Detection Of Small Bowel Polyps Research Articles

Capsule endoscopy versus magnetic resonance enterography for the detection of small bowel polyps in Peutz–Jeghers syndrome

Our study aimed to assess the diagnostic utility of magnetic resonance enterography (MRE) compared to capsule endoscopy (CE) for the detection of small bowel polyps in patients with Peutz-Jeghers syndrome (PJS); with findings verified by balloon enteroscopy (BE). Adult patients were prospectively recruited across two tertiary centres and underwent MRE followed by CE, with a subsequent BE performed in patients with significant (≥10 mm) polyps. The primary endpoint was the total number of significant (≥10 mm) small bowel polyps detected. The number of patients with at least one significant polyp, correlation with BE findings, and patients' preferences were secondary endpoints. A total of 20 patients (7 male; mean age 34.9 years) underwent both investigations. The number of polyps ≥10 mm detected by CE was greater than by MRE (47 vs 14 polyps, P = 0.02). The number of patients with at least one significant polyp identified by CE was 11 (55 %) compared with 7 (35 %) identified by MRE (P = 0.25). Subsequent BE in 12 patients identified a total of 26 significant polyps in 8 patients. The positive predictive value of finding a polyp at BE was higher for MRE (100 %) compared to CE (60 %). Overall patient preferences identified CE as the preferred modality. This prospective study demonstrated that CE identifies significantly more small bowel polyps compared with MRE in patients with PJS. Correlation between the two techniques and subsequent BE however was relatively poor.

Detection of Small Bowel Polyps and Ulcers in Wireless Capsule Endoscopy Videos

Over the last decade, wireless capsule endoscopy (WCE) technology has become a very useful tool for diagnosing diseases within the human digestive tract. Physicians using WCE can examine the digestive tract in a minimally invasive way searching for pathological abnormalities such as bleeding, polyps, ulcers, and Crohn's disease. To improve effectiveness of WCE, researchers have developed software methods to automatically detect these diseases at a high rate of success. This paper proposes a novel synergistic methodology for automatically discovering polyps (protrusions) and perforated ulcers in WCE video frames. Finally, results of the methodology are given and statistical comparisons are also presented relevant to other works.

Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position

Peutz-Jeghers syndrome (PJS) is a familial polyposis syndrome characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. The aim of our study was to retrospectively determine the diagnostic value of MR enterography (MRE), performed in supine and prone position, in the detection of small bowel polyps in PJ patients. We retrospectively reviewed MRE examinations of 8 PJS patients who underwent MRE, pushed-double-ballon enteroscopy, laparoscopic endoscopy or surgery, within 3 months. Polietilenglicole was orally administered before the examination. True FISP and HASTE sequences were acquired in supine and prone position; 3D VIBE Gd-enhanced sequences in prone position only. Concordance between MRE and endoscopy was 72.6% for polyps <15mm, 93% for polyps >15mm. In supine and prone position concordance with endoscopy for polyps <15mm was 63% and 66.8%, respectively. In the detection of smaller polyps the difference between supine position only and supine plus prone position was statistically significant (P<0.027). MRE performed by combining prone and supine position was accurate in the detection of PJS polyps, with 93% concordance with enteroscopy for larger and more risky polyps. MRE offers a promising and non invasive alternative to capsule endoscopy, suggesting the possibility of an effective yearly surveillance in PJ patients.

Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps

BackgroundFamilial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps.Method20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history.ResultsWithin the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum.ConclusionCE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12608000616370

Feasibility of Video Capsule Endoscopy in the Management of Children With Peutz‐Jeghers Syndrome: A Blinded Comparison With Barium Enterography for the Detection of Small Bowel Polyps

Feasibility of Video Capsule Endoscopy in the Management of Children With Peutz‐Jeghers Syndrome: A Blinded Comparison With Barium Enterography for the Detection of Small Bowel Polyps

Feasibility of Video Capsule Endoscopy in the Management of Children With Peutz‐Jeghers Syndrome: A Blinded Comparison With Barium Enterography for the Detection of Small Bowel Polyps

