Diagnosis Of Small Bowel Diseases Research Articles

Diagnosis of Small-Bowel Disease: Comparison of Magnetic Resonance Enteroclysis and Conventional Enteroclysis

In this prospective study, 32 patients with symptoms suggestive of small-bowel disease underwent conventional enteroclysis and magnetic resonance (MR) enteroclysis. Image quality, luminal distension, wall thickening, homogeneity of luminal opacification, the presence of artefacts and extraluminal changes were assessed. Small-bowel pathologies were subsequently proved surgically and by follow-up examinations in 19 (59.4%) of the patients. Abnormal findings were detected by MR enteroclysis in 11 of these 19 patients (57.9%). Normal findings on MR enteroclysis were found in eight of the 19 patients (42.1%) whereas conventional enteroclysis detected abnormal findings in these patients. Abdominal lesions outside the small bowel, comprised renal cysts, cholelithiasis, ovarian cysts and horseshoe kidney, and were detected by MR enteroclysis in two, one, four and one, respectively, of these normal patients but not by conventional enteroclysis. Excluding lesions outside of the small bowel, a higher rate of false-negative results and the missing of superficial lesions occurred with MR enteroclysis. It is, therefore, suggested that MR enteroclysis should not be used as a primary way of evaluating small-bowel disease and its use should be restricted to follow-up examinations of known disease.

Dose Endoscopic Ultrasonography Impact Diagnosis of Intestinal Diseases?

Substantial development in equipment such as miniprobe endosonography and enteroscopy has made it possible to use endoscopic ultrasonography (EUS) to detect any part of the digestive tract. EUS plays a vital role in evaluating a lower intestinal malignancy, particularly rectal cancer, to determine whether the disease is localized (T1-2, N0) and appropriate for surgery or locally advanced (T any, N1-2) and would benefit from preoperative neoadjuvant chemoradiation. Moreover, follow-up by EUS may contribute to early recognition of focal tumor recurrence, particularly for lesions that cannot be detected by other imaging modalities. EUS is also an invaluable modality for diagnosing intestinal submucosal tumors, such as gastrointestinal stromal tumors, lipomas, lymphangiomas, leiomyomas, carcinoids, and others such as intestinal endometriosis. Although a definite diagnosis of a submucosal tumor is generally confirmed by cytology or histology results, EUS-guided fine needle aspiration or core biopsy is a fairly helpful practice. EUS is also useful for discriminating between Crohn`s disease and ulcerative colitis as well as assessing disease severity. Moreover, it has emerged as a powerful imaging tool to manage perianorectal diseases. EUS also has the potential to be useful for intra-small intestinal ultrasonography for the diagnosis of small bowel diseases in the future. (Intest Res 2011;9:179-188)

Development of a High-specificity Sandwich ELISA System for the Quantification of Human Intestinal Fatty Acid-Binding Protein (I-FABP) Concentrations

Intestinal fatty acid-binding protein (I-FABP), a low molecular mass (approximately 15 kDa) cytoplasmic protein, is specifically located in epithelial cells of small bowel mucosal layer. This protein is rapidly released into the circulation after injury and/or destruction of these cells due to poor mesenteric blood flow and necrosis. Therefore, it can be used as a potential diagnostic biomarker for small bowel disease. In the present study, we have succeeded in developing a sandwich enzyme-linked immunosorbent assay (ELISA) system for quantification of human I-FABP. The range of sandwich ELISA system was 0.1–50 ng/mL of I-FABP in serum, and showed excellent quantitative characteristics such as reproducibility, dilution linearity, and recovery. No cross-reactivities were detected with other types of FABPs. As measured with this ELISA system, the serum I-FABP concentration was 1.1 ± 0.9 ng/mL in 61 healthy individuals, indicating that the reference value was below 2.0 ng/mL regardless of gender and age. Furthermore, mild abdominal pain or diarrhea before blood sampling did not affect I-FABP levels. Thus, this ELISA system could be used to accurately quantify human I-FABP concentrations in serum samples. These results suggest that it could be used as a new biomarker for the diagnosis of small bowel disease.

