azienda ospedalierauniversitariapoliclinico seconda ... · congresso nazionale –palermo 28/30...
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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
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Wireless Capsule Endoscopy
Years after Michelassi Stricturoplasty
for Crohn’s Disease
Relatore
Pietro Schettino
Congresso Nazionale – Palermo 28/30 Ottobre 2010
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VCE nella Malattia di Crohn
Diagnosi
Disease assessment:
a. Sede
b. Estensione (lesioni digiunali)
c. Tipo
d. Recidiva post-chirurgica
e. Risposta alla terapia
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Contraindications
Absolute:
Suspected small intestinal obstruction
Pacemakers/AICD’s.
Pregnancy
Relative:
Motility disturbances:
Gastroparesis/Achalasia
Small bowel diverticulosis
Poor surgical candidatesPoor surgical candidates
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Complications
Retention of capsule: 1-5%
Bowel obstruction: .5 %
Aspiration: Rare
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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
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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
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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
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• 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
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Before
After
Patency Procedure
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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.
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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.
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what is the best choice?
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VCEVCE
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VCEVCE
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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
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« 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