Evaluation Of Small Bowel Disorders Research Articles

Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience.

ObjectiveEvaluation and management of small bowel disorders have always been challenging due to the limitations of the existing technology. Motorized power spiral enteroscopy (PSE) is an innovative new technique that offers easier, faster, and more complete small bowel evaluation with the ability to perform therapeutics. We aimed to evaluate the safety and efficacy of PSE in various indications.MethodsRetrospective analysis of prospectively collected data of consecutive patients, who underwent PSE at a tertiary care center. Primary outcome measures were technical success rate, pan‐enteroscopy rate, diagnostic and therapeutic yield, and the secondary outcomes measures were the depth of maximal insertion, median insertion time, and adverse events.ResultsFifty‐four patients (mean age of 49.38 ± 16.26 years) underwent PSE for small bowel evaluation. Technical success rate was 95.55% (antegrade route) and 93.10% (retrograde route). Pan‐enteroscopy rate is 46.29% and antegrade enteroscopy to the cecum was achieved in eight patients. Overall diagnostic and therapeutic yields were 85.18% and 30.76%, respectively. The most common findings were ulcero‐stricturing lesions (51.92%) followed by vascular lesions (9.61%). The most common histopathologic diagnosis was Crohn's disease in 29.62%. Median depth of maximal insertion was 400 cm (range 150–550 cm; antegrade route) and 180 cm (range 50–350 cm; retrograde route). The median insertion time to depth of maximal insertion was 70 min (range 30–110 min; antegrade route) and 45 min (range 20–70 min; retrograde route). PSE‐associated major adverse events occurred in one patient and minor adverse events were seen in 48.14%.ConclusionPSE is a safe and effective modality for the evaluation of small bowel disorders with a high diagnostic yield.

Role of CT Entrography in evaluation of small bowel disorders

Abstract The small bowel has always been considered a difficult structure for evaluation, because of its extensive length, its position in the digestive tract, its tortuosity and over lapping loops Purpose of this work is to study elteht of CT Enterography in the assessment of different small bowel diseases. CT Enterography offers superior small bowel visualization compared to standard Abdomino-pelvic CT and provides complementary diagnostic information to capsule endoscopy and MR Enterography more over it can detect the extraluminal pathology Purpose of this work is to study elt eht of CT Enterography in the assessment of different small bowel diseases. Patients & methods the study was performed over 43 patients. Complaining from abdominal pain, chronic diarrhea, loss of weight and recurrent vomiting .all patient had full clinical assessment and laboratory investigations. Results were compared to the upper and lower GIT endoscopies as well as laboratory and histopathology results. Results the most frequent finding were inflammatory bowel disease with95% sensitivity, neoplastic with sensitivity 92%, malabsorption 83.4% sensitivity and vascular diseases Conclusion CT Entrography is a safe well tolerated imaging technique that represents simple and effective method in assessment of different small bowel diseases as it is sensitive to early intestinal wall changes and evaluating the associated mesenteric and extra intestinal alterations as well

Role of multi detector computed tomography (MDCT) in evaluation of small bowel disorders

Role of multi detector computed tomography (MDCT) in evaluation of small bowel disorders

The Use of Balloon-assisted Enteroscopy at a Large Volume Centre: A Retrospective Analysis

ObjectivesBalloon-assisted enteroscopy (BAE) is increasingly used for the evaluation of small bowel disorders. We quantified local diagnostic and therapeutic yields of BAE in patients with suspected small bowel diseases.MethodsAdult patients undergoing BAE between January 2010 and July 2015 at McGill University Health Centre were included. Procedures were identified using a prospectively maintained database. Patients were excluded if procedure report was unavailable. Electronic medical records were reviewed. Analyses were restricted to patients who did not have a previous BAE.ResultsBAE was performed in 453 patients, including 421 anterograde cases. Patients had a mean age of 61.0 ± 17.5 years. Most common indications for referral were obscure gastrointestinal bleeding (OGIB) (n=207, 45.7%), abnormal imaging (n=88, 19.4%), suspected small bowel neoplasia (SBN) (n=39, 8.6%) and Crohn’s disease (CD) (n=31, 6.8%). A diagnosis was established in 216 procedures (47.7%). A pre-endoscopic indication of CD (odds ratio [OR]: 3.78; 95% Confidence Interval [CI], 1.60–8.90), OGIB (OR: 3.69, 95% CI, 2.03–6.71), suspected SBN (OR: 2.45; 95% CI, 1.06–5.65) and previous VCE (OR: 9.33; 95% CI, 3.24–26.90) were associated with abnormal findings. A therapeutic procedure was performed in 126 cases (28.3%). OGIB (OR: 7.00; 95% CI, 3.83–12.81), previous video capsule endoscopy (VCE) (OR: 7.86; 95% CI, 2.93–21.04) and suspected SBN (OR: 6.30; 95% CI, 2.58–21.04) were associated with performance of a therapeutic intervention. Complication rate was 1.6%, with bleeding in seven cases and one perforation.ConclusionsIn carefully selected patients, such as those with OGIB, Crohn’s disease and previous VCE, BAE was a safe procedure that led to the identification of abnormal findings and therapeutic interventions.