Der Einsatz einer steuerbaren Endoskopiekapsel zur Untersuchung des Magens

BACKGROUND AND STUDY AIMS: Video capsule endoscopy has been established in diagnosis of small-bowel disease and has been evaluated for esophageal pathology and recently for colorectal diagnostics. Gastric capsule endoscopy has not hitherto been feasible due to the stomach's large surface area and volume. We present the first application of a magnetically navigated capsule in the human stomach. PATIENTS AND METHODS: 29 volunteers and 24 patients (men 42, women 11; mean age 47.5 years) were included in a feasibility study. Low-level magnetic fields were used to maneuver the double-sensor video capsule within the human stomach with an air-water interface provided by ingestion of 1300 ml water within 1 hour before examination. Visualization of all parts of the stomach was attempted; time for visualization was recorded, and a subjective assessment of completeness of visualization was documented. RESULTS: There was technical failure in one individual; thus technical success rate was 98 %. In the 52 remaining cases, examiners assessed that the antrum, body, fundus, and cardia were fully visualized in 98 %, 96 %, 73 % and 75 %, respectively. Mean duration of examinations was 30 min (range 8-50), with a longer time (mean 37 min) for volunteers for study reasons. In total, 30 findings were identified: 14 were detected by both gastroscopy and capsule, 10 lesions were identified by guided capsule examination only, 6 by gastroscopy only. No significant capsule-related adverse events occurred. CONCLUSION: Magnetically navigated video capsule endoscopy appears to be feasible and sufficiently accurate for gastric examination. It may permit endoscopic examinations that are more patient-friendly and without sedation. Comparative studies are under way.

Single balloon enteroscopy for diagnosis of small bowel diseases

Objective To evaluate the safety, indications and clinical efficacy of single balloon enteroscopy （SBE） for diagnosis of small bowel diseases. Methods Data of 30 patients （ 21 males and 9 fe- males） with suspected small bowel diseases, who underwent SBE from June to September 2009, were retrospectively studied to analyze the access, procedure time and complications of SBE. Results A total of 35 SBE procedures were performed on 30 patients. Procedures were performed via oral, anal and the combined routes in 15, 10 and 5 cases, respectively, and definite diagnosis was made in 26 cases （86. 7% ）. The av- erage access times via oral and anal routes were 49.7 rain and 48.6 min, respectively. Patietns showed normal vital signs during the procedures. No such procedure-related complications as eadiovascular events, se- vere abdominal pain, bleeding or perforation, were observed. Conclusion SBE is a safe and reliable diag- nostic modality of high clinical value for small bowel diseases. Key words: Diagnosis; Single balloon enteroscopy; Small bowel diseases

Feasibility of stomach exploration with a guided capsule endoscope

Video capsule endoscopy has been established in diagnosis of small-bowel disease and has been evaluated for esophageal pathology and recently for colorectal diagnostics. Gastric capsule endoscopy has not hitherto been feasible due to the stomach's large surface area and volume. We present the first application of a magnetically navigated capsule in the human stomach. 29 volunteers and 24 patients (men 42, women 11; mean age 47.5 years) were included in a feasibility study. Low-level magnetic fields were used to maneuver the double-sensor video capsule within the human stomach with an air-water interface provided by ingestion of 1300 ml water within 1 hour before examination. Visualization of all parts of the stomach was attempted; time for visualization was recorded, and a subjective assessment of completeness of visualization was documented. There was technical failure in one individual; thus technical success rate was 98 %. In the 52 remaining cases, examiners assessed that the antrum, body, fundus, and cardia were fully visualized in 98 %, 96 %, 73 % and 75 %, respectively. Mean duration of examinations was 30 minutes (range 8 - 50), with a longer time (mean 37 minutes) for volunteers for study reasons. In total, 30 findings were identified: 14 were detected by both gastroscopy and capsule, 10 lesions were identified by guided capsule examination only, 6 by gastroscopy only. No significant capsule-related adverse events occurred. Magnetically navigated video capsule endoscopy appears to be feasible and sufficiently accurate for gastric examination. It may permit endoscopic examinations that are more patient-friendly and without sedation. Comparative studies are under way.

