Suspected Small Bowel Research Articles

Mo2009 - Inpatient Video Capsule Endoscopy for Suspected small Bowel Bleeding in Patients with Non-Bleeding Diverticula on Colonoscopy

Mo2009 - Inpatient Video Capsule Endoscopy for Suspected small Bowel Bleeding in Patients with Non-Bleeding Diverticula on Colonoscopy

Cycled Enteral Antibiotics in Suspected Small Bowel Bacterial Overgrowth Complicating Short Bowel Syndrome - Experience from a Tertiary Neonatal Centre of Canada

Cycled Enteral Antibiotics in Suspected Small Bowel Bacterial Overgrowth Complicating Short Bowel Syndrome - Experience from a Tertiary Neonatal Centre of Canada

Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn's Disease.

Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn’s disease and ulcerative colitis. Crohn’s disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn’s disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn’s disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn’s disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn’s disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.

Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction: Scrima A, Lubner MG, King S, et al. AJR 2017;208:785-793

Small bowel obstruction (SBO) is a common concern in patients who present to the emergency department (ED) with acute abdominal pain. It is important to determine which patients with suspected SBO's will do well with conservative management versus those who will require urgent surgery, as prior data suggests that those who fail conservative management and ultimately require surgery have increased resultant morbidity and mortality.

69-Year-Old Man With Abdominal Pain and Obstipation

69-Year-Old Man With Abdominal Pain and Obstipation

Abdominal Multidetector Computed Tomography for Suspected Small-Bowel Obstruction: Multireader Study Comparing Radiologist Performance for Predicting Surgical Outcomes

To compare performance of junior (JR)/senior (SR) abdominal radiologists using multidetector computed tomography (MDCT) to predict surgical intervention, bowel resection, and presence of bowel ischemia in patients with suspected small-bowel obstruction (SBO). Retrospective, institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, blinded, independent review of MDCT studies for suspected SBO in 179 adults (mean age, 55.8 years; 86 men/93 women) was performed by 12 board-certified radiologists (6 JR, 6 SR). Readers rated likelihood of need for surgery, bowel ischemia, and resection. Correlation with clinical outcomes/pathology was performed. Pooled receiver operating characteristic area under the curve for surgery, ischemia, and resection were 0.802, 0.736, and 0.824 and 0.773, 0.851, and 0.751 JR/SR, respectively. Sensitivity/specificity for predicting surgery was 86.7%/65.4% and 79.6%/64.4%. No differences existed between JR/SR performance overall (P = 0.451); highest/lowest performing readers between groups (P < 0.001) and within groups (P = 0.008) varied. Junior radiologists performed as well as SR in predicting surgical outcomes on MDCT in patients with suspected SBO.

Su1980 - Capsule Endoscopy Complements Magnetic Resonance Enterography and Ileo-Colonoscopy in the Evaluation of Suspected Small Bowel Crohn’s Disease in Pediatric Patients

Su1980 - Capsule Endoscopy Complements Magnetic Resonance Enterography and Ileo-Colonoscopy in the Evaluation of Suspected Small Bowel Crohn’s Disease in Pediatric Patients

Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction.

The purpose of this article is to assess the value of a large panel of clinical and MDCT variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (< 72 hours), bowel ischemia, and bowel resection. MDCT studies performed at admission for 179 nonconsecutive adults (mean age, 55.8 years; 86 men and 93 women) with suspected SBO were retrospectively reviewed by three board-certified radiologists. In addition to assessing individual CT features, each radiologist scored the overall likelihood of each main outcome measure using a 5-point scale. All relevant clinical and laboratory data were abstracted from electronic medical record review. Univariate and multivariate analyses were performed. Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081). A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.

Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices.

