans, Intestinal Mucosa, Cell Viability, Cytokine, Chemokine, Caco-2 cells, Tumor necrosis factor-alpha, Biological activity, Secretion, Interleukin, Intestinal Inflammation, Immunosuppressive Agents, Allicin, and Anti-inflammatory agent
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Research Interests: Gastroenterology, Medicine, Humans, Internal Medicine, Smoking, and 15 moreFemale, Male, Clinical Sciences, Middle Aged, Adult, Budesonide, Neurosciences, Crohn Disease, Confidence Interval, Mesalamine Uk, Mesalamine, Severity of Illness Index, Adverse effect, discontinuation, and Paediatrics and reproductive medicine
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Research Interests: Gastroenterology, Medicine, Israel, Inflammatory Bowel Disease, Humans, and 13 moreInternal Medicine, Follow-up studies, Colonoscopy, Clinical Sciences, Colitis, Prevalence, Middle Aged, Time Factors, Retrospective Studies, Prognosis, Inflammatory Bowel Diseases, Severity of Illness Index, and mass Screening
To the editors, It is estimated that more than 300,000 intragastric balloons (IGBs) have been successfully used for weight loss for the last 30 years. Balloon deflation is among the complications reported in the literature and ranges from... more
To the editors, It is estimated that more than 300,000 intragastric balloons (IGBs) have been successfully used for weight loss for the last 30 years. Balloon deflation is among the complications reported in the literature and ranges from 3.2 to 3.4% [1, 2]. A fluidfilled IGB is customarily injected with 2–5 ml of a 1% solution of methylene blue such that deflation results in absorption of the methylene blue and its excretion in the urine. This causes a bluish discoloration of the urine and alerts the patient to the deflation. The deflated balloon can either stay in the stomach for a period of time from which it is removed by the endoscopist, or it can migrate into the intestines and pass into the stool with or without symptoms of nausea and pain along the way. In rare circumstances, the migrated IGB impacts the small bowel with a resultant small bowel obstruction (SBO). In her review of 17 IGB publications, Mathus-Vliegen reported a 3.2% (132/4037) incidence of BioEnterics intragastric balloon (BIB) deflations, with 5 of those 132 deflated balloons causing a small bowel obstruction—a SBO incidence of 0.12% (5/4037) [1]. In his review of 16 IGB publications, Imaz reported a 3.4% (116/3429) incidence of BIB balloon deflations with 26 of those 116 causing Bdigestive tract obstruction^—which includes both SBO and gastric outlet obstruction [2]. There have been multiple case reports of deflated IGBs (BIB, Heliosphere, Obalon, and Elipse) with resultant SBO that have been treated with laparotomy, laparoscopy, laparoscopy-assisted enteroscopy [3–17], and double balloon enteroscopy retrieval [18] in the last 17 years. In 1982 and 1985, there were two case reports of successful ultrasound or CT-guided percutaneous aspirations of obstructing balloons, with spontaneous fecal passage of the aspirated balloon [19, 20], and an unsuccessful percutaneous aspiration in 2012 with a Heliosphere balloon [21]—the aspiration succeeded; however, the balloon impacted again distally in the small bowel. We recently encountered an obstructing deflated intragastric balloon which we referred to our interventional radiologist: A 400-ml Spatz3 Adjustable IGB (Spatz FGIA Inc., NY, USA) was implanted in a 22-year-old female with a BMI of 34.5 (height 158 and weight 86 kg) that resulted in a 16-kg weight loss—9-kg weight loss in the first 5 months, plus an additional 7-kg weight loss following an upward adjustment with the addition of 300 ml to her balloon at month five. Following extraction at month 12, she regained 3 kg and her BMI rose from 28 to 29.2 over the ensuing 3 months. She requested a second balloon and was implanted with a 700-ml balloon. At the end of the fourth month, the patient had a sudden loss of all balloon-related symptoms (burps and fullness) followed by the onset of mid abdominal pain. The pain was cramping, periumbilical, and associated with nausea without vomiting. At endoscopy that evening, the balloon was not seen in the stomach. Abdominal x-ray revealed air fluid levels and CT scan was consistent with an early mid jejunal small bowel obstruction. The patient was admitted to the surgical department. Push enteroscopy using a pediatric colonoscope that reached the proximal to mid jejunum did not reach the balloon. Review of the CT scan by the interventional radiologist revealed that there was a significant amount of fluid in the balloon. There were several potential access points for a percutaneous aspiration of the deflated balloon. Following discussions with the surgeons, the gastroenterologists, and the patient, a percutaneous CT-guided aspiration was undertaken. The * Jeffrey Brooks jeff@spatzmedical.net
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The O-specific polysaccharide (O-SP) domain of Shigella LPS is both an essential virulence factor and a protective antigen for this genus. A critical level of serum IgG anti-O-SP was shown to confer immunity to shigellosis, likely by... more
