To evaluate the effectiveness of our proposed bowel preparation method for colon capsule endoscopy. A pilot, multicenter, randomized controlled trial compared our proposed "reduced volume method" (group A) with the "conventional volume method" (group B) preparation regimens. Group A did not drink polyethylene glycol electrolyte lavage solution (PEG-ELS) the day before the capsule procedure, while group B drank 2 L. During the procedure day, groups A and B drank 2 L and 1 L of PEG-ELS, respectively, and swallowed the colon capsule (PillCam COLON® capsule). Two hours later the first booster of 100 g magnesium citrate mixed with 900 mL water was administered to both groups, and the second booster was administered six hours post capsule ingestion as long as the capsule had not been excreted by that time. Capsule videos were reviewed for grading of cleansing level. Sixty-four subjects were enrolled, with results from 60 analyzed. Groups A and B included 31 and 29 subjects, respectively. Twenty-nine (94%) subjects in group A and 25 (86%) subjects in group B had adequate bowel preparation (ns). Twenty-two (71%) of the 31 subjects in group A excreted the capsule within its battery life compared to 16 (55%) of the 29 subjects in group B (ns). Of the remaining 22 subjects whose capsules were not excreted within the battery life, all of the capsules reached the left side colon before they stopped functioning. A single adverse event was reported in one subject who had mild symptoms of nausea and vomiting one hour after starting to drink PEG-ELS, due to ingesting the PEG-ELS faster than recommended. Our proposed reduced volume bowel preparation method for colon capsule without PEG-ELS during the days before the procedure was as effective as the conventional volume method.

INTRODUCTION: Noninvasive colorectal cancer (CRC) screening methods with higher sensitivity for advanced colorectal neoplasia (ACN) than the fecal immunochemical test (FIT) alone are warranted. This study aimed to elucidate the diagnostic performance of a risk stratification score calculated using baseline individual characteristics and its combination with FIT for detecting ACN. METHODS: This cross-sectional analysis of data from a prospective cohort in Izu Oshima, Japan, included asymptomatic individuals age 40–79 years who underwent both 2-day quantitative FIT and screening colonoscopy. The 8-point risk score, calculated based on age, sex, CRC family history, body mass index, and smoking history, was assessed. Colonoscopy results were used as reference. RESULTS: Overall, 1,191 individuals were included, and 112 had ACN. The sensitivity and specificity of the 1-/2-day FIT (cutoff: 50–200 ng Hb/mL) for ACN were 17.9%–33.9% (4.9%–22.0% for right-sided ACN) and 91.8%–97.6%, respectively. The risk score's c-statistic for ACN was 0.66, and combining the score (cutoff: 5 points) with 1-/2-day FIT (cutoff: 50–200 ng Hb/mL) yielded a sensitivity and specificity for ACN of 46.4%–56.3% (43.9%–48.8% for right-sided ACN) and 76.6%–80.8%, respectively. The specificity of the risk score and FIT combination for all adenomatous lesions was 82.4%–86.4%. DISCUSSION: The 8-point risk score remarkably increased the sensitivity for ACN, particularly for right-sided ACN. Although the specificity decreased, it was still maintained at a relatively high level. The risk score and FIT combination has the potential to become a viable noninvasive CRC screening option.

To clarify the endoscopic and clinical findings of cytomegalovirus (CMV) gastritis after allogeneic hematopoietic stem cell transplantation (allo-SCT). Between 1999 and 2005, 523 patients underwent allo-SCT at our hospital, and 115 of these patients with gastrointestinal symptoms underwent esophagogastroduodenoscopy. CMV gastritis was diagnosed pathologically in seven patients (1.3%) with the other 108 patients serving as controls. Six of the seven patients developed positive CMV antigenemia, and five complained of abdominal pain. Development of abdominal pain preceded CMV antigenemia in four of the five patients. Endoscopic examination showed oozing (n = 2), erosion (n = 6), and redness (n = 5) in the seven patients with CMV gastritis, while the control patients showed oozing (n = 3), erosion (n = 24), and redness (n = 100). Erosion and oozing were more frequently documented in patients with CMV gastritis compared with the controls, and the differences were statistically significant (P = 0.0012 and 0.029, respectively). CMV inclusion bodies were documented in 12 of 14 biopsy specimens obtained from erosive lesions, while they were identified in 4 of 15 biopsy specimens obtained from lesions other than erosions (P = 0.0025). This study suggests that erosion and oozing, as well as abdominal pain, are useful indicators in the diagnosis of CMV gastritis following allo-SCT.

