CC May 2015 Video capsule endoscopy

echoecho's version from 2015-05-07 00:14


Question Answer
In 2000, video capsul endoscopy (VCE) was introduced as a non-invasive way to do what?visualize the mucosa of the small intestine
How is VCE done?a small camera is inside a capsule that is swallowed and images are sent to a computer
Compare the diagnostic yeild to barium imaging?VCE diagnostic yield is 25-50% better than barium imaging
*** The strongest recomemndations for the use of VCE are for evaluation of what?occult GI bleeding
List the 3 scenarios when VCE should be performed?1. as the next step in evaluating obscure GI bleeding after NORMAL upper and lower endoscopies 2. should be done ASAP AFTER negative endoscopies to increase diagnostic yield in cases of obscure overt bleeding 3. should be performed in patients with iron deficiency anemia and negative upper and lower endoscopies
In obscure overt GI bleeding where a small bowel source is suspected, the yield of VCE is approximately ____%?60%
Compare the above (VCE) as to yields for small bowel radiography? for push enteroscopy? for angiography?3-20%; 3-30%; 5-15%
For pts w/ obscure GI bleeding and confirmed iron deficiency anemia, the yield is ____% with ________ accounting for 45% of lesions?67%; ANGIOECTASIAS
*** Recently, VCE has been used for other indications. It has a role in pts with suspected known ____ disease?Crohn's disease
*** Explain how VCE is useful for diagnosis of Crohn's disease?1. it can make the dx in pts w/ suggestive s/s but NEGATIVE endoscopy 2. It can r/o dx in those with nonspecific inflammation noted on other studies
In one study, VCE was more sensitive (90% vs 26%) and equally specific (100%) compared to what studies?small bowel follow-through studies
For established Crohn's patients, VCE can assess what?the status of the small bowel and guide therapy
What is one problem with VCE which can be increased in Crohn's patients?retention of the capsule
VRE should not be performed in what type of patient?in a patient that there is significant concern regarding obstruction
List the two roles that VCE can play in celiac disease?1. used to confirm the dx AFTER appropriate antibody blood tests (when compared to duodenal biopsy and histology {gold standard of dx}, VCE has a sensitivity of 85-89% and specificity of 95-100%. 2) helpful in cases of equivocal celiac disease or to assess pts w/ celiac dse that is NONRESPONSIVE to therapy
VCE is also used for screening and surveillance for polyps in pts with what 2 diseases?1. Peutz-Jeghers syndrome 2. Familial adenomatous polyposis
The FDA approved the _________ for pts who have had an incomplete colonoscopy despite adequate prepartion where complete evaluation was not technically possible?PillCam-2
The Europena Society for Gastrointestinal Endoscopy guidelines suggest that it can be used as an alternative to colonoscopy in _______-risk patients?average
Recent technology has improved, so VCE has a wider filed of vision and is better to detect what?polyps
VCE improvements have resulted in improved _____ (sensitivity vs. specificity) but the ______ (sensitivity vs. specificity) remains lower than colonoscopy?sensitvity; specificity
Sensitivity depends on the ______ of the bowel preparation?adequacy
Compared to conventional colonoscopy, what can be said of the VCE preparation?it requires a greater volume of bowel prep fluid (administered the evening BEFORE and then again the MORNING oft he test) and also administration of a laxative agent during the test to speed bowel transit
While VCE is less invasive, it does NOT allow for what?biopsy or removal of polyps that are discovered (still needs a conventional colonoscopy)
Are there any indications for the use of VCE of the colon for inflammatory bowel disease?no
List the 3 patient types that VCE is NOT recommended for?1. evaluation of pts w/ isolated abdominal pain or diarrhea w/o the presence of inflammatory markers 2. evaluation of isolated weight loss 3. clinical situations where there is a high risk of retention (known inflammatory bowel disease, radiation enteritis)