Kapselendoskopie: Vorbereitung und Prokinetika

Durch die Einführung der Kapselendoskopie wurde die Untersuchung des Dünndarms revolutioniert, insbesondere die Diagnostik einer mittleren gastrointestinalen Blutung. Die Diagnostik mittels der Kapselendoskopie kann jedoch eingeschränkt sein durch das Vorhandensein von Stuhlresten oder Luftblasen. Im Gegensatz zur Hersteller­empfehlung verbessert die Vorbereitung mittels Darmlavage die Sicht auf die Mukosa und erhöht hierdurch die diagnostische Ausbeute. Ein weiteres Problem ist die inkomplette Untersuchung des Dünndarms durch eine verzögerte Magen- und / oder Dünndarmtransitzeit. In mehreren Studien konnte kein eindeutiger Vorteil für den zusätzlichen Einsatz eines Prokinetikums gezeigt werden.

W1591: Clinical Evaluation of Endoscopic Ultrasonography With Single-Balloon Enteroscopy for Diagnosis of Small Bowel Diseases

W1591: Clinical Evaluation of Endoscopic Ultrasonography With Single-Balloon Enteroscopy for Diagnosis of Small Bowel Diseases

Diagnosis of gastrointestinal stromal tumors with double-balloon enteroscopy

Traditional imaging techniques are insufficient for diagnosis of small bowel diseases. Double-balloon endoscopy is a novel method for the diagnosis of this region. Here, we report three cases diagnosed with gastrointestinal stromal tumors by double-balloon enteroscopy, which were missed by the other imaging techniques including capsule endoscopy. In summary, double-balloon enteroscopy should be performed if there is high clinical suspicion for small bowel pathology even if the capsule endoscopy is negative.

Inter-observer agreement on the interpretation of capsule endoscopy findings based on capsule endoscopy structured terminology: A multicenter study by the Korean Gut Image Study Group

Objective. Capsule endoscopy (CE) is a novel investigation for the diagnosis of small-bowel disease but its interpretation is highly subjective. We studied the inter-observer agreement and accuracy of the interpretation of CE findings based on capsule endoscopy structured terminology (CEST). Material and methods. Fifty-six CE video clips were collected from eight university hospitals in South Korea and were independently reviewed by 13 gastroenterology experts and 10 trainees. All investigators recorded their findings based on CEST. To determine the accuracy of individual viewers, we defined the ‘gold standard’ as a joint review by four experts. Results. The 56 CE video clips included five normal cases, 19 cases of protruding lesions, 21 cases of depressed lesions, three cases of flat lesions, one case of abnormal mucosa, six cases with blood in the lumen, and one case of stenotic lumen. The overall mean accuracies for the experts and trainees were 74.3% ± 22.6% and 61.7% ± 25.4%, respectively. The overall accuracy for the trainee group was significantly lower than that for the expert group (P < 0.001), especially in normal, tumor, venous structure, and ulcer cases. The accuracies of the two groups varied with the CE findings. The accuracies were higher in cases with more prominent intraluminal changes (e.g. active small-bowel bleeding, ulcer, tumor, stenotic lumen). In contrast, subtle mucosal lesions, such as erosion, angioectasia, and diverticulum, had lower accuracies. The mean kappa values for the experts and trainees were 0.61 (range 0.39–0.97) and 0.46 (range 0.17–0.66), respectively. Conclusions. Our results showed that there was substantial agreement between experts and moderate agreement between trainees. In order to achieve higher accuracies and better inter-observer agreement, we need not only more experience with CE but also consensus regarding CEST terminology.

