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Can endoscopy be avoided in the assessment of ulcerative colitis in clinical trials?
Mon, 23 Jan 2012 07:50:00 -0000
Background:There is no gold standard index in the measurement of ulcerative colitis (UC) disease activity in clinical trials. Mucosal healing has been described as an important clinical endpoint requiring endoscopic assessment, which is unpleasant for the patient and may hamper recruitment to trials. The aim of this study was to determine whether endoscopy is necessary in the assessment of UC disease activity and whether a noninvasive disease activity index (partial Mayo score) could be used to predict the Mayo score.Methods:In all, 149 subjects with moderate to severe UC enrolled in a clinical trial were assessed using total and partial Mayo scores. Histologic assessment of biopsies was performed. A regression model was constructed to predict total Mayo score from the partial Mayo score and histology score from the Mayo score. A Bland–Altman test of agreement was performed.Results:The partial Mayo score correlated closely with the total Mayo score at week 4 (rho = 0.97) and week 8 (rho = 0.98). The model to predict total from partial Mayo score showed excellent correlation (rho = 0.97) and good agreement with the total Mayo score at week 4 and the week 8 validation set (rho = 0.97) and accurately classified disease severity (kappa = 0.82). The model to predict histology score from the Mayo score correlated only moderately with the actual histology score at week 4 (rho = 0.59) and week 8 (rho = 0.36).Conclusions:The Mayo score can be accurately predicted from the partial Mayo score. A noninvasive index can replace the Mayo score in future clinical trials. (Inflamm Bowel Dis 2012;)
Wireless capsule endoscopy fragmentation in a patient with Crohn's disease.
de Magalhães Costa MH, da Luz Moreira A, Zaltman C Wireless capsule endoscopy fragmentation in a patient with Crohn's disease. Clin Gastroenterol Hepatol. 2011 Nov;9(11):e116-7 Authors: de Magalhães Costa MH, da Luz Moreira A, Zaltman C PMID: 21601654 [PubMed - indexed for MEDLINE]
Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding.
Gupta T, Ibrahim M, Deviere J, Van Gossum A Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding. World J Gastroenterol. 2011 Nov 7;17(41):4590-5 Authors: Gupta T, Ibrahim M, Deviere J, Van Gossum A Abstract AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB). METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE. RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001). CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE. PMID: 22147964 [PubMed - indexed for MEDLINE]
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Can endoscopy be avoided in the assessment of ulcerative colitis in clinical trials?
Mon, 23 Jan 2012 07:50:00 -0000
Background:There is no gold standard index in the measurement of ulcerative colitis (UC) disease activity in clinical trials. Mucosal healing has been described as an important clinical endpoint requiring endoscopic assessment, which is unpleasant for the patient and may hamper recruitment to trials. The aim of this study was to determine whether endoscopy is necessary in the assessment of UC disease activity and whether a noninvasive disease activity index (partial Mayo score) could be used to predict the Mayo score.Methods:In all, 149 subjects with moderate to severe UC enrolled in a clinical trial were assessed using total and partial Mayo scores. Histologic assessment of biopsies was performed. A regression model was constructed to predict total Mayo score from the partial Mayo score and histology score from the Mayo score. A Bland–Altman test of agreement was performed.Results:The partial Mayo score correlated closely with the total Mayo score at week 4 (rho = 0.97) and week 8 (rho = 0.98). The model to predict total from partial Mayo score showed excellent correlation (rho = 0.97) and good agreement with the total Mayo score at week 4 and the week 8 validation set (rho = 0.97) and accurately classified disease severity (kappa = 0.82). The model to predict histology score from the Mayo score correlated only moderately with the actual histology score at week 4 (rho = 0.59) and week 8 (rho = 0.36).Conclusions:The Mayo score can be accurately predicted from the partial Mayo score. A noninvasive index can replace the Mayo score in future clinical trials. (Inflamm Bowel Dis 2012;)
Wireless capsule endoscopy fragmentation in a patient with Crohn's disease.
de Magalhães Costa MH, da Luz Moreira A, Zaltman C Wireless capsule endoscopy fragmentation in a patient with Crohn's disease. Clin Gastroenterol Hepatol. 2011 Nov;9(11):e116-7 Authors: de Magalhães Costa MH, da Luz Moreira A, Zaltman C PMID: 21601654 [PubMed - indexed for MEDLINE]
Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding.
Gupta T, Ibrahim M, Deviere J, Van Gossum A Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding. World J Gastroenterol. 2011 Nov 7;17(41):4590-5 Authors: Gupta T, Ibrahim M, Deviere J, Van Gossum A Abstract AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB). METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE. RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001). CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE. PMID: 22147964 [PubMed - indexed for MEDLINE]
endoscopy - Google News
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Sites:
American Society for Gastrointestinal Endoscopy: The American Society for Gastrointestinal Endoscopy (ASGE) promotes excellence in gastrointestinal endoscopy for practice, research, and education to members, health care professionals, and the public.El Salvador Atlas of Gastrointestinal VideoEndoscopy: A large data base of video clips and images with case reports of gastrointestinal endoscopy at present with 1152 video clips.
Endo Club Nord: An international forum for practice-oriented gastrointestinal endoscopy.
Endoscopic Gastroplication: Dr. Anthony Starpoli specializes in the treatment of chronic acid reflux and heartburn.
Endoscopic Ultrasonography: Staging and diagnosis of gastrointestinal and pancreatic disease using the specialized medical evaluation endoscopic ultrasound (EUS). Includes journal articles and answers to common questions.
Gastrolab: Provides information focused on endoscopic evaluation of digestive disorders. Gastrolab is a medical research centre in Vasa, Finland.
Laparscopy.com: This web-site provides an interactive enjoyable multimedia database to inform about the advancing technology of laparoscopic surgery and other microinvasive techniques.
My Endoscopy Procedure: learn more and allay any fears of having a colonoscopy and endoscopy procdure.
National Institute of Health (NIH) Consensus Statement Gbout Gallstones and Laproscopic Cholecystectomy: Provides consensus guidelines developed by multiple disciplines to address all aspects of treatment of gallstones including timing of surgery and different treatment modalities.
Notes on Cyber Gastroenterology: Notes on cyber Gastroenterology Dr. J.Murra-Saca,El Salvador
Notes on Cyber Gastroenterology.: Endoscopic images and cases from Gastroenterology clinic based in San Salvador [English/Spanish].
San Diego Institute for Pancreaticobiliary Disease: Dr. Iman Mikhail, utilizing ERCP and general endoscopy. Information on practice, articles, hospital affiliations, and contacts.
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