BackgroundContinuous flow left ventricular assist device (CF-LVAD) patients have a high prevalence of gastrointestinal bleeding from the small bowel. Video capsule endoscopy (VCE) is often used for diagnosis in these patients, but efficacy has yet to be determined. In this study, we evaluated the efficacy of VCE in the management of CF-LVAD patients with suspected small bowel bleeding by comparing to a non-VCE CF-LVAD control group.MethodsWe retrospectively reviewed the charts of all patients with CF-LVADs implanted at Stanford Hospital from January 2010 to October 2015. Patients were included in the study if there was a clinical suspicion of small bowel bleeding and either a negative upper endoscopy or colonoscopy.ResultsA total of 26 patients met inclusion criteria for a total of 15 encounters where VCE was done, and 25 where VCE was not done. There were no statistical differences when comparing these groups in terms of medical therapy use (thalidomide or octreotide), enteroscopy use (double-balloon or push), intervention on lesions, or any 30-day outcomes. There was no advantage to VCE with regard to the composite endpoint time to re-bleed or death related to re-bleeding (median 114 vs. 161 days, P = 0.15) after removing patients who did not get a VCE due to death or critical illness.ConclusionsWe did not find VCE changed management or outcomes in CF-LVAD patients with suspected small bowel bleeding at our institution when compared to a non-VCE control group. Our experience is small and single center, and larger, multi-center studies could further elucidate the utility of VCE in this patient population.

361 Suspected Small Bowel Obstruction in the Emergency Department: Accuracy of Point-of-Care Ultrasound

361 Suspected Small Bowel Obstruction in the Emergency Department: Accuracy of Point-of-Care Ultrasound

Optimal Diagnostic Approaches for Patients with Suspected Small Bowel Disease.

While the domain of gastrointestinal endoscopy has made great strides over the last several decades, endoscopic assessment of the small bowel continues to be challenging. Recently, with the development of new technology including video capsule endoscopy, device-assisted enteroscopy, and computed tomography/magnetic resonance enterography, a more thorough investigation of the small bowel is possible. In this article, we review the systematic approach for patients with suspected small bowel disease based on these advanced endoscopic and imaging systems.

PTU-010 A Combination of Pillcam®SB2 and Smartpill® in the Investigation of Patients Referred for Assessment of Known or Suspected Small-Bowel Crohn’s Disease &amp; Their Association with Faecal Calprotectin Levels; Case Series

Introduction SmartPill® (Given Imaging Corp., Yoqneam, Israel) is an ingestible, wireless, non-imaging capsule device that records physiological data including contractions, pH and temperature throughout the gastrointestinal (GI) tract. 1 There are currently scarce data looking at SmartPill® assessment of patients with known or suspected small-bowel Crohn’s Disease(CD). 2 We designed this pilot study to investigate feasibility and safety of SmartPill® assessment of gut motility in this group (local ethics committee approval ref.12/SS/0013). Methods Over one year (2012), patients with known or suspected CD, referred for small-bowel capsule endoscopy (SBCE), were invited to participate. Patients underwent hydrogen breath test to exclude small-bowel bacterial overgrowth, patency capsule (Agile®) to confirm luminal patency and provided stool samples for faecal calprotectin (FC). Patients ingested PillCam®SB2, then SmartPill®4 h afterwards. Thirty-three healthy controls were obtained from unpublished data. For statistical analysis, P Results Over the aforementioned period, 12 patients were recruited (7 F/5 M, mean age 44.2 ±16.6 years). 10 underwent complete SmartPill® examination (1 stomach retention, 1 dropout). Pillcam®SB2 was complete in 10 (1 stomach retention, 1 dropout). Mean FC was 340 ±307.7 μg/g. The study group had longer transit times and lower gut motility index (MI) compared to controls, where MI = Ln (sum of pressure amplitudes × number of contractions + 1). The difference in motility appears statistically significant (P Conclusion This study is the first pilot to attempt combining SBCE and SmartPill® in clinical assessment of small-bowel CD. Current data on motility in CD is scarce. Multimodal information could provide a clearer clinical picture. 3–5 Furthermore, despite concerns about capsule retention in CD patients, our study suggests SmartPill® appears safe for use if a patency capsule is employed beforehand. References 1 Tran K, Brun R, Kuo B. Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice. Therap Adv Gastroenterol 2012; 5 :249–260. 2 Rao SSC, Camilleri M, Haler WL, et al . Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil 2011; 23 :8–23. 3 Koulaouzidis A, Iakovidis DK, Karargyris A, et al . Wireless endoscopy in 2020: Will it still be a capsule? World J Gastroenterol 2015; 21 :5119–30. 4 Dignass A, Van Assche G, Lindsay JO, Lemann M, Soderholm J, et al . The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis 2010; 4 :28–62. 5 Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, et al . Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut 2003; 52 :390–92. Disclosure of Interest D. Yung: None Declared, J. Plevris: None Declared, A. Koulaouzidis Grant/research support from: ESGE- Given®Imaging Research grant 2011

