|
1
|
Wang YP, Karmakar R, Mukundan A, Tsao YM, Sung TC, Lu CL, Wang HC. Spectrum aided vision enhancer enhances mucosal visualization by hyperspectral imaging in capsule endoscopy. Sci Rep 2024; 14:22243. [PMID: 39333620 PMCID: PMC11436966 DOI: 10.1038/s41598-024-73387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 09/17/2024] [Indexed: 09/29/2024] Open
Abstract
Narrow-band imaging (NBI) is more efficient in detecting early gastrointestinal cancer than white light imaging (WLI). NBI technology is available only in conventional endoscopy, but unavailable in magnetic-assisted capsule endoscopy (MACE) systems due to MACE's small size and obstacles in image processing issues. MACE is an easy, safe, and convenient tool for both patients and physicians to avoid the disadvantages of conventional endoscopy. Enabling NBI technology in MACE is mandatory. We developed a novel method to improve mucosal visualization using hyperspectral imaging (HSI) known as Spectrum Aided Visual Enhancer (SAVE, Transfer N, Hitspectra Intelligent Technology Co., Kaohsiung, Taiwan). The technique was developed by converting the WLI image captured by MACE to enhance SAVE images. The structural similarity index metric (SSIM) between the WLI MACE images and the enhanced SAVE images was 91%, while the entropy difference between the WLI MACE images and the enhanced SAVE images was only 0.47%. SAVE algorithm can identify the mucosal break on the esophagogastric junction in patients with gastroesophageal reflux disorder. We successfully developed a novel image-enhancing technique, SAVE, in the MACE system, showing close similarity to the NBI from the conventional endoscopy system. The future application of this novel technology in the MACE system can be promising.
Collapse
Affiliation(s)
- Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan
- Institute of Brain Sciences, National Yang Ming Chiao Tung University, 155, Li-Nong St., Sec.2, Peitou, Taipei City, 11217, Taiwan
| | - Riya Karmakar
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Arvind Mukundan
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Yu-Ming Tsao
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Te-Chin Sung
- Insight Medical Solutions Inc., No. 1, Lixing 6th Rd., East Dist., Hsinchu City, 300096, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan.
- Institute of Brain Sciences, National Yang Ming Chiao Tung University, 155, Li-Nong St., Sec.2, Peitou, Taipei City, 11217, Taiwan.
| | - Hsiang-Chen Wang
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan.
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan.
- Hitspectra Intelligent Technology Co., Ltd., 8F.11-1, No. 25, Chenggong 2nd Rd., Kaohsiung, 80661, Taiwan.
| |
Collapse
|
|
2
|
Lu SC, Mukundan A, Karmakar R, Tsao YM, Nguyen HT, Wang HC. Research progress in narrow-band imaging of capsule endoscopes based on hyperspectral image conversion technology. 2024 CONFERENCE ON LASERS AND ELECTRO-OPTICS PACIFIC RIM (CLEO-PR) 2024:1-2. [DOI: https:/doi.org/10.1109/cleo-pr60912.2024.10676538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Affiliation(s)
- Song-Cun Lu
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Arvind Mukundan
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Riya Karmakar
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Yu-Ming Tsao
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Hong-Thai Nguyen
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Hsiang-Cheng Wang
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| |
Collapse
|
|
3
|
Martinov Nestorov J, Sokic-Milutinovic A, Pavlovic Markovic A, Krstic M. Could Capsule Endoscopy Be Useful in Detection of Suspected Small Bowel Bleeding and IBD-10 Years of Single Center Experience. Diagnostics (Basel) 2024; 14:862. [PMID: 38732278 PMCID: PMC11083052 DOI: 10.3390/diagnostics14090862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel-Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn's disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel's diverticulum and Crohn's disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.
Collapse
Affiliation(s)
- Jelena Martinov Nestorov
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Sokic-Milutinovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Pavlovic Markovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Krstic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| |
Collapse
|
|
4
|
Wongsiriamnuey T, Limsrivilai J. Current Perspectives on Small Bowel Tumors: Overview of Prevalence, Clinical Manifestations, and Treatment Approaches. SIRIRAJ MEDICAL JOURNAL 2024; 76:225-233. [DOI: 10.33192/smj.v76i4.267555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
Small bowel tumors (SBTs) constitute a rare yet increasingly recognized group of gastrointestinal neoplasms, accounting for less than 5% of all gastrointestinal cancers. Despite their infrequency, the incidence of SBTs has exhibited a notable upward trend, underscoring the importance of understanding these diverse and complex tumors. This review consolidates current knowledge on SBTs, encompassing epidemiology, risk factors, clinical manifestations, diagnostic advancements, and treatment modalities. Data from various sources are analyzed to present a comprehensive overview of the evolving landscape of SBTs. Our findings indicate that adenocarcinomas, carcinoid tumors, lymphomas, and gastrointestinal stromal tumors (GISTs) are the common SBTs. While adenocarcinoma and neuroendocrine tumors are the common types of SBTs in the West, GIST and lymphoma are more common in Asia. Common risk factors include genetic syndromes and inflammatory bowel diseases. There is variability in clinical presentations depending on the type of tumors. Although diagnostic challenges persist, advancements in imaging and endoscopic techniques have improved detection rates. Treatment strategies are evolving; surgical resection remains the mainstay for localized disease, augmented by systemic therapies and targeted agents for advanced stages. This review emphasizes the importance of early detection and individualized treatment approaches in improving outcomes for SBT patients. It addresses the need for ongoing research and innovation in managing these tumors.
Collapse
|
|
5
|
Tsao Y, Mukundan A, Lu S, Wang HC, Wang YP, Lu CL. Development of narrow-band image imaging based on hyperspectral image conversion technology for capsule endoscopy. OPTICS IN HEALTH CARE AND BIOMEDICAL OPTICS XIII 2023. [DOI: 10.1117/12.2688844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
|
|
6
|
Tsao Y, Mukundan A, Lu S, Wang HC, