Investigation Of Small Bowel Disease Research Articles

Small bowel disease prevalence on video capsule endoscopy in chronic granulomatous disease-associated inflammatory bowel disease.

Patients with chronic granulomatous disease (CGD) may develop inflammatory bowel disease (IBD). Characterization of small bowel disease in this cohort is scarce. Here, we sought to determine the prevalence and characteristics of small bowel disease and evaluate the clinical utility of video capsule endoscopy (VCE) for its diagnosis. A retrospective study was performed on patients with CGD who were evaluated for gastrointestinal disease with VCE as a part of ongoing natural history studies at a single academic center. VCEs were reviewed for inflammatory findings and severity of disease utilizing the Capsule Endoscopy Crohn's Disease Activity Index. Radiographic studies and endoscopies performed within 30days of VCE were compared with small bowel inflammatory findings. Twenty-six VCEs corresponding to 25 patients were found. The majority of patients were male and White; mean age was 28years old. The majority (85%) demonstrated presence of small bowel inflammatory findings on VCE including strictures, ulcers, erosions, and erythema. Duodenal and ileal inflammatory disease on endoscopy did not correlate with disease on VCE. Moderate-severe colonic disease correlated with moderate-severe disease on VCE. Radiography did not correlate with disease on VCE. Prolonged small bowel transit time correlated with moderate-severe small bowel disease. Small bowel IBD was highly prevalent in this cohort of patients with CGD. Limitations included small sample size. Given that radiology and duodenal/ileal disease did not correlate with VCE findings, VCE-driven investigation of small bowel disease should be considered in patients with CGD-associated IBD, particularly those with colonic disease.

Su1325 PROLONGED OPERATING TIME HAVE A SUBSTANTIAL EFFECT ON PROMOTING COMPLETE EXAMINATION RATE OF CAPSULE ENDOSCOPY COMPARED WITH ENDOSCOPIC DELIVERY OF CE ALONE

Small bowel capsule endoscopy (SB CE) has become the gold standard for the investigation of small bowel diseases. The most common applications of CE include obscure gastrointestinal bleeding (OGIB), suspected Crohn’s disease, small-intestine tumors and polyps, etc. The diagnostic yield of SB CE has been reported to vary widely and can be affected by many factors, such as indications, bowel preparation, reviewers’ experience, and so on. Complete examination was defined as capsule passing through the whole small intestine during its working time, and the complete examination rate (CER) is also one of the important factors that can influences the diagnostic yield of CE. Some methods have been adopted to promote the CER; among them are real-time monitoring plus endoscopic delivery of CE into the duodenum and prolonging examination time with increased battery life. In order to study which of the two methods mentioned above is more effective for improving the CER, three types of modality of CE examination were analyzed. We conducted a retrospective review of 241 consecutive patients, 61 of whom had undergone 8-h PillCam SB CE (8 h operating time) from July 2005 to April 2011 without real-time monitoring, 7 consecutive 8-h PillCam SB CE and 173 consecutive 12 h PillCam SB2-ex (12 h operating time) patient all with real-time monitoring and endoscopic delivery of CE if necessary (CE unable pass through the pylorus 1.5 h after the start of the inspection) from July 2011 to November 2018. We grouped the patients as follows: A, 61 cases 8-h PillCam CE without real-time monitoring; B, 180 cases 8-h PillCam CE with monitoring (7 actual 8 h, and 173 actual 12 h but assumed the CE only work for 8 h and only data of the former 8 h were calculated); C, 173 cases 12 h PillCam SB2-ex actual data. GTT (gastric transit time), SBTT (Small bowel transit time) and CER of the three groups were analyzed. We found that twenty-nine (16.1%, 29/180) endoscopic delivery of CE were performed in group B, but there was no difference between group A and B in GTT, SBTT or CER. CER of group C (94.8%, 164/173) was much higher than that of group A (78.7%, 48/61) or B (72.8%, 131/180) (Chi-square test with Bonferroni correction; C vs. A, p ＜ 0.01 & C vs. B, p ＜ 0.001), and SBTT of group C (322.0 ± 133.1 min) was much longer than that of group A (253.8 ± 80.9 min) or B (269.3 ± 98.4 min) (One-Way ANOVA Tamhane's T2 or Dunnett's T3 test; C vs. A & C vs. B, p ＜ 0.001) (table 1). In conclusion, longer operating time have a substantial effect on promoting complete examination rate of CE, while endoscopic delivery of CE have little or no effect on it. Endoscopic delivery of CE plays a role in eliminating the risk of inspection failure, such as unable to ingestion, or excessive time wasted in the esophagus or stomach, but too early or too frequently endoscopic delivery of CE is not necessary.