The clinical value of MRI in the diagnosis of small-bowel diseases

Objective To evaluate the feasibility and the clinical value of MRI in the diagnosis of small-bowel disease. Methods Sixty-three patients with suspected small-bowel diseases and 3 volunteers without signs of small bowel disease underwent MRI examination. Thirty-one patients whose diagnoses were confirmed by pathology or clinical results were categorized into two groups (neoplastic and normeoplastic). The conspicuity of bowel wall, the sensitivity of MRI in detecting small-bowel lesions, and the accuracy rate of diagnosis were calculated. The average bowel wall thickness between the two groups was assessed by using Wilcoxon signed-rank test. Enlarged mesenteric lymph nodes, mesenteric infiltration, and small-bowel stenosis were analyzed by using Fisher's exact test in each group respectively. Results MRI examinations of all 66 subjects were successfully performed. Images were rated on a continuous 4-peint scale. Sixty-two cases (93.9%) were scored as 2 or 3. The diagnoses of 31 patients (neoplastic group (n = 10) and nonneoplastic group (n = 21) were confirmed by pathology or clinical results. The sensitivity, accuracy of MRI in identifying small bowel diseases were 100% (31/31) and 77.4% (24/31) respectively. The average bowel wall thickness of the two groups was 23 mm(7.0-65.0 mm) and 5 mm(2.0-35.0 mm) respectively, and there was a statistically significant difference between the two groups (Z = - 2.949, P 0.05). Conclusion MRI can depict the location and extension of the small-bowel disease accurately and it is an effective method in the diagnosis of small-bowel disease. Key words: Intestine,small; Intestinal diseases; Magnetic resonance imaging

Evaluation of capsule endoscopy in the diagnosis of small bowel disease

To evaluate the clinical utility of capsule endoscopy in diagnosing small bowel disease. A retrospective review of 155 cases undergone capsule endoscopy examinations from September 2002 to March 2007 in our hospital were performed. Gastric and small bowel transit time, patient tolerability, number of complete and incomplete examinations, and examination findings were evaluated. A total of 155 cases were reviewed, and 159 times of capsule endoscopy examination were finished. Of the 155 patients, 97 suffered from obscure gastrointestinal bleeding, 42 abdominal pain, 6 abdominal discomfort, 4 diarrhea, and 6 body check. The capsule endoscopy examination for the entire small bowel were finished in 93.1%(148/159)cases. All the patients had no discomfortable feeling during the examinations. The capsule endoscopy remained in the stomach for an average of 65.5 min(1 to 335 min). The mean transit time in the small bowel was 282.2 min(45 to 524 min). The diagnostic yield of capsule endoscopy was 78.6%(125/159). Vasculopathy was present in 43.4% patients, enteritis in 28.3%, submucous knot in 10.1%, diverticulum of small intestine in 8.2%, and small intestine tumor in 5.7%. Other findings consisted of polyposis of small intestine, foreign objects and parasite. The diagnostic yield of obscure gastrointestinal bleeding by capsule endoscopy was 89.7%, and of abdominal pain was 73.8%. Capsule endoscopy is safe and well tolerated. Capsule endoscopy is a valuable diagnostic tool in the evaluation of occult small bowel disease, especially for obscure gastrointestinal bleeding.

OMOM capsule endoscopy in diagnosis of small bowel disease

To assess the diagnostic efficiency of OMOM capsule endoscopy (CE) in a group of patients with different indications. Data from 89 consecutive patients (49 males, 40 females) with suspected small bowel disease who underwent OMOM CE (Jinshan Science and Technology Company, Chongqing, China) examination were obtained by retrospective review. The patients' indications of the disease consisted of the following: obscure gastrointestinal bleeding (OGIB), abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for patients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea (85.7% vs 53.3%, P<0.005). Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB (small bowel) CE (Given Imaging, Yoqneam, Israel).