The O-specific polysaccharide (O-SP) domain of Shigella LPS is both an essential virulence factor and a protective antigen for this genus. A critical level of serum IgG anti-O-SP was shown to confer immunity to shigellosis, likely by complement-mediated bacteriolysis of the inoculum. Conjugate Shigella O-SP vaccines were shown to be safe and immunogenic in children, and, in a preliminary study,
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During endoscopic retrograde cholangiopancreatography, pressures of the common bile duct, the pancreatic duct and the sphincter of Oddi were recorded in 64 patients with various diseases of the pancreaticobiliary system. The manometric... more
During endoscopic retrograde cholangiopancreatography, pressures of the common bile duct, the pancreatic duct and the sphincter of Oddi were recorded in 64 patients with various diseases of the pancreaticobiliary system. The manometric study was found to be helpful in the diagnosis of papillary dysfunction and in the assessment of the adequacy of papillotomy and the size of a choledochoduodenostomy. Furthermore, it is possible that nitrates may be effective in the treatment of patients with papillary dysfunction.
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The present study was undertaken to evaluate the effect of omeprazole on liver blood flow in the rat by using the indocyanine green (ICG) technique and measuring both ICG clearance and hepatic extraction
Research Interests: Medicine, Liver, Animals, Male, Rats, and 3 moreIndocyanine green, Omeprazole, and Medical and Health Sciences
Two APC germline mutations, E1317Q and I1307K, have been linked to colorectal cancer (CRC) risk. Whereas the I1307K variant is almost exclusively encountered in (Ashkenazi) Jews, E1317Q is not restricted to certain ethnic populations.... more
Two APC germline mutations, E1317Q and I1307K, have been linked to colorectal cancer (CRC) risk. Whereas the I1307K variant is almost exclusively encountered in (Ashkenazi) Jews, E1317Q is not restricted to certain ethnic populations. Data on its contribution to CRC risk in Jewish patients are sparse. To assess the contribution of E1317Q to CRC development in the Jewish population. A total of 538 consecutive Israeli Jewish CRC patients and 440 controls were genotyped for E1317Q. In addition, the rate of the I1307K APC missense mutation and the two predominant Jewish mutations in hMSH2, A636P, and 324delCA, associated with hereditary nonpolyposis colon cancer (HNPCC), were determined. The E13117Q missense mutation was detected in 6/538 (1%) of CRC patients and 5/440 (1%) of controls. The I1307K variant was found in 8% of all patients and in 11% (35/322) of patients of Ashkenazi Jewish descent. Carriers and noncarrier CRC patients did not differ in age of onset or associated colonic adenomatous polyps. The carrier rate among controls was 5% among Ashkenazim and 1.6% among non-Ashkenazi individuals. The 324delCA hMSH2 mutation was not observed in this cohort, and 4 of 322 Ashkenazi patients (1.2%) displayed the A636P mutation. In Jewish CRC patients the E1317Q variant plays little if any role in colorectal cancer susceptibility and genetic testing for this variant is not warranted. The I1307K mutation is associated with a moderate excess risk for CRC, but age of onset seems not to be earlier and this variant is not associated with a multiple colonic polyp phenotype. Founder mutations in hMSH2 are rare in consecutive CRC patients.
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Gastric polypectomy is associated with increased risk of bleeding. The use of endoscopic ultrasound (EUS) before polypectomy to decrease the rate of bleeding in such patients has not been studied. All gastric polyps excised by snare... more
Gastric polypectomy is associated with increased risk of bleeding. The use of endoscopic ultrasound (EUS) before polypectomy to decrease the rate of bleeding in such patients has not been studied. All gastric polyps excised by snare polypectomy were evaluated. The primary outcome was the occurrence of immediate or delayed bleeding episodes. Postpolypectomy bleeding was correlated with the presence of blood vessels at the base of the polyp on EUS examination. Characteristics of both patients and polyps were analyzed as risk factors for postpolypectomy bleeding. One-hundred and two snare polypectomies were performed. Fifty-seven polyps (56%) had been evaluated by prior EUS. Bleeding occurred in 7 (7%) patients. Of these, 4 had not undergone EUS evaluation, whereas in 3 patients who had had a prepolypectomy EUS evaluation, none were found to harbor a visible blood vessel. Bleeding did not occur in any of the 8 patients in whom EUS suggested the presence of blood vessel. The size, location, type, and histology did not show any significance in predicting postpolypectomy bleeding. The risk of bleeding after endoscopic resection of gastric polyps was 7%. EUS evaluation before gastric polypectomy does not seem to contribute to the safety of such a procedure.