What defines quality in small bowel capsule endoscopy.

Small bowel capsule endoscopy is considered a first-line diagnostic tool for the investigation of small bowel diseases. Gastroenterological and endoscopic societies have proposed and established measures known as quality indicators, quality measures or performance measures for the majority of endoscopic procedures, in order to ensure competence, healthcare quality and define areas requiring improvement. However, there is a paucity of publications describing small bowel capsule endoscopy quality indicators. Hereby, we attempt to identify and describe a number of pre-procedure, intra-procedure and post-procedure quality indicators, regarding process measures in small bowel capsule endoscopy, after a comprehensive review of the literature.

Preparing the bowel for small bowel video capsule endoscopy

© 2 01 5 M A H ea lth ca re L td Video capsule endoscopy (VCE) is well accepted as a safe and effective diagnostic technique for the investigation of small bowel disease. It is most commonly used in patients with obscure gastrointestinal bleeding, and where there is suspicion of active Crohn’s disease. Other established indications include coeliac disease and polyposis syndromes. The procedure is noninvasive, well tolerated, and allows patients to remain ambulatory during the 8-hour recording. A miniature video camera is swallowed by the patient, enabling visualisation of the entire small bowel before the disposable capsule is excreted naturally. Images are captured at a rate of up to six frames per second Preparing the bowel for small bowel video capsule endoscopy

Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel

Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE).The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications.SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance.These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.

MR Enterography Is a Useful Test in the Investigation of Small Bowel Disease

Purpose: MR Enterography (MRE) aids assessment of Crohn's disease (CD) but may also be indicated in the investigation of other SB pathology. We studied the frequency and clinical impact of incidental findings detected by MRE in patients with suspected or known CD. Methods: We conducted a retrospective review of 1022 MRE studies performed between June, 2009 and February, 2013 at our institution. Clinical data (demographics, disease characteristics and therapy) were obtained from electronic patient records. Incidental findings were defined as unexpected lesions in or outside the small intestine, unknown at the time of referral and unrelated to inflammatory bowel disease (IBD). Results: Of 1,022 MRE studies 500 patients had a diagnosis of IBD, 418 had CD, 61 had ulcerative colitis (UC) and 21 had IBD unclassified (IBDU). Of 418 CD patients, 243 were female, mean age 36. Abnormalities were noted in 306 MRE scans, 170 active non-stricturing, 121 active stricturing and 13-fibrostenotic disease. Within active groups were 35 fistulae and 12 abscesses. Incidental findings included colonic inflammation (10), gallstones (17), ovarian cysts (22), jejunal intussusception (1), sacroileitis (1), renal cysts (11), hepatic cysts (12), splenic haemangioma (1), mesenteric abscess (1), adrenal nodule (2), uterine fibroid (5), chronic pancreatitis (1) and splenomegaly (2). Eighty-two studies were performed in UC or IBDU; 48 were female, mean age 33. Seventeen patients had small bowel thickening with signs of active inflammation in 12/17. Incidental findings included a right ischio-anal fossa collection, pancreatic divisum, gallstones, liver and ovarian cysts, diverticular disease, large bowel abnormalities in 6 patients, colitis (5) and colonic polyps (1). MRE was performed in 522 patients without IBD. Indications included iron deficiency anaemia, abdominal pain, weight loss, diarrhoea, rectal bleeding, vomiting and abnormal colonoscopy. Findings included small bowel thickening (4), sub-acute small bowel obstruction (2), small bowel stricture (1), small bowel malignancies (2) and small bowel intussusception (1). Incidental findings included ovarian, hepatic and renal cysts, adrenal adenoma, splenic and liver haemangioma, PUJ obstruction, AAA, liver metastases, gallstones, pelvic abscess, uterine fibroids, large bowel stricture, diverticular disease, cirrhosis, lymphadenopathy, horseshoe kidney, atrophic pancreas and acute appendicitis. Conclusion: A small but significant proportion of patients have important incidental findings at MRE. MRE can add meaningfully to the investigation of SB pathology. A careful selection of patients can be achieved through a collaborative multi-disciplinary approach.

