Diagnosis Of Small Bowel Lesions Research Articles

Diagnostic value of capsule endoscopy and small bowel CT virtual endoscopy in identifying small intestine diseases

Objective To explore the diagnostic value of capsule endoscopy and small bowel CT virtual endoscopy(CTVE) in identifying of small intestinal diseases. Methods Fifty-five cases patients of suspected small intestinal diseases who were treated by Capsule endoscopy and small bowel CTVE examination in the Affiliated Hospital of North China University of Science & Technology and Kailuan Majiagou Mine Hospital from January 2009 to December 2015 were chosen.The detection rate and diagnostic accuracy of small bowel disease were compared between the two methods. Results There was no significant difference in the detection rate of CTVE and capsule endoscopy(80.7% vs.89.5%, P=0.719). There was significant difference in the accuracy of CTVE and capsule endoscopy in the diagnosis of small intestinal non space occupying lesions(60.7% vs.89.3%, P=0.040). The correct rate of diagnosis of small bowel lesions was 93.1% in CTVE, and 51.7% in capsule endoscopy, there was statistically significant difference between the two ways(P=0.032). Conclusion Capsule endoscopy and CTVE are both non invasive tests, the operation is simple, safe, and the patients are easy to accept, and they are both helpful in the diagnosis of small bowel diseases.Capsule endoscopy has an advantage in the diagnosis of small bowel lesions, while CTVE is superior to capsule endoscopy in terms of small bowel occupying lesions.Combined use of the two ways can improve the diagnostic rate of small bowel disease. Key words: small intestinal neoplasms; Small bowel disease; CT virtual endoscopy; Capsule endoscopy

Ileal ulcers in a patient with Henoch-Schönlein purpura

Summary Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis, gastrointestinal, and renal involvement. The most common gastrointestinal complaint is abdominal pain. The characteristic endoscopic findings are ulcers seen in the second portion of the duodenum. We present the case of a 45-year-old man suffering from abdominal pain. Erythematous purpura over bilateral lower extremities and soreness of the joints developed 3 days before abdominal pain. An abdominal computed tomography showed an edematous change of the intestinal wall and the distal part of the ileum. A retrograde single balloon enteroscopy revealed several discrete ulcers and hyperemic mucosa in the distal ileum. The middle, proximal, and terminal ileum and ileocecal valve to the rectum were not affected. Under the impression of HSP, nonsteroidal anti-inflammatory drugs and prednisolone were administered. We concluded that balloon-assisted enteroscopy is helpful for differential diagnosis of small bowel lesions in adult patients with HSP.

Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions.

Background and study aims: The clinical utility of computed virtual chromoendoscopy with flexible spectral imaging color enhancement (FICE) in capsule endoscopy (CE) remains controversial. To clarify the clinical utility of FICE-enhanced CE in evaluating small bowel lesions, we quantitatively assessed white light (WL), FICE, and blue mode (BM) images and examined the sensitivity of these 3 imaging modes of small-bowel lesions from patients who underwent CE. Methods: The CIELAB color difference (∆E) and visual analogue scales (VAS) were measured in 261 CE images (3 different lesion categories) using WL and FICE set 1, 2, and 3, and BM images, respectively. Three endoscopists reviewed CE videos with WL, 3 FICE mode settings, and BM, and compared the sensitivity and detectability for small intestinal diseases from 50 patients who underwent CE. Results: In the assessment of visibility in the 152 vascular lesion images, the ∆E and VAS of FICE set 1, 2, and BM images were significantly higher than that of WL images. In 88 erosion/ulceration images, the ∆E and VAS of FICE set 1 and 2 images were significantly higher than that of WL images. In 21 tumor images, there were no significant differences in ∆E among these modalities. When analyzed on a per-patient basis, FICE settings 1 and 2 had the highest sensitivity (100 %) and specificity (97.3 – 100 %) for vascular lesions. As for erosive/ulcerative lesions, FICE setting 2 had the highest sensitivity (100 %) and specificity (97.2 %). For tumors or polyps, WL had the highest sensitivity (90.9 %) and specificity (87.1 %). In per-lesion analysis, FICE settings 1 and 2 showed significantly superior detection ability over WL for vascular lesions. In the detection of erosive/ulcerative lesions, FICE setting 2 was significantly superior to WL. In tumor images, there was no significant improvement with any of the settings relative to WL images. Conclusions: FICE is most useful for improving CE image quality and detection in cases of angioectasia and erosion/ulceration of the small intestine.

A preliminary study of intra-luminal ultrasonography in diagnosis of small bowel diseases

Objective To study the application of intra-luminal ultrasonography （ intra-small intestinal uhrasonography, ISIU） in demonstration of normal small intestine and diagnosis of small bowel lesions. Methods From December 2011 to December 2012, ISIU was performed in 50 patients who were screened by capsule endoscopy, gastroscopy, colonoscopy, and double-balloon enteroscopy to observe the normal tissue structures and lesions of the small intestine. Additional abdominal ultrasound （ US ） and spiral CT （SCT） were applied in patients with identified lesions in small intestine. Results ISIU was completed in 47 patients out of 50 enrolled ones. A total of 10 lesions in small intestine were detected, all of them were iden- tified by ISIU, while in which only 1 was found by US and 3 by SCT. Normal small intestinal wall demon- strated 6 layers under ISIU, with slight difference between jejunum and ileum. Conclusion ISIU provides high-resolution image of the structure at all levels of the normal small intestine, and can clearly observe lesion source and internal echo, and thus help to improve the rate of diagnosis of diseases of the small intestine. Key words: Capsule endoscopes; Double-Balloon enteroscopy; Intra-small intestinal ultrasonography ; Diagnosis ;

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools. to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE. this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding). in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24). there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren´t identified by the conventional mode.

Sa1712 Clinical Usefulness of Capsule Endoscopy With Flexible Spectral Imaging Color Enhancement for Diagnosis of Small Bowel Lesions

Computed virtual chromoendoscopy with flexible spectral imaging color enhancement (FICE) system might improve detection and characterization of small bowel lesions. The aim of this study is to evaluate whether the RAPID®6 Access CE system equipped with FICE is useful for enhancing the visibility of small bowel lesions.

The power suction maneuver in single-balloon enteroscopy

Up until the past 10 years, the diagnostic work-up for small-bowel diseases, employing modalities such as contrast studies and computed tomography, was poor and mostly unyielding. Push enteroscopy and intraoperative enteroscopy were performed in a few experienced institutions. However, it is not possible to reach all portions of the jejunum and the ileum by the push enteroscope, while intraoperative enteroscopy demands a surgical route. The introduction of capsule endoscopy has been a long-awaited advance in the diagnosis of small-bowel lesions. Wireless capsule endoscopy has overcome obstacles, but still has some weaknesses, such as the inability to biopsy and treat the detected lesions. Capsule endoscopy also has some limitations in patients with surgical strictures and in those with altered gastrointestinal anatomy, including Roux-en-Y reconstruction [1] [2] [3].

Correlation of magnetic resonance enteroclysis (MRE) and wireless capsule endoscopy (CE) in the diagnosis of small bowel lesions in Crohnʼs disease

The aim was to evaluate and compare the diagnostic performance of magnetic resonance enteroclysis (MRE) and wireless video capsule endoscopy (CE) in detecting and classifying small bowel Crohn's disease (CD) proximal to the terminal ileum. Nineteen patients with histologically proven CD (M:F = 13:6; mean 34 years, range 17-65) were prospectively included in the study when presenting with clinical signs suggesting stricturing or inflammatory lesions of CD in the proximal small bowel. All patients underwent MRE with an infusion technique and were then admitted to CE. As for the presence or absence of pathology, results of MRE and CE were in total agreement for 44/52 (85%) evaluated segments. In judging lesion severity, MRE and CE yielded identical results in 29/52 (56%) segments. MRE underestimated pathology in 7/52 (14%) segments and revealed more severe pathology in 6/52 (12%) segments. CE identified subtle (n = 7) or severe (n = 2) mucosal pathology while MRE was normal. CE entirely missed severe inflammatory mural changes depicted in MRE in 1/52 (2%) segments. MRE and CE show good correlation in the detection and localization of inflammatory bowel disease. As for disease activity, MRE is inferior in the detection of superficial mucosal disease but reliably discloses the presence of severe inflammatory changes within the bowel wall and beyond, which may be underestimated from the endoscopic aspect of the mucosal surface. MRE helps to rule out severe stenoses that should be referred for immediate surgical intervention. In conclusion, both modalities are complementary and MRE should be used in more severe cases of Crohn's disease and in patients who might have involvement beyond the mucosa of the small bowel.

Video Capsule Endoscopy: What Is the Role in Surveillance of Hereditary Colon Cancer Syndromes?

Video capsule endoscopy (VCE) is a new technology which has proven to be effective for screening of the entire small bowel in those hereditary colon cancer-prone disorders that predispose to small bowel polyps and small bowel cancer (SBC). VCE appears to be superior to both barium studies and push enteroscopy for diagnosis of small bowel lesions in these disorders. However, in the interest of maximum benefit to our high-risk patients, the endoscopist must fully understand the natural history of hereditary colorectal cancer (CRC) disorders and their molecular genetics. It is in this realm that a comprehensive cancer family history will be of great benefit in allowing greater certainty in diagnosis and, in particular, in ability to focus on the specific germline mutation that may help to confirm the hereditary CRC syndrome of concern.

A Prospective Comparison of Capsule Endoscopy and Double Balloon Enteroscopy in Small Bowel Disease

Backgrounds: Capsule endoscopy and double balloon enteroscopy opened the new era of small bowel disease and have demonstrated a useful tool for the diagnosis of small bowel lesions. But there were only a few studies in comparison capsule endoscopy with double balloon enteroscopy until recently. The aim of this study was to evaluate a usefulness of capsule endoscopy and double balloon enteroscopy in small bowel disease and compare capsule endoscoy with double balloon enteroscopy in diagnostic yield. Patients and Methods: From Nov. 2004 to Nov. 2005, eleven patients (5 male, 6 female; median age 44 years range 21-66 years) with obscure gastrointestinal bleeding and chronic abdominal pain were examined with capsule endoscopy and double balloon enteroscopy by separate examiners. The definite diagnosis for each study was defined as the correlation of clinical situation. Results: Indications of study were 8 obscure gastrointestinal bleeding and 3 chronic abdominal pain. Capsule endoscopy identified positive finding in seven patients (63.6%). Double balloon enteroscopy identified positive finding in nine patients (81.8%). One patient with chronic abdominal pain was excluded organic small bowel disease by capsule and double balloon enteroscopy. There were two discrepant results between capsule endoscopy and double balloon enteroscopy. One patient was nonspecific finding in capsule endoscopy and angiodysplasia in double balloon enteroscopy. The other patient was ileal erosion in capsule endoscopy and gastrointestinal stromal tumor in double balloon enteroscopy. Both examination were well tolerated and had not any complication of procedure. One patient with angiodysplasia underwent therapeutic enteroscopy by argon plasma coagulation. Conclusions: Both capsule endosocpy and double balloon enteroscopy showed high diagnostic yield without any complication. There was not statistical significance in diagnostic yield between capsule endoscopy and double balloon enteroscopy. Key words: Small bowel disease, capsule endoscopy, double balloon enteroscopy.

How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions

To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. Capsule endoscopic (CE) examination by using M2A capsule endoscope TM (Given Imaging, Yoqneam, Israel) was performed in thirty nine patients (26 males, 13 females) with suspected small intestinal lesions. The composing of the patients was as follows: obscure gastrointestinal bleeding in twenty three patients, known Crohn's disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin. In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding (73.9%). Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn's disease, CE revealed better evaluation of the disease extension. In 3 of 8 (37.5%) patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal. In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn's disease.

Clinical Impact of Capsule Endoscopy Compared to Push Enteroscopy: 1-Year Follow-Up Study

The long-term outcome for patients with obscure bleeding after capsule endoscopy (CE) is still unclear. In this study, the clinical outcome was used as the gold standard to determine the sensitivity and specificity of CE and push enteroscopy (PE) in the diagnosis of small-bowel lesions in patients with obscure bleeding. Fifty-eight patients from a previous prospective study (comparing PE and CE) were included; the patients were contacted after 1 year. The final diagnosis, bleeding status, new gastrointestinal examinations, and treatments performed were recorded. On the basis of these data, each case was classified into true/false positive or true/false negative findings at PE and CE. The results were compared with the initial classification of lesions observed at CE: highly relevant (P2) and less relevant (P0, P1) lesions. Follow-up data were available for 56 patients. According to the defined true/false positive and negative cases, the sensitivity and specificity values for CE and PE were 92 % and 48 %, and 80 % and 69 %, respectively ( P < 0.01 for the difference between CE and PE). Highly relevant (P2) lesions observed at CE were more frequently classified into true-positive cases (15 of 18 versus seven of 22; P < 0.01) and led more frequently to therapeutic decisions (11 of 18 versus five of 22; P = 0.02) in comparison with less relevant lesions (P0, P1). CE is a highly sensitive examination for the detection of small-bowel lesions in patients with obscure gastrointestinal bleeding, with a specificity lower than that of PE when the clinical outcome is used as the gold standard.

Small intestine contrast ultrasonography (sicus) in the diagnosis of small intestine lesions

After the ingestion of iso-osmolar polyethylene glycol solution, the small bowel can be visualized on ultrasonography. The aim of this study was to assess sensitivity and specificity of SICUS in diagnosis of small bowel lesions. A total of 53 consecutive patients with suspected intestinal pathology underwent a diagnostic workup, including a small bowel follow-through and SICUS performed by independent operators. The sonologist was unaware of the clinical data. Diagnostic sensitivity and specificity were assessed using radiologic findings. Diagnostic sensitivity of SICUS was 100%, with a specificity of 97%. The concordance index was 0.956 (p < 0.003, K statistics) and the conformity between SICUS and radiology was 1. The diagnostic accuracy of SICUS to detect small bowel lesions is comparable to that of small bowel follow-through. Results of this study support the use of noninvasive, widely available, inexpensive, and nondemanding SICUS as an initial investigation in patients with suspected small bowel disease. (E-mail:enrico.corazziari@unizoma.it)

Sensitivity and specificity of small intestine contrast ultrasonography (SICUS) in the diagnosis of small bowel lesions

Sensitivity and specificity of small intestine contrast ultrasonography (SICUS) in the diagnosis of small bowel lesions

A method of double-contrast roentgen examination of the small intestine.

Advances in accuracy of diagnosis of lesions in the esophagus, stomach, duodenal bulb, and colon have far surpassed achievements in demonstration of organic lesions of the jejunum and ileum. Though great strides have been made by Mackie (25), Snell and Camp (39), Golden (19), Pendergrass and Comroe (31) and others in the demonstration of functional changes in the bowel, adequate examination of the small intestine and satisfactory delineation and demonstration of its lesions remain a challenge to the radiologist. There are three principal reasons for lack of progress in roentgen diagnosis of small bowel lesions: (1) the time-consuming nature of the examination; (2) difficulty in interpretation of minor changes in the bowel; (3) the extremely low incidence of organic disease in this part of the digestive tract, so that the examiner has little to show, in the way of positive diagnoses, for the effort expended in many examinations. It is the purpose of this paper to review the various methods of examination of the small intestine, furnishing a background for the development of the double-contrast technic used in selected cases in the University Hospitals (Minneapolis). Current Methods of Examination of the Small Bowel and Review of the Literature Oral Administration of Barium: The method most frequently employed in the roentgen examination of the small intestine is the so-called “motor meal,” more recently designated by Golden as “the intestinal study” (19). It is based on the administration of barium sulfate by mouth in varying quantities and concentration. Morse and Cole (29) described a standard technic for the procedure in 1927 and Golden subsequently modified this, administering a mixture of 120 gm. of barium sulfate suspended in 4 or 5 ounces of physiological saline solution. He recommended that films be made at half-hour intervals for a period of five to six hours, with fluoroscopy two or three times during this interval and spot films to demonstrate areas of suspected anatomical variations. Weber and Kirklin (43, 44, 45) use 8 ounces of a mixture of equal parts (by volume) of water and barium sulfate. The patient is examined roentgenoscopically at fifteen-minute intervals, spot films being obtained as indicated. When the stomach is almost empty, a palatable meal is given for the purpose of stimulating peristalsis and accelerating the passage of the head of the meal into the terminal ileum and colon. The usual delay in filling of the terminal ileum is thus avoided. Åkerlund (6) uses a thinner mixture, consisting of three parts of barium sulfate to four parts of water and stresses especially the fluoroscopic examination. In 1937 Pansdorf (30) advocated fractional filling of the small intestine by administering the barium mixture in four 1-ounce doses at fifteen-minute intervals. Hodges (23), aware of the time-consuming nature of small bowel examination, adopts a practical approach for screening of patients.