The discomfort of internal gastrointestinal examination may soon be a thing of the past. We have developed a new type of endoscopy, which for the first time allows painless endoscopic imaging of the whole of the small bowel. This procedure involves a wireless capsule endoscope and we describe here its successful testing in humans.

Wireless capsule endoscopy

Gastroscopy, small bowel endoscopy, and colonoscopy are uncomfortable because they require comparatively large diameter flexible cables to be pushed into the bowel, which carry light by fibreoptic bundles, power, and video signals. Small bowel endoscopy is currently especially limited by problems of discomfort and failure to advance enteroscopes far into the small bowel. There is a clinical need for better methods to examine the small bowel especially in patients with recurrent gastrointestinal bleeding from this site.

https://gut.bmj.com/content/gutjnl/52/suppl_4/iv48.full.pdf

Wireless capsule endoscopy.

https://www.gastrojournal.org/article/S0016-5085(03)01998-X/pdf

Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: Report of 100 consecutive cases

https://www.cghjournal.org/article/S1542-3565(04)00453-7/pdf

Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions.

https://www.giejournal.org/article/S0016-5107(01)38589-9/pdf

Electrical stimulation for propelling endoscopes

Little is known about the effect of achalasia and gastroesophageal reflux disease (GERD) on compliance of the esophageal body and the lower esophageal sphincter (LES). Twenty-two patients with achalasia, 14 with GERD, and 14 asymptomatic volunteers were assessed. Recording apparatus consisted of a specially developed PVC bag tied to a compliance catheter, a barostat, and a polygraph. Intrabag pressures were increased incrementally while the bag volume was recorded. In each subject, pressure-volume graphs were constructed for both the esophageal body and LES and the compliance calculated. In achalasia, compliance of the esophageal body was significantly higher (P < 0.01) than in controls, whereas LES compliance was similar. Patients with GERD had a highly compliant LES in comparison to both controls and to patients with achalasia (P < 0.01 and P < 0.001, respectively); however there was no difference in their esophageal body compliance. In conclusion, foregut motility disorders can cause changes in organ compliance that are detectable using a barostat and a suitably designed compliance bag. Further measurement of compliance may provide clues to the pathogenesis of these disorders.

Compliance measurement of lower esophageal sphincter and esophageal body in achalasia and gastroesophageal reflux disease.

The complications of open antireflux operations may be reduced by laparoscopic techniques. Fifteen patients of median age 42 (range 16-79) years with gastro-oesophageal reflux underwent laparoscopic fundoplication. Preoperative and postoperative assessment was by clinical scoring, oesophageal pH measurement and manometry. Median (range) operating time was 115 (60-210) min and hospital stay 3 (1-6) days, with no conversions to open operation and only one minor wound infection. Four patients had occasional reflux symptoms on postoperative assessment at a median of 7 weeks and nine had occasional dysphagia. Median DeMeester symptom scores improved from 4 to 1.5 (P = 0.001). There were significant increases in both lower oesophageal sphincter pressure and length. The nocturnal proportion of time at pH < 4 decreased from 9.6 to 0.05 per cent (P = 0.02), although the drop in total proportion of time at pH < 4 (10.4 to 2.2 per cent) was not statistically significant (P = 0.08). Early objective results of laparoscopic fundoplication show improved symptoms, decreased acid reflux and altered lower sphincter function. The procedure combines the benefits of early mobilization and reduced morbidity with the efficacy of the traditional open operation.

Physiological and symptomatic outcome after laparoscopic gastric fundoplication.

Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication.

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