A 62-year-old man who was diagnosed with malignant pleural mesothelioma ([ Fig. 1 ]) underwent right extrapleural pneumonectomy. He was followed up with chest radiographs, computed tomographic scans, and laboratory investigations, none of which showed any findings. Nine months later, he was readmitted for the investigation of tarry stools and iron deficiency anemia. Esophagogastroduodenoscopy, total colonoscopy, red blood cell scintigraphy, and computed tomography did not identify any cause for the gastrointestinal bleeding. Video capsule endoscopy, however, revealed multiple protruding lesions with slight but continuous oozing throughout the entire small intestine ([ Fig. 2 a ]); and double-balloon enteroscopy identified protrusions that were covered with normal mucosa with central ulceration and mild bleeding ([ Fig. 2 b ]). Examination of biopsy specimens showed these protusions to contain tumor cells which ranged in appearance from large polyhedral cells to spindle-shaped cells ([ Fig. 3 a ]). Immunohistochemical examination revealed tumor cells positive for the mesothelial markers, calretinin and WT1 ([ Fig. 3 b ]), and the protrusions were diagnosed as metastatic malignant mesothelioma of the small bowel. Fig. 1 a A chest radiograph showing right-sided pleural thickening and a pleural effusion. b A computed tomographic scan of the chest showed diffuse pleural thickening of the right hemithorax. Fig. 2 a Video capsule endoscopy revealed multiple protruding lesions with slight but continuous oozing, and these were found from the proximal jejunum to the terminal ileum. b Multiple protruding lesions measuring 20 - 30 mm were clearly shown by double-balloon enteroscopy. These protrusions were covered with normal mucosa, with central ulceration and evidence of mild bleeding. Fig. 3 a The tumor cells ranged in appearance from large polyhedral cells to spindled-shaped cells, with vesicular nuclei and prominent nucleoli and with a moderate amount of cytoplasm (hematoxylin and eosin stain, original magnification × 20). b The tumor cells showed cytoplasmic and nuclear staining for calretinin (original magnification × 20). Malignant pleural mesothelioma is an aggressive tumor and its incidence has increased significantly in recent years [ 1 ]. Small-bowel metastasis from malignant pleural mesothelioma has never been reported before, so this apparently is the first case. Furthermore, we obtained clear endoscopic images of the lesions while the patient was still alive. Some patients with gastrointestinal bleeding remain undiagnosed even after upper endoscopy and total colonoscopy [ 2 ], and most of these patients will have bleeding sites in the small bowel. Video capsule endoscopy and double-balloon enteroscopy have been introduced recently for the evaluation of the small bowel. Iddan et al. [ 3 ] were the the first to report on capsule endoscopy and it is now widely accepted as an investigation for small-intestinal screening. Even trivial bleeding was detected in this case by capsule endoscopy, although red blood cell scintigraphy had failed to detect its source. A similar result was confirmed previously by Hartmann et al. [ 4 ]. Double-balloon enteroscopy, which was developed by Yamamoto et al. [ 5 ], enabled us to obtain biopsy specimens, which circumvented a limitation of capsule endoscopy. The combination of capsule endoscopy and double-balloon enteroscopy contributed significantly to our reaching a diagnosis in this case. Endoscopy_UCTN_Code_CCL_1AC_2AC