PWE-200 Mr Enterography is a Useful test in the Investigation of Small Bowel Disease

IntroductionMR enterography (MRE) aids assessment of small bowel (SB) inflammatory bowel disease (IBD). We aimed to determine the frequency and clinical impact of incidental findings detected by MRE in patients...

Small Bowel Capsule Endoscopy: Indications, Limitations and Diagnostic Yield

Small bowel capsule endoscopy (CE) is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine. The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine, such as obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, polyposis syndromes, etc . CE has become the gold standard for the diagnosis of most diseases of the small bowel. Lately this technique has also been used for esophageal and colonic diseases. The review focuses on the indications, limitations and diagnostic yield of capsule endoscopy in the investigation of small bowel diseases.

MR Enterography Is a Useful Test in the Investigation of Small Bowel Disease

Purpose: MR enterography (MRE) is useful in the assessment of small bowel inflammatory bowel disease (IBD) but may also be indicated in the investigation of other small bowel (SB) pathology. We aimed to determine the frequency and clinical impact of incidental findings detected with MRE in patients with suspected or known Crohn's disease (CD). Methods: We conducted a retrospective review of 250 MRE studies performed between June 2009 and August 2011 at our institution. Clinical data including demographics, disease characteristics and therapy were obtained from electronic patient record review. Incidental findings were defined as unexpected lesions in or outside the small intestine, previously unknown or unsuspected at the time of referral and unrelated to IBD. Through a thorough inspection of records we analyzed the impact of incidental MRE findings. Results: Of 250 MRE studies 122 patients had a diagnosis of IBD, 109 had CD, 11 had ulcerative colitis and 2 had IBD unclassified (IBDU). Sixty-nine of 109 CD patients were female, mean age 35 (range 16-68) and median disease duration of 5 years (range 0-39). Of patients with CD abnormalities were noted in 77 MRE scans; 54 active non-stricturing, 22 active stricturing and 1 fibrostenotic disease. Within active groups were 7 fistulae and 4 abscesses in 7 patients. Incidental findings included colonic inflammation (4), gallstones (3), ovarian cyst (5), sacroileitis (1), renal cyst (2), hepatic cyst (1), splenic haemangioma (1), adrenal nodule (1) and uterine fibroid (1). There were 13 studies performed in patients with UC or IBDU. The mean age was 30 (range 17-42) and 4 of these patients were female. Two of these patients had small bowel disease on MRE, small bowel thickening and enhancement in one and small bowel stenosis and signs of active inflammation in the other. Incidental findings included a fluid filled collection in the right ischio-anal fossa, pancreatic divisum and liver cysts. There were large bowel abnormalities in 3 patients, colitis in 2 and colonic polyps in the third. MRE was performed in 128 patients without IBD. Indications included abdominal pain, weight loss, diarrhea, vomiting, previous abnormal colonoscopy or intra-abdominal abscess and to specifically rule out IBD in some patients. The majority of these studies showed no small bowel abnormality. Incidental findings included ovarian hepatic cysts and renal cysts, gallbladder polyp, horseshoe kidney and atrophic pancreas. Conclusion: A proportion of patients have important incidental findings at MRE. MRE can add meaningfully to the investigation of SB pathology. A careful selection of patients for MRE can be achieved through a collaborative multi-disciplinary approach between radiologists and clinicians.

CT Enterography is a Useful Test in the Investigation of Small Bowel Disease

CT Enterography is a Useful Test in the Investigation of Small Bowel Disease

Capsule Endoscopy in Crohn’s Disease

Capsule endoscopy (CE) represents a significant advance in the investigation of small bowel diseases. Two-thirds of Crohn's disease (CD) patients have small bowel involvement at diagnosis. Study of small intestine mucosa by CE may have a strong impact on CD management in a near future. CE may be superior to small bowel cross-sectional imaging for detection of mucosal lesions consistent with CD and a normal CE has a high negative predictive value for active small bowel CD. A GI imaging study should generally precede CE to rule out complications such as fistulas and strictures. In established CD, CE may be useful in patients with unexplained symptoms when other investigations are inconclusive, if this will alter management. The low specificity of CE is its main drawback. Furthermore, there are no validated CD diagnosis criteria for CE and no severity indexes have been independently validated. The role of CE in evaluating mucosal healing and postoperative recurrence will require additional investigation.