Capsule Endoscopy : Single Center Experience = التنظير بالكبسولة : تجربة مركز واحد

Objective: Capsule endoscopy (CE) has revolutionized the evaluation of small bowel disorders, particularly obscure gastrointestinal bleeding (OGIB). The aim of this study was to determine the findings and the diagnostic yield of CE in a large series of patients with suspected small bowel disease mainly OGIB; as well as to compare our results to that of other reported centers. Methods: Data on 230 patients who underwent capsule endoscopy for suspected small bowel related symptoms and/ or signs mainly overt (81 patients) or occult (66 patients) OGIB were obtained by retrospective chart review and review of an internal computer database of capsule endoscopy patients. Data presented as percentages, p value used to show differences whenever relevant. Results: Out of 230 patients investigated for small bowel related symptoms and /or signs, 7 patients excluded mainly due to improper preparation, of the remaining 223, 128 (57.3%) had some lesion detected by CE,80 (35.8%) had definite lesions detected that could unequivocally explain patients' complaints. Patients with overt GI bleeding had the highest diagnostic yield (64.1%), this was significantly greater (P < 0.001) compared to that in patients with occult bleeding (43.9%) as well as those with abdominal pain and/or diarrhea (33.3%). Angiodysplasia is the most common cause of OGIB (26.5%). Conclusions: The yield of clinically important findings on CE in patients with OGIB is 55% and is greater in patients with obscure-overt than obscure-occult GI bleeding. Angiodysplasia account for the majority of significant lesions in both groups.

Capsule Endoscopy Is Superior to Multidetector CT Scan for Evaluation of Small Bowel Disorders: A Meta-analysis

Capsule Endoscopy Is Superior to Multidetector CT Scan for Evaluation of Small Bowel Disorders: A Meta-analysis

Diagnostic modalities for the evaluation of small bowel disorders.

This review summarizes the recent developments in the evaluation of small bowel disorders using videocapsule endoscopy (VCE) and serological and breath-test biomarkers. The ability to visualize the small bowel was revolutionized with the introduction of VCE technology. VCE allows for accurate, noninvasive visualization of the small bowel mucosa. This device is invaluable in the investigation of obscure gastrointestinal bleeding (OGIB), occult bleeding with iron deficiency anaemia, small bowel Crohn's disease (CD), small bowel neoplasms and other mucosal disorders. Recent studies underscored the utility of VCE for documenting the extent and severity of small bowel CD as well as monitoring activity after therapy. The accuracy of the discrimination between small bowel tumours and benign bulges has been improved by a novel endoscopic algorithm. The accuracy of VCE was also evaluated as a potential noninvasive alternative to small bowel biopsies in suspected celiac disease. New findings have been made using breath tests and other biomarkers for the diagnosis of celiac disease, irritable bowel syndrome and bacterial overgrowth. VCE as well as breath-test biomarkers play a major and expanding role in the diagnosis and monitoring of various small bowel disorders.