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The study aims to evaluate the risk of advanced histology within small colonic polyps and assess whether this risk warrants different recommendation for surveillance and treatment of such polyps. A retrospective study of all patients... more
The study aims to evaluate the risk of advanced histology within small colonic polyps and assess whether this risk warrants different recommendation for surveillance and treatment of such polyps. A retrospective study of all patients undergoing their first ever colonoscopy and polypectomy in a tertiary hospital for one of three indications: screening, positive family history,and positive occult blood in stool. The histological reports of all resected polyps were retrieved and stratified according to the various polyps' sizes. Advanced neoplasia was defined as tubular adenoma ≥10 mm or any size polyp with advanced histology, i.e., villous or tubulovillous adenoma, high-grade dysplasia, intramucosal carcinoma, or invasive cancer. Seven hundred forty-one patients who had a total of1,192 resected polyps were included. Of polyps ≤5 mm in size, 1.6% harbored invasive cancer or high-grade dysplasia,and additional 4.1% contained villous component. The rate of advanced histology for polyps sized 6-9 mm was over 15%. The rate of advanced histology in polyps ≤5 mm was not significantly different when employing sensitivity analysis accounting for possible under or overestimation of polyp sizes by 1 and 2 mm. However, 4.6% of polyps sized 6-9 mm were found to harbor an invasive or high-grade dysplasia component when taken into account a 2-mm overestimation. A non-negligible fraction of small polyps harbor advanced histology. This finding suggests that expectant follow-up by non-invasive colonic imaging modalities for small polyps or not reporting them may put more than 5% of patients at risk of dysplasia progression.
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A missense mutation within the APC gene, I1307K, was described in Ashkenazi individuals at risk for colorectal cancer (CRC) and in the general population. The anecdotal reporting of the occurrence of this mutation in some non-Ashkenazi... more
A missense mutation within the APC gene, I1307K, was described in Ashkenazi individuals at risk for colorectal cancer (CRC) and in the general population. The anecdotal reporting of the occurrence of this mutation in some non-Ashkenazi individuals led us to hypothesize that within the Jewish people, the I1307K polymorphism may reflect a founder mutation, and that the mutation is not restricted to ethnic Ashkenazis. To test that notion, and to establish the occurrence rate of the I1307K polymorphism in non-Ashkenazi Jewish populations, we screened Iraqi and Moroccan Jews and consecutive Jewish CRC patients and performed haplotype analysis with APC-linked markers in two I1307K carrier families. We analyzed Jewish individuals: 210 Moroccans, 160 Iraqis, 148 Ashkenazi, and 349 CRC patients (227 Ashkenazi and 122 non-Ashkenazi). The mutation detection scheme included PCR followed by denaturing gradient gel electrophoresis (DGGE) or modified restriction analysis (MRA). Haplotypes were assessed using three intragenic and three flanking markers. The I1307K polymorphism was detected in 29/227 Ashkenazi (12.8%), 2/122 (1.6%) non-Ashkenazi CRC patients, and in 2 individuals each (approximately 1%) within the Moroccan and Iraqi populations. Allelic pattern analysis in all our I1307K carriers, revealed a common haplotype for the three intragenic markers tested, in all mutation carriers, regardless of ethnic origin. The I1307K polymorphism, therefore, exists in all ethnic Jewish populations: Ashkenazi and non-Ashkenazi, with or without colon cancer. Jewish I1307K mutation carriers share a common allelic pattern with APC-linked markers. This strongly supports the notion of a founder mutation for I1307K.
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The GI Mentor (Simbionix, Lod, Israel) is a computer-based simulator used for training in endoscopy. It contains modules for training in hand-eye coordination, upper and lower gastrointestinal endoscopy, endoscopic retrograde... more
The GI Mentor (Simbionix, Lod, Israel) is a computer-based simulator used for training in endoscopy. It contains modules for training in hand-eye coordination, upper and lower gastrointestinal endoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. It provides experience in the steering and torque of the endoscope, suction, and inflation, a realistic view through the monitor, and a realistic force feedback when performing the procedure. Its advantages include its availability for training with no need for previous preparation and the constant interaction with the trainee. It is costly, however, and presently is suitable only for the initial steps of training.