Peutz-Jeghers syndrome (PJS) in children may present with anaemia, intussusception, or obstruction from an early age and surgery is common. Prophylactic polypectomy may reduce subsequent complications. Traditional barium enterography (BE) has poor sensitivity and requires significant radiation. We compared the performance of capsule endoscopy (CE) with BE in children with PJS. Children with PJS (ages 6.0-16.5 years) were prospectively recruited and underwent BE followed by CE, each reported by expert reviewers blinded to the alternate modality. Number of "significant" (>10 mm) and total number of polyps were recorded. Child preference was assessed using a visual analogue questionnaire. Definitive findings were assessed at laparotomy or enteroscopy, when performed. There was no significant difference for >10 mm polyp detection. Six polyps were found in 3 children by both modalities: 3 polyps in 2 children at CE, 3 polyps in 1 child at BE (P=0.50). Re-review of 1 CE identified 3 polyps that were missed in 1 child at initial reading. Significantly more <10 mm polyps were identified by CE than BE: 61 vs 6 (P=0.02). CE was significantly more comfortable than BE (median score CE 76 [interquartile range 69-87] vs BE 37 [interquartile range 31-68], P=0.03) and was the preferred investigation in 90% (P=0.02). CE is a feasible, safe, and sensitive test for small bowel polyp surveillance in children with PJS. It is significantly more comfortable than BE and is the preferred test of most children for future surveillance. There is a learning curve for reporting CE studies in PJS and appropriate training is essential.

A Prospective Trial Comparing Wireless Capsule Endoscopy and Barium Contrast Series for Small Bowel Surveillance in Hereditary Polyposis Syndromes

Background: Capsule endoscopy has demonstrated its clinical utility in the evaluation of the small bowel and, accordingly, it has been suggested that it could be useful for the identification of small intestinal polyps in patients with polyposis syndromes. Objectives: To establish the effectiveness of wireless capsule endoscopy for detecting small bowel polyps in patients with hereditary gastrointestinal polyposis syndromes in comparison with barium contrast series. Patients and Methods: Consecutive patients with gastrointestinal polyposis syndromes were included. Small bowel follow-through series and capsule endoscopy were performed within one-week in a blind fashion. Number and location of polyps were analyzed. Results: Twenty-four patients with familial adenomatous polyposis (n = 20) or Peutz-Jeghers syndrome (n = 4) were included. Capsule endoscopy detected small bowel polyps in 7 out of 24 patients (29%), whereas barium contrast study identified small intestinal polyps in only 3 of these 7 patients. In the four remaining patients, all of them with familial adenomatous polyposis, polyps detected by the capsule but missed in radiographic series were located at either ileum (2 cases), jejunum (1 case) or duodenum (1 case). No procedure-related complication was observed in any patient. Conclusions: Wireless capsule endoscopy is a high accurate technique for the detection of small bowel polyps, and it represents a valuable alternative to barium contrast series in the surveillance of patients with hereditary gastrointestinal polyposis syndromes. Background: Capsule endoscopy has demonstrated its clinical utility in the evaluation of the small bowel and, accordingly, it has been suggested that it could be useful for the identification of small intestinal polyps in patients with polyposis syndromes. Objectives: To establish the effectiveness of wireless capsule endoscopy for detecting small bowel polyps in patients with hereditary gastrointestinal polyposis syndromes in comparison with barium contrast series. Patients and Methods: Consecutive patients with gastrointestinal polyposis syndromes were included. Small bowel follow-through series and capsule endoscopy were performed within one-week in a blind fashion. Number and location of polyps were analyzed. Results: Twenty-four patients with familial adenomatous polyposis (n = 20) or Peutz-Jeghers syndrome (n = 4) were included. Capsule endoscopy detected small bowel polyps in 7 out of 24 patients (29%), whereas barium contrast study identified small intestinal polyps in only 3 of these 7 patients. In the four remaining patients, all of them with familial adenomatous polyposis, polyps detected by the capsule but missed in radiographic series were located at either ileum (2 cases), jejunum (1 case) or duodenum (1 case). No procedure-related complication was observed in any patient. Conclusions: Wireless capsule endoscopy is a high accurate technique for the detection of small bowel polyps, and it represents a valuable alternative to barium contrast series in the surveillance of patients with hereditary gastrointestinal polyposis syndromes.

Feasibility and Diagnostic Utility of Video Capsule Endoscopy for the Detection of Small Bowel Polyps in Patients with Hereditary Polyposis Syndromes

At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel. We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients. A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients. Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.

Value of capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes (FAP, PJS, FJP)

Value of capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes (FAP, PJS, FJP)