MR Enterography: A New Experience in Iran

: Magnetic resonance enterography (MRE) is playing an increasingly important role in the evaluation of small bowel disorders particularly in patients with Crohns disease (CD). Despite advances in endoscopic techniques that can help gastroenterologists directly visualize the colon, the small bowel remains relatively inaccessible. Absence of ionizing radiation, improved soft-tissue contrast, the ability to provide dynamic information about bowel distention and motility, and a relatively safe intravenous contrast agent are the main advantages of MRE. It can also provide superior diagnostic information about CD especially in differentiating active inflammatory disease from chronic fibrostenotic disease. Although a true epidemiologic profile of CD in Iran is not quite clear, its incidence is widely on the presumably due to gradual adoption of a western lifestyle in Iran. Unlike developed countries, MRE is not well-known by most Iranian radiologists. In this talk, we will aim to discuss the technical aspects of MRE and illustrate the range of imaging findings in patients suspected to have CD who referred to a university hospital in Tehran with a referral gastroenterology center.

Small Bowel Imaging: Clinical Applications of the Different Imaging Modalities—A Comprehensive Review

In the last years, MR and CT techniques have been optimized for small bowel imaging and are playing an increasing role in the evaluation of small bowel disorders. In comparison to traditional barium fluoroscopic examinations, spatial and temporal resolution is now much more improved partially thanks to modern bowel distending agents. However, there is a global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime. Owing to the excellent soft tissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation, and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders.

CT and MR enterography in evaluating small bowel diseases: when to use which modality?

MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantages of these techniques over traditional barium fluoroscopic examinations due to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility. MRI has many properties that make it well suited to imaging of the small bowel: the lack of ionizing radiation, the improved tissue contrast that can be obtained by using a variety of pulse sequences, and the ability to perform real time functional imaging. Moreover, MR modalities allow visualization of the entire bowel, without overlapping bowel loops, as well as the detection of both intra- and extraluminal abnormalities.The intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel diseases.

Guide to magnetic resonance in Crohnʼs disease

Considering that multiple imaging examinations are often necessary for monitoring Crohn's disease (CD) activity and severity in order to guide and monitor appropriate treatment, the ideal imaging test would be reproducible, well tolerated by patients, and free of ionizing radiation. For these reasons recent studies have highlighted the role of a magnetic resonance imaging (MRI) technique optimized for small bowel imaging in the evaluation of small bowel disorders. In this regard there are two main methodological approaches represented by MR enterography, following administration of an oral contrast medium, and MR enteroclysis, following administration of contrast medium through a nasojejuneal tube. MRI may be used to demonstrate the pathologic findings and complications of CD. In particular, MR has excellent sensitivity and specificity, ranging from 88%-98% and 78%-100%, respectively, for the detection of active inflammation, wall thickening, ulcerations, increased wall enhancement, increased vascularity, perienteric inflammation, and reactive adenopathy. MR also allows more accurate identification of associated complications including penetrating and fibrostenotic disease as well as the more rare extraintestinal manifestations that are usually associated with severe and longstanding intestinal inflammation, the latter often guiding the therapeutic approach. In the progression of CD some rare complications can occur that, to our knowledge, were only briefly or never mentioned in the radiological literature regarding MR enterography or enteroclysis and in which the application of these techniques play a key role.

Inter-observer Disagreement of Capsule Endoscopy Interpretation

Purpose: Capsule endoscopy (VCE) is frequently performed for the evaluation of small bowel disorders. The yield is operator-dependent as there is no gold standard. The discordance in capsule interpretation between readers has not been adequately evaluated. Our aim was to determine the rate of discordant VCE findings in a retrospective cohort of patients referred to our center. Methods: This is a retrospective chart review. Eligible patients were referred to our institution for deep enteroscopy (DE) for presumed small bowel abnormalities. To be included, patients must have previously had a VCE. The outside physician's report as well as the capsule video had to be available for on-site review by an experienced endoscopist. VCE results including location of possible or definite abnormalities were compared between interpreters in a blinded fashion by a gastroenterology trainee. Primary outcome was the rate of discordance between VCE interpretations. Discordance was classified as major or minor based on prespecified criteria. The agreement was analyzed using the kappa statistic. The VCE findings were compared to a gold standard of DE where available. Results: One-hundred ninety patients were referred for DE and had previous VCE. Of these, 100 studies were available for review and 55 patients underwent one or more subsequent DE. The average age was 64.7 years and 40% were male. The indication for the capsule study was: obscure GI bleeding in 91%, polyp or mass in 7%, and stricture in 2%. Overall, 95% of capsule studies were interpreted as positive outside and 86% on-site. Diagnostic disagreement for VCE findings was 39% (22 major and 17 minor), and for location was 19% (all minor). Inter-observer agreement for negative (P0), possible (P1), and probable (P2) findings κ=0.241. Among misdiagnosed lesions were tumors (12/25 or 48%), vascular malformations (14/37, 37.8%), and ulcerative lesions (5/7, 71.4%). The diagnostic concordance between on-site VCE and DE was 88%. Conclusion: We found a substantial discrepancy in VCE interpretation among gastroenterologists which may be due to technological limitations, the lack of a validated reference standard, and the experience of the endoscopist. These findings are relevant for studies investigating clinical outcomes of VCE in patients with small bowel disorders and deserve further research. Disclosure: Dr Chiorean - Speaker's Bureau: Given Inc.