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Surgery for esophageal cancer carries a high mortality rate and a low rate of resectability for cure. Accurate preoperative staging is therefore of utmost importance. Staging is based on computerized tomography (CT), and recently, the use... more
Surgery for esophageal cancer carries a high mortality rate and a low rate of resectability for cure. Accurate preoperative staging is therefore of utmost importance. Staging is based on computerized tomography (CT), and recently, the use of endoscopic ultrasonography (EUS). We performed EUS and CT on 10 patients with esophageal cancer. Tumors were staged according to the TNM classification. According to the CT results, seven patients had a T3 tumor, one T1-2 and two T0. All patients were diagnosed as T3 by EUS. One patient, who was treated by combined modality treatment with chemotherapy and radiotherapy, converted to T0. Six patients were operated on, and in five, pathological findings were of an invasive tumor. The T stage was predicted correctly in five patients by CT and in all six patients by EUS. N stage was correctly diagnosed in two patients by CT and in five by EUS. It is concluded that EUS is superior to CT for preoperative staging of esophageal tumors. EUS should be unde...
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Research Interests: Medicine and Colonoscopy
... Die DBE ist eine komplexe Untersuchung. Sie sollte nur von trainierten und erfahrenen Endoskopikern durchgeführt werden. ... [29]. Die existierenden endoskopischen Scores und Indizes für die Schwere eines Morbus Crohn sind nur für die... more
... Die DBE ist eine komplexe Untersuchung. Sie sollte nur von trainierten und erfahrenen Endoskopikern durchgeführt werden. ... [29]. Die existierenden endoskopischen Scores und Indizes für die Schwere eines Morbus Crohn sind nur für die Ileokoloskopie validiert. ...
Research Interests: Medicine and Gynecology
... two computer-based simulators of the gastrointestinal tract: the GI-Mentor, which was developed by Simbionix (Tel-Hashomer, Israel), and the ... Gastrointest Endosc 2000; 52: 701–3. 23 Aabakken L, Adamsen S, Kruse A. Performance of a... more
... two computer-based simulators of the gastrointestinal tract: the GI-Mentor, which was developed by Simbionix (Tel-Hashomer, Israel), and the ... Gastrointest Endosc 2000; 52: 701–3. 23 Aabakken L, Adamsen S, Kruse A. Performance of a colonoscopy simulator: experience on ...
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The mechanism(s) responsible for the insulin-like effects of vanadate are still unclear, although several possible explanations have been raised. However, the possibility that vanadate induces inhibition of insulin degradation in the... more
The mechanism(s) responsible for the insulin-like effects of vanadate are still unclear, although several possible explanations have been raised. However, the possibility that vanadate induces inhibition of insulin degradation in the liver was not examined yet. Therefore, in the present study we examined the effect of vanadate on the extraction of insulin by the perfused rat liver using an open, non-recycling system. Baseline insulin extraction (44 +/- 2% and 37 +/- 3%) was not affected by the administration of 1 and 5 microM vanadate (decreased to 42 +/- 2% and 36 +/- 1, respectively, p = NS). Vanadate had no adverse effects on liver viability, and the bile flow remained stable during and after vanadate administration (0.87 +/- 0.08 microliter/min/g liver prior to Vs. 0.084 +/- 0.11 microliter/min/g liver following vanadate administration). This study shows that vanadate does not inhibit insulin extraction by the perfused liver, and that does of vanadate that effectively inhibit hepatic glucose production possess no adverse effects on liver viability.