Diagnostic and Therapeutic Utility of Double‐Balloon Enteroscopy in Children

Diagnostic and therapeutic benefits of double-balloon enteroscopy (DBE) have been documented in adults, with few data available on pediatric patients. We evaluated the diagnostic and therapeutic utility of DBE in children. A prospective assessment of 113 DBE procedures in 58 consecutive children younger than 18 years (36 boys, 22 girls; median age 12.7 years, range 1-18 years) was performed for a variety of suspected small bowel (SB) disorders from January 2008 to August 2012 in a tertiary referral center for pediatric patients. All of the children had undergone upper gastrointestinal endoscopy and ileocolonoscopy. A total of 19 patients had undergone radiological investigations for SB (n = 11 magnetic resonance imaging; n = 5 barium enterography; n = 3 computed tomography) and 54 patients had undergone wireless capsule endoscopy (WCE). The overall median (range) examination time was 92.5 (45-275) minutes. The median (range) estimated insertion length of SB distal to pylorus was 230 (80-450) cm and proximal to ileocecal valve was 80 (5-275) cm. The common indications for DBE were polyposis syndromes (n = 21) and obscure gastrointestinal bleeding (n = 16). The findings included polyps (n = 19), mucosal ulcers and erosions (n = 8), submucosal elevations with white nodules (n = 4), and angioma/angiodysplasia (n = 2). The overall diagnostic yield for SB lesions using DBE was 70.7% (41/58) and for WCE was 77.7% (42/54). Endotherapeutic intervention was successfully used in 46.5% (n = 27/58). The endoscopic, medical, and surgical contributions to change in management by DBE were 72.4% (n = 42/58). Three complications (5.2%) were noted with uneventful recovery. The diagnostic yield of DBE was comparable to WCE, but with the addition of therapeutic possibility and histological yield. We believe this technique could be a valuable addition to existing endoscopic techniques, complementary to WCE, and may be considered as an alternative diagnostic and therapeutic option in the SB in children.

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

Tu1301 8-Hour CE Versus 12-Hour CE in a Cohort of Hospitalized Patients Undergoing CE for Suspected Small Bowel Disorders

Capsule endoscopy (CE) is a non-invasive test that is effective in the diagnosis of small bowel (SB) disorders. One of the main limitations of the 8-hour Pillcam SB2 (8H CE) is failure to reach the cecum and potential to miss lesions in the distal SB, especially in hospitalized patients. A 12-hour Pillcam SB2 CE (12H CE) with a prolonged battery life was introduced to overcome this limitation.

Impact of Device-assisted Enteroscopy on the Diagnosis and Management of Suspected and Established Small Bowel Crohnʼs Disease

Impact of Device-assisted Enteroscopy on the Diagnosis and Management of Suspected and Established Small Bowel Crohnʼs Disease

Antegrade Is More Effective Than Retrograde Enteroscopy for Evaluation and Management of Suspected Small-Bowel Disease