Small bowel enteroscopy.

Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.

Air (CO2) Double-Contrast Barium Enteroclysis

In the 1980s and 1990s in North America and Europe, air (CO(2)) double-contrast barium enteroclysis took a back seat to biphasic methylcellulose double-contrast enteroclysis in the investigation of small-bowel diseases. The widespread application of capsule endoscopy in the 21st century has identified a number of limitations of radiologic examinations in the investigation of mucosal diseases of the small intestine. Evidence-based studies comparing barium, computed tomographic (CT), and magnetic resonance (MR) enteroclysis have shown that in spite of improvements in small-bowel examination methods using CT and MR, barium examinations remain superior in the depiction of mucosal abnormalities, particularly the apthoid lesions of early Crohn disease. Barium small-bowel examinations have been recommended in the patient with a negative CT or MR enteroclysis study where the pretest probability of Crohn disease is high. A recent prospective comparison of methylcellulose double-contrast barium enteroclysis to capsule endoscopy with review of the literature has shown that air enteroclysis depicts mucosal details better than does methylcellulose double-contrast enteroclysis because of the "washout" effect of methylcellulose on superficial mucosal features. Recent articles have shown that air enteroclysis compares favorably with wireless capsule endoscopy and double-balloon endoscopy in the diagnosis of mucosal abnormalities of the small bowel. This article describes the authors' technique of performing air double-contrast enteroclysis, its clinical indications, and its pitfalls.

Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease

To compare results of capsule endoscopy with those of barium enteroclysis or CT enteroclysis. Retrospective review of hospital records revealed 65 patients who had an enteroclysis and small bowel capsule endoscopy. The diagnostic yield of capsule endoscopy was compared with the enteroclysis using Fisher's exact test. The main indications were obscure gastrointestinal bleeding (n = 37) and suspected Crohn disease (n = 17). Radiologic studies included CT enteroclysis (n = 30), and fluoroscopic barium enteroclysis with carbon dioxide (n = 18) or with methylcellulose (n = 17). Capsule endoscopy had a higher diagnostic yield (8/17) compared to barium-methylcellulose cellulose enteroclysis (1/17) (P = 0.02). The diagnostic yield of capsule endoscopy was not significantly different compared with barium-carbon dioxide (12/18 vs. 10/18) enteroclysis or with CT enteroclysis (9/30 vs. 8/30). Vascular lesions were better assessed with capsule endoscopy. However, the CT enteroclysis found more lesions in patients with chronic abdominal pain. Barium-carbon dioxide enteroclysis and CT enteroclysis have similar diagnostic yields for small bowel disease compared to capsule endoscopy. Barium methylcellulose has an inferior diagnostic yield.

Radiologic Investigations Complement and Add Diagnostic Information to Capsule Endoscopy of Small-Bowel Diseases

The purpose of our study was to review how commonly performed radiologic examinations compare with capsule endoscopy in the investigation of small-bowel diseases, to analyze the limitations of capsule imaging, and to propose an algorithm for use of specific radiologic examinations to complement wireless capsule endoscopy. The diagnostic yield of capsule endoscopy is superior to that of radiologic examinations except air double-contrast enteroclysis for mucosal details. Radiologic investigations find new applications in clinical practice by complementing capsule endoscopy to overcome its limitations.