Wireless Capsule Endoscopy (CE)

Purpose: Compare the diagnostic yield of CE in children with small bowel series, EGD and colonoscopy with biopsies. Methods: Retrospectively reviewed the records of all children who underwent CE at our institution between March 2007 and May 2008. Results of CE were compared with those of small bowel radiographic studies, EGD with biopsies and colonoscopy with biopsies. Results: Total 24 patients had CE, EGD, colonoscopy with biopsies and small bowel series. Nine males (37.5%) and 15 females (62.5%) were part of study. Age ranging from 10 to 18 years with a mean age of 15 years. The indications for CE included unexplained abdominal pain, diarrhea, hematochezia and/or weight loss. In the selected patients, findings were suggestive of small bowel disease on colonoscopy to the terminal ileum with biopsies in 4.2% (table B) and small bowel series in 16.7% (table C), however CE revealed small bowel disease in 54.8% of patients, included 33.3% were suggestive of Crhon's disease (table E). CE diagnosed gastric disease in 20.9% of patients compared to 33.4% on EGD and biopsies (table A). Furthermore 2/4 (50%) of patient with abnormal small bowel series had normal CE and 24/24 (100%) of patient had normal passage of CE Conclusion: Capsule Endoscopy provides a valuable and safe tool in the evaluation of pediatric patients for diagnosis of small bowel diseases such as IBD, when compared to traditional diagnostic methods. However, more experience and larger studies are needed in the pediatric population to further evaluate the effectiveness of CE in the diagnosis of small bowel disease.

Endoscopic Ultrasonography with Double Balloon Enteroscopy for Small Bowel Diseases

This paper covers the literature published through June 2007 on endoscopic ultrasonography (EUS) and double-balloon enteroscopy (DBE) for small bowel diseases. Only three papers were published on the topic of EUS with DBE. We review the procedure and the collective experience with EUS for diagnosis of small bowel diseases with DBE. This technique offers high-resolution cross-sectional images of small bowel lesions and may contribute to the accurate diagnosis of small bowel diseases.

Effectiveness and Safety of Capsule Endoscopy in the Diagnosis of Small Bowel Diseases

To assess the effectiveness, safety, and clinical use of capsule endoscopy (CE) in the diagnosis of small bowel diseases. Systematic review carried out in the main electronic databases, including MEDLINE, EMBASE, and COCHRANE. Papers were selected independently by the 2 researchers and the quality was determined using a purpose-designed scale. A total of 9 systematic reviews and 28 original papers were included [11 assessed obscure gastrointestinal bleeding, 9 Crohn's disease (CD), and 4 hereditary polyposis syndromes]. The diagnostic yield of CE for the diagnosis of obscure gastrointestinal bleeding ranged from 39% to 77%. The diagnostic yield of push enteroscopy was lower than 40% in all but 1 study. CE detected suggestive findings in 19% to 71% of patients with suspected CD, whereas radiologic techniques did so in only 0% to 37% of the cases. In patients with suspected recurrence, detection with these techniques was 58% to 81% and 19% to 67%, respectively. Endoscopic capsule detected a greater number of polyps in patients with polyposis syndromes but other techniques allowed for better localization. Although CE occupies a preferential place in the diagnosis of gastrointestinal bleeding and CD; there is insufficient evidence to establish whether it could be used as a first line diagnostic test. The evidence is insufficient to ascertain this technique's usefulness in small bowel disorders other than obscure bleeding or CD.

Interobserver Agreement On Interpretation of Capsule Endoscopy Findings Based On Capsule Endoscopy Structured Terminology (CEST): The Korean Gut Image Study Group, Multi-Center Study

Background/Aims: Capsule endoscopy (CE) is novel investigation for diagnosis of small bowel disease but its interpretation is highly subjective. So Capsule Endoscopy Structured Terminology(CEST) was proposed for standardization of reporting in 2005. We studied the interobserver agreement and accuracy on the interpretation of CE findings based on CEST. Methods: Fifty-six CE video clips were collected from 8 university hospital in Korea. Thirteen experts and ten trainees in gastroenterology independently reviewed 56 CE video clips.

