Azienda OspedalieraUniversitariaPoliclinico Seconda ... · Congresso Nazionale –Palermo 28/30...
Transcript of Azienda OspedalieraUniversitariaPoliclinico Seconda ... · Congresso Nazionale –Palermo 28/30...
Azienda Ospedaliera Universitaria Policlinico
Seconda Università degli Studi di NapoliDipartimento di Chirurgia generale e specialistica
U.O.C. di Chirurgia Endoscopica
Direttore: Prof. Angelo Pezzullo
Prof. Vincenzo Napolitano Prof. Giuseppe Amato
Dott. Pietro Schettino Dott.ssa Rosamaria Bozzi
Congresso Nazionale – Palermo 28/30 Ottobre 2010
Wireless Capsule Endoscopy
Years after Michelassi Stricturoplasty
for Crohn’s Disease
Relatore
Pietro Schettino
Congresso Nazionale – Palermo 28/30 Ottobre 2010
VCE nella Malattia di Crohn
Diagnosi
Disease assessment:
a. Sede
b. Estensione (lesioni digiunali)
c. Tipo
d. Recidiva post-chirurgica
e. Risposta alla terapia
Contraindications
Absolute:
Suspected small intestinal obstruction
Pacemakers/AICD’s.
Pregnancy
Relative:
Motility disturbances:
Gastroparesis/Achalasia
Small bowel diverticulosis
Poor surgical candidatesPoor surgical candidates
Complications
Retention of capsule: 1-5%
Bowel obstruction: .5 %
Aspiration: Rare
Variabilità della % di ritenzione della VCE a seconda del quadro clinico.
Chewitz AJG 200621 %4 / 19Suspected
stenosis
Chewitz AJG 200613 %5 / 38Suspected CD
Chewitz AJG 20061.6 %1 / 64CD
Li et al GIE 20061.5 %10 / 667OGBI
Gestwein et al
Clin Gastroint.Hep
‘05
0%0 / 773Healthy
volunteers
Retention rateRetentionSituation
Capsule Endoscopy is Superior to SBFT
For the Evaluation of Crohn’s Disease
Author N SBFT Yield CE Yield
Scapa 2002 13 0% 46%
Fireman 2003 17 0% 71%
Herrerias 2003 21 0% 43%
Hara 2005 17 0% 71%
Mow 2004 50 32% 60%
Arguelles 2004 12 0% 59%
Sant’Anna 2005 20 0% 60%
**Patients with strictures by SBFT were excluded likely
accounting for low yields of SBFT
Patency System
Patency CapsulePatency Capsule Patency ScannerPatency Scanner
26mm long X 11mm diameter
(same dimensions as
CapsuleSB)
A dissolvable capsule containing a detectable Radio Frequency Identification
(RFID) tag and is propelled through the GI tract by natural peristalsis.
Spada C., et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given
patency capsule. Endoscopy 2005;37;9:793-800
• Capsule disintegrates after 40 hours
• Capsule excreted intact in >80% of
patients in less than 40 hours
Capsule disintegrates after 40 hours
-
Patency
proven
Ingestion
Scanning*
(24-36 hours)
Patency
NOT
proven
*If Given® Patency
Scanner is
contraindicated,
use fluoroscopy
Patency Procedure
Spada C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given
patency capsule. Endoscopy 2005;37;9:793-800
Before
After
Patency Procedure
Case Report
• In 2005 a 27-year-old woman, affected with CD underwent
surgery for a long ileal stenosis (74 cm), which was treated
by performing a side-to-side isoperistaltic stricturoplasty,
with a jejunostomy closed 7 months later.
• After 3 years the patient was asthenic and presented
mild malleolar oedema. Serum albumin (2.9 g/dl),
total protein test (6.0 g/dl) and haemoglobin (6.7 g/dl)
were low and a blood transfusion was necessary.
Case Report
•• TheThe patient did not complainpatient did not complain ofof obstructive obstructive
symptomssymptoms. .
•• Crohn’s Disease Activity IndexCrohn’s Disease Activity Index (CDAI)(CDAI) waswas 170. 170.
•• Erythrocyte sedimentationErythrocyte sedimentation rate(30 mm/h) and rate(30 mm/h) and
CC--reactive proteinreactive protein (20 mg/l)(20 mg/l) were slightly were slightly
increasedincreased. .
•• Intestinal ultrasonographyIntestinal ultrasonography,, pancolonscopypancolonscopy
and and aesophagogastroscopy wereaesophagogastroscopy were negativenegative for for
recurrencerecurrence.
The patient refused to undergo MRE,
and a small bowel barium enema was
administered, revealing no stenotic tracts.
what is the best choice?
VCEVCE
VCEVCE
We believe that WCE can be performed
maybe in selected CD patients who have
undergone surgery.
However, further studies are needed to
clarify the WCE role in patients with long-
stricturoplasties and to establish which
examination could be the most effective in
selecting patients.
Conclusion
« Non capisco tutto
questo clamore per lo
sbarco dell'uomo sulla luna,
Io l'avevo
previsto trent'anni fa e
fui deriso. Già, ma Giulio
Verne l'aveva previsto un
secolo prima »
« Nella vita, a differenza
degli scacchi, il gioco
continua dopo lo scacco
matto. »
Isaac Asimov
Grazie per l’attenzione
1965