Research Interests: Endocrinology, Biology, Medicine, Internal Medicine, Insulin, and 10 moreLiver, Animals, Male, Perfusion, Clinical Sciences, Rats, Wistar Rats, Vanadate, Rat Liver, and Vanadates
Previous studies have demonstrated that vanadate ions mimic many of the actions of insulin in in vitro systems. Also, vanadate administered to diabetic hyperglycemic rats lowers their blood glucose levels to normal values. In this study... more
Previous studies have demonstrated that vanadate ions mimic many of the actions of insulin in in vitro systems. Also, vanadate administered to diabetic hyperglycemic rats lowers their blood glucose levels to normal values. In this study we demonstrate that vanadate inhibits glucose output in the isolated perfused rat liver. Glucose production was suppressed maximally (about 50% to 60%), on addition of extremely low vanadate ion concentrations (0.5 to 1 mumol/L). This concentration is about two log units lower than the vanadate ion concentrations that are required to activate hexose uptake and glucose metabolism in vitro and is within the range of endogenous intracellular vanadium concentration. Insulin had little or no effect in inhibiting hepatic glucose output in this experimental system. The effect of vanadate ions is rapid in onset and is not accompanied by any signs of liver toxicity as assessed by various criteria. In conclusion, the study indicates that (a) vanadate ions inhibits hepatic glucose output, maximally and at extremely low, nontoxic concentrations (ID50 = 0.7 +/- 0.1 mumol/L). (b) The modulation action of the ion is fast and probably occurs at point(s) distal to the insulin receptor itself. (c) The liver participates in the process of maintaining euglycemia in diabetic rats receiving optimal doses of vanadate orally.
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The correlation between the width of muscularis propria and esophageal pressure in patients with the nutcracker esophagus is unknown. We examined by endoscopic ultrasonography the width of the muscularis propria in patients with... more
The correlation between the width of muscularis propria and esophageal pressure in patients with the nutcracker esophagus is unknown. We examined by endoscopic ultrasonography the width of the muscularis propria in patients with nutcracker esophagus. The width of muscularis propria was measured at the gastroesophageal junction and at the lower, middle, and upper esophagus in 18 patients and 10 control subjects. Mean muscularis propria diameter in patients was 1.8 +/- 1.4, 1.5 +/- 1.2, 1.5 +/- 0.8, and 1.2 +/- 0.4 mm at the gastroesophageal junction, lower, middle, and upper esophagus. In the control group, the mean width was 1.2 +/- 0.3, 1.2 +/- 0.3, 1.1 +/- 0.3, and 0.9 +/- 0.1 mm, respectively. The difference was significant at the gastroesophageal junction and upper esophagus. The muscularis propria was wider than 3 mm in 30% of patients. There was no correlation between the site of the wide muscularis propria and the esophageal segment where high pressure was recorded. Length of disease, frequency of symptoms, and length of each symptomatic period did not correlate with the width of muscularis propria. The muscularis propria is thickened in one third of patients with nutcracker esophagus. The extent and magnitude of this thickening do not correspond to the location and the magnitude of the manometric abnormality or clinical presentation.
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BACKGROUND & AIMS Helicobacter pylori resides within the gastric mucosa, a niche hostile to other microorganisms. Human gastrin levels are elevated after infection and return to normal after eradication. The aim of this study was to... more
BACKGROUND & AIMS Helicobacter pylori resides within the gastric mucosa, a niche hostile to other microorganisms. Human gastrin levels are elevated after infection and return to normal after eradication. The aim of this study was to test the direct effect of gastrin on the growth of H. pylori. METHODS H. pylori and control bacteria were grown with gastrin or control peptides and growth rate was determined. (125)I-labeled gastrin was used to determine uptake. RESULTS Human gastrin stimulated H. pylori growth in a specific, dose-dependent manner. Gastrin shortened the lag time, increased growth rate in the logarithmic phase, and increased final bacterial concentration at the stationary phase. These effects were shown over a wide concentration range, including physiological luminal and serum levels. Labeled gastrin uptake was inhibited by unlabeled gastrin. Controls consisting of cholecystokinin and pentagastrin inhibited gastrin uptake but did not stimulate growth. In contrast, somatostatin and epidermal growth factor had no effect on either gastrin uptake or bacterial growth. These results suggest a structurally restricted, receptor-mediated, gastrin-specific effect. CONCLUSIONS Human gastrin is a specific growth factor for H. pylori and may have a role in the adaptation of H. pylori to its unique habitat.