Video capsule endoscopy in small-bowel tumours: A single centre experience

Objective. Early diagnosis of small-bowel tumours is crucial for curative surgery. Although videocapsule endoscopy (VCE) has improved the diagnosis of small-bowel diseases, there are few data about the role of this examination in small-bowel malignancies. The aim of this study was to evaluate the diagnostic yield of VCE in small-bowel malignancies. Material and methods. From March 2001 to July 2006, 380 patients were studied by VCE in our centre. Data on 13 consecutive patients (3.4%) affected by small-bowel malignancy were retrospectively assessed from a prospectively collected database. Indications for VCE were: obscure gastrointestinal bleeding in 9 patients (70%), abdominal pain, coeliac disease, long-lasting fever and hepatic metastasis in the other 4 patients, respectively, (7.5%). Before VCE, patients had undergone 65 procedures, including oesophagogastroduodenoscopy, colonoscopy, push-enteroscopy, small-bowel radiographies, abdominal CT scanning, nuclear medicine bleeding-scan, positron emission tomography and octreoscan. Results. VCE detected jejunal polyps in 6 patients (46.2%), ulcerated stricture in 3 (23%), and erosions, stricture with ileal inflammation, submucosal nodule and active bleeding in 4 patients, respectively. The diagnosis was confirmed after surgery in 11 cases. One patient died of ischaemic myocardial infarction 3 days after VCE, before surgery. Histological examination showed lymphoma (n=3), small-bowel metastasis from colonic carcinoma (n=3), carcinoid tumour (n=3), gastrointestinal stromal tumour (GIST) (n=2), metastatic melanoma (n=1) and primary small-bowel adenocarcinoma (n=1). VCE had an influence on the diagnosis or management of 10/13 patients. Conclusions. VCE is the diagnostic test with the highest yield for small-bowel malignancies, since it can detect small-bowel tumours that are often missed by traditional examinations.

Nuevas aplicaciones de la cápsula endoscópica: PILLCAM TM ESO

Capsule endoscopy has opened a new era in small bowel examination. Its indications are now well-defined and currently, wireless capsule endoscopy is considered as the first-line imaging tool for the diagnosis of small bowel diseases. ECE has been shown to be feasible, safe and a good alternative technique in patients refusing conventional endoscopy. Although results reported in both GERD and cirrhotic patients are encouraging, great differences in terms of accuracy (particularly in GERD patients) have been found in published studies. These differences have been attributed to study designs, the lack of adequate experience and inconvenience of ingestion protocols. In summary, more large-scale studies evaluating the new 14-fps capsule, adequate ECE-experience and new modified ingestion protocols are still needed.

Double-balloon enteroscopy for the diagnosis and treatment of obscure bleeding, inflammatory bowel diseases and polyposis syndromes: we see more but do we know more?

Background/Aims: Our aim was to report our experience with the Fujinon EN-450 T5 therapeutic double-balloon endoscope (DBE) in the diagnosis of small bowel diseases. Methodology: Between August 2005 and October 2006, 52 DBE procedures were conducted in 47 consecutive patients (M/F: 22/25, age:51.6 SD19.5years) presenting at our tertiary referral hospital (37 and 7 patients from oral and anal route, respectively; 5 patients from both). All procedures were performed using i.v. anesthesia, at our outpatient clinic. Results: Indication included suspected small-bowel bleeding in 28 patients, suspected/known IBD in 12 and polyposis/suspected neoplasia in 7. In obscure bleeding small-bowel abnormality was found in 18 patients (64.3%) including angiodysplasias/erosions and one polypoid lesion. In suspected IBD, it was diagnosed in 2 out of 8 cases. In patients with polyposis syndromes, polyps were found in two Peutz-Jeghers patients, while another patient with suspected stenosis was diagnosed with primary adenocarcinoma. The average insertion length was app. 213cm. No severe complications were observed. Conclusions: Based on our experience DBE is a safe and useful method for evaluating and treating small bowel disease in selected patients with obscure bleeding, IBD or polyposis syndromes, however, the clinical importance of minute lesions still needs to be determined.