Antegrade and retrograde enteroscopy are useful for evaluating the proximal and distal small bowel, respectively. We compared the diagnostic yield, therapeutic yield, and complications of antegrade and retrograde enteroscopy. We performed a retrospective review of a prospectively maintained database of patients who underwent small-bowel enteroscopy at our institution from January 2008 to August 2009. All enteroscopies were performed using single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or spiral enteroscopy (SE). A total of 250 enteroscopies were performed; 182 were antegrade (91 SBE, 52 DBE, and 39 SE) and 68 were retrograde (23 SBE, 37 DBE, and 8 SE). The mean age of the patients was 61.5 ± 15.8 years. The most common indication for small-bowel endoscopy was obscure gastrointestinal bleeding (n = 83). The diagnostic yield was significantly higher for antegrade than retrograde enteroscopy (63.7% vs 39.7%; P < .001). Antegrade procedures were of shorter duration than retrograde enteroscopy (44.3 ± 22.0 vs 58.9 ± 29.7 min; P < .001), and the mean depth of maximal insertion was significantly greater with antegrade endoscopy (231.8 ± 122.1 vs 103.4 ± 102.8 cm; P < .001). The therapeutic yield also was significantly higher for anterograde enteroscopy than retrograde enteroscopy (55.5% vs 44.1%; P < .001). There were no significant differences in complications. Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease.

Provision of service and training for small bowel endoscopy in the UK

ObjectiveTo determine the location and use of small bowel endoscopy services in the UK and to analyse training uptake to assess future demand and shape discussions about training and service...

Capsule Endoscopy for Suspected Small Bowel Bleeding in Patients with Portal Hypertension

Background/Aims: In Korea, limited data are available on small bowel bleeding in patients with portal hypertension. This study reports on the use of capsule endoscopy in cases of suspected small bowel bleeding in patients with portal hypertension. Methods: Capsule endoscopy was used at our hospital to evaluate small bowel disease in 501 cases from July 2003 to June 2010. Of those cases, nine patients with portal hypertension due to liver cirrhosis with suspected small bowel bleeding were selected for the study. A retrospective analysis was performed using data from medical records. Results: Six of the nine (66.7%) patients were males with an average age of 53.4 years. The average hemoglobin level was 8.1 g/dL. Abnormalities noted during capsule endoscopy included portal hypertensive enteropathy in all nine cases (100%), jejunal varices in four (44.4%), jejunal and ileal angiodysplasia in five (55.5%), multiple small bowel erosions in one (11.1%), granularity of the jejunal mucosa in one (11.1%), and small bowel erythema in three (33.3%). Active bleeding from jejunal varices was detected in two patients (22.2%). Despite having no obvious active bleeding during the capsule endoscopy, four patients (44.4%) were diagnosed with portal hypertensive enteropathy with obscure small bowel bleeding. Conclusions: Capsule endoscopy is a useful diagnostic tool for the evaluation of small bowel bleeding in patients with portal hypertensive enteropathy. Additional prospective and multicenter studies on the use of capsule endoscopy are needed to evaluate the incidence and clinical importance of portal hypertensive enteropathy. (Intest Res 2011;9:129-138) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures

The patency capsule (PC) is used before capsule endoscopy (CE) in patients with known or suspected small-bowel (SB) strictures or obstruction (SBO) to avoid CE retention. False-positive PC examination results can occur in patients with delayed transit without obstruction, precluding the use of CE. Radiological tests are another option to evaluate the presence of SBO before CE. Comparison of the PC and radiological examinations to detect clinically significant SB strictures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PC, and radiological tests for detecting significant strictures. Forty-two patients underwent a PC study and radiological examinations. Both of the examinations showed similar sensitivity (57% vs 71%; P = 1.00) and specificity (86% vs 97%; P = .22). The receiver-operating characteristic curves evaluating combined sensitivity and specificity were also similar in both the PC and radiological examinations (0.71 vs 0.84, respectively; P = .46). Pooling results from both the PC and radiological tests had the highest sensitivity and NPV (100%, 100%). False-positive results occurred in 5 PC examinations and 1 radiological examination. The PC examination had 3 false-negative results (9%), whereas radiological tests had 2 (6%). Retrospective study. The NPV for the PC and radiological tests were not significantly different, suggesting that if findings on either test are negative before CE, the patient will most likely pass the capsule without incident. Radiological tests can be used to minimize PC study false-positive results by confirming or excluding the presence of a significant stricture suspected by the PC and to localize the PC if passage is delayed.