The role of imaging in small bowel disease

A successful small bowel imaging strategy depends on choosing the right investigation to answer the right clinical question. Barium studies are readily available, reproducible, easy to perform, consistent and currently the workhorse in the investigation of small bowel disease. CT enteroclysis (CTE) and MR enteroclysis (MRE) provide both luminal and extraluminal information during a single examination. MRE, in particular, is a low radiation dose study and an attractive imaging option when investigating Crohn's disease in young patients. Wireless capsule endoscopy (WCE) is considered more sensitive than barium and CT for small mucosal lesions and obscure gastrointestinal (GI) bleeding. Radionuclide studies are best employed when a specific diagnosis is suspected. The small bowel represents the most challenging part of the alimentary canal to image. A successful imaging strategy is dependent on using the most appropriate radiology to answer the right clinical question. A number of conventional imaging strategies, such as barium follow-through, have been successfully used to characterize small bowel pathology, but newer techniques, including CT enteroclysis or MR enteroclysis (CTE or MRE) and wireless capsule endoscopy (WCE), have been introduced and are gaining popularity. The purpose of this review is to describe and fully illustrate the different imaging modalities and techniques currently available in the investigation of small bowel disease. We will assess the strengths and weaknesses of each test and highlight their most appropriate use.

Capsule endoscopy: current indications and future prospects

Capsule endoscopy represents a significant advance in the investigation of small bowel diseases and the beginning of wireless endoscopic imaging. Capsule endoscopy involves swallowing a video capsule endoscope, which is painless and relatively safe. Its use has been established for suspected small bowel bleeding, and the role of capsule endoscopy in the investigation of inflammatory bowel disease, iatrogenic disease, polyposis syndromes and coeliac disease is evolving. It is likely that in many instances it will become the next test after standard endoscopic evaluation. Early data suggest that capsule endoscopy improves outcome in patients with suspected small bowel bleeding, but more data are required on outcomes for the other indications.

A Comparison of Endoscopic and Surgical Collection Procedures for the Analysis of the Bacterial Flora in Duodenal Fluid from Cats

In order to assess an endoscopic collection procedure, populations of bacteria in duodenal fluid from seven adult cats were compared in paired samples obtained by endoscopy and direct needle aspiration during laparotomy. Each sample of duodenal juice was subjected to quantitative and qualitative culture of bacteria under both aerobic and anaerobic conditions. There were no significant differences in total numbers or individual species of bacteria comparing the two collection procedures. These findings indicate that collection of duodenal juice by endoscopy using the procedure described provides a representative sample of small bowel fluid for the assessment of the bacterial flora. Therefore, there appears to be no need for more invasive or complicated sampling techniques when quantitative and qualitative culture of duodenal juice is indicated as part of an investigation of small bowel disease in cats.

Two way push videoenteroscopy in investigation of small bowel disease

Aims—To evaluate the diagnostic yield and safety of a new push type videoenteroscope (PVE) for diagnosis of small bowel disease.Methods—Three hundred and thirteen patients were referred for one or two...

Video push enteroscopy in the investigation of small bowel disease: defining clinical indications and outcomes.

Push enteroscopy is a new technique for investigation of the small intestine. The clinical indications are still being defined. It also offers the potential for therapeutic intervention in suitable cases. To evaluate further the role of push enteroscopy in the diagnosis and treatment of patients with suspected or known small bowel disease. A prospective record was kept of all patients having enteroscopy at Royal Prince Alfred Hospital between March 1995 and July 1997. The procedure was performed 73 times in 68 patients. Indications and diagnoses were noted. The outcome in patients with obscure gastrointestinal bleeding or anaemia in whom a vascular lesion was treated with a heater probe was also determined. Enteroscopy was performed in 23 patients for gastrointestinal bleeding of obscure origin. An active or possible bleeding source was found in 13 (57%). The commonest of these was jejunal angiodysplasia. In the 21 patients with chronic iron deficiency anaemia a lesion was found in ten (48%). The majority of these were in the stomach, as described by others. The diagnostic yield in the 16 patients having enteroscopy for known or suspected small bowel disease was 56%. One patient underwent balloon dilatation of a postoperative jejunal stricture. Eleven patients with obscure bleeding or anaemia had ablation of a vascular lesion with a heater probe. Transfusion requirements fell after this procedure, particularly in those with active bleeding at the time of the examination. In five of the 11 no further transfusions were required in over six months of follow-up. The most common indications for enteroscopy are obscure gastrointestinal bleeding, chronic anaemia and known or suspected small bowel disease. A positive result can be expected in over 50% of patients. The treatment of vascular lesions via the enteroscope has a significant impact of subsequent transfusion requirements.