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Patients with spondyloarthropathies are often found to have signs of small-bowel inflammation when examined by ileocolonoscopy. Because capsule endoscopy has been found to be superior to other endoscopic and radiological modalities in the... more
Patients with spondyloarthropathies are often found to have signs of small-bowel inflammation when examined by ileocolonoscopy. Because capsule endoscopy has been found to be superior to other endoscopic and radiological modalities in the detection of small-bowel inflammation, we aimed to compare the diagnostic yield of capsule endoscopy with that of ileocolonoscopy in the detection of small-bowel lesions in patients with spondyloarthropathies. Twenty patients with documented seronegative peripheral arthritis, ankylosing spondylitis, or sacroiliitis, who had not taken nonsteroidal anti-inflammatory drugs (NSAIDs) in the preceding 2 months, participated in the study. The patients underwent capsule endoscopy, followed by ileocolonoscopy within 7 days, with blinded assessment of both examinations. Biopsies were taken when indicated and adverse events were monitored. Patients completed a questionnaire on their satisfaction with the two procedures. A total of 20 patients (11 men, 9 women; mean age 41+/-13 years) with seronegative inflammatory spondyloarthropathies but without abdominal complaints completed the study. No adverse effects were reported and all the capsules were excreted. Of these 20 patients, 11 (55%) had a normal small bowel on both examinations. Significant small-bowel findings (erythema, mucosal breaks, aphthous or linear ulcers, erosions) were detected by capsule endoscopy in six patients (30%) and by ileocolonoscopy in only one patient. In addition, capsule endoscopy detected significant upper gastrointestinal pathology in 40% of patients. The patients preferred capsule endoscopy to ileocolonoscopy. Capsule endoscopy detected more small-bowel lesions than ileocolonoscopy, and provided additional potentially relevant information on upper gastrointestinal pathology in patients with spondyloarthropathies.
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Research Interests: Randomization, Risk, Medicine, Endoscopy, Prospective studies, and 14 moreHumans, Feasibility Studies, Patient Compliance, Colonoscopy, Clinical Sciences, Time Factors, Randomized Controlled Trial, Perforation, Diverticulitis, Adenocarcinoma, Acute Disease, Malignancy, mass Screening, and Colonic Neoplasms
The limited angle of view of standard colonoscopes means that lesions can be missed. A multidirectional viewing system (OmniVision) has been developed recently and has been incorporated into the Aer-O-Scope (GI View Ltd., Ramat Gan,... more
The limited angle of view of standard colonoscopes means that lesions can be missed. A multidirectional viewing system (OmniVision) has been developed recently and has been incorporated into the Aer-O-Scope (GI View Ltd., Ramat Gan, Israel), a disposable, self-propelling, and self-navigating colonoscope. The objectives of this study were to qualitatively assess the sensitivity of this viewing system in an ex vivo porcine polyp induction model, and to demonstrate its feasibility and safety in live pigs. For the ex vivo part of the study, six red metal beads of various sizes were randomly sewn into the mucosa of an unfolded, 2-meter-long porcine colonic segment. Seven passages of the Aer-O-Scope were video-recorded separately and blindly reviewed by six experienced gastroenterologists. The sensitivity of the Aer-O-Scope to detect beads of various sizes was calculated. For the in vivo experiment, in a repeated-measure study, nine female domestic pigs were examined with the Aer-O-Scope with the OmniView optics, followed immediately by examination with standard optical colonoscopy in order to assess the integrity of the colonic mucosa. In the ex vivo study the sensitivity of the Aer-O-Scope was 97.6% (CI 94.0%-100%) for any bead (i. e. any "polyp"). The rate of polyp detection was similar for the six endoscopists, and was consistent for all bead sizes. The average false-positive rate was 0.3% polyps per run (SD 0.61%). The mean time taken for the video assessment was 8.0 minutes (SD 4.0 minutes). In the in vivo experiments with the Aer-O-Scope, both the front-viewing and omnidirectional-viewing systems were functional in all cases. The colon in front of the optical capsule was well distended and a complete and meticulous inspection of the entire colonic mucosa was performed in all the pigs. There were no adverse events. The OmniVision system allows for a highly sensitive inspection of the colonic mucosa without the need for tip manipulation. Clinical studies are warranted in order to validate these results in humans.
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The clinical significance of unexplained dilation of the common bile duct (CBD) seen at endoscopic retrograde cholangiopancreatography (ERCP) in non-jaundiced patients with abdominal pain, was studied in a group of 14 patients. A CBD... more
The clinical significance of unexplained dilation of the common bile duct (CBD) seen at endoscopic retrograde cholangiopancreatography (ERCP) in non-jaundiced patients with abdominal pain, was studied in a group of 14 patients. A CBD diameter of more than 15 mm was associated with choledocholithiasis (29%), periampullary carcinoma (14%), papillary stenosis (14%), or no definite pathology (43%) during a follow-up of 20 months. Dilation of the CBD exceeding 20 mm, was associated with periampullary carcinoma or papillary stenosis in 80% of the patients. It is recommended that such a group of patients be followed very closely, and the ERCP examination repeated within a few months.