MR Imaging of small bowel in Crohn's disease

MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantage of these techniques over traditional barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure [Brenner DJ, Hall EJ.

MR imaging of the small bowel in Crohn's disease

MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantage of these techniques over tradition barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure [Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84]. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility [Froehlich JM, Patak MA, von Weymarn C, Juli CF, Zollikofer CL, Wentz KU. Small bowel motility assessment with magnetic resonance imaging. J Magn Reson Imaging 2005;21:370–75]. A recent study showed that certain subgroups of patients with Crohn's disease may be exposed to higher doses of radiation; those diagnosed at an early age, those with upper tract inflammation, penetrating disease, requirement of intravenous steroids, infliximab or multiple surgeries [Desmond AN, O’Regan K, Curran C, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut 2008;57:1524–29]. Therefore it has been suggested that techniques that can reduce or eliminate radiation exposure should be considered for imaging [Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84]. Owing to the excellent softtissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders. In this article we will review the technical issues related to the performance of MR enterography and enteroclysis and discuss the role and controversies of using MR in the assessment of inflammatory bowel disease.

Correlation of CT Enteroclysis With Surgical Pathology in Crohn's Disease

The response to therapy in Crohn's disease (CD) depends on the inflammatory or fibrostenotic nature of the underlying pathological process. Standard diagnostic tests cannot reliably distinguish between these two entities. Although CT enteroclysis (CTE) has shown promise in the evaluation of small bowel disorders, its accuracy for the differentiation of CD phenotypes is unknown. To determine the accuracy of CTE compared with surgical pathology in patients with CD and to assess the association of CTE variables with inflammatory or fibrostenotic pathological lesions. CTE studies from patients who underwent resective bowel surgery for CD were reviewed and compared with the pathological specimens using a standardized scoring system. Patients were excluded if they had incomplete studies, nonresective surgeries, or a diagnosis of malignancy. CTE variables, such as mucosal and mural enhancement, wall thickness, engorgement of vasa recta (comb sign), adenopathy, and the presence and severity of strictures were compared with the pathology results using Mantel-Haenszel chi2, Spearman's rank coefficient, and logistic regression analyses. Of the 54 patients enrolled, 10 were excluded. The remaining patients (61% female, 84% white) underwent 44 surgical interventions generating 47 bowel segments that were included in the analysis. The indications for surgery were: bowel obstruction in 21; perforating disease in 13; and refractory, nonobstructive disease in 15. The accuracy of CTE for inflammatory and fibrostenotic lesions was 76.6% and 78.7% using a four- and three-point grading system, respectively. There was good correlation between CTE and pathology in regards to inflammation (Spearman's r = 0.7, P < 0.0001) and fibrostenosis (Spearman's r = 0.6, P < 0.0001) scores. The pathological inflammation score was significantly associated with the CTE variables mucosal enhancement, wall thickness, comb sign, and adenopathy (Mantel-Haenszel chi2 P values 0.04, 0.04, <0.0001, and 0.016, respectively). The pathological fibrostenosis score was significantly associated with the presence and severity of stenosis on CTE (P= 0.001 and 0.007, respectively). By logistic regression analysis, the strongest association was seen with the comb sign (OR 5.52, P < 0.001) for inflammation and the presence of stenosis (OR 5.87, P= 0.006) for fibrostenosis. There was no interaction between the time interval from CTE to surgery and the strength of these associations. CTE may reliably differentiate between inflammatory and fibrostenotic lesions and may have an important role in the management of CD. Specific CTE variables correlate with each of these phenotypes and deserve further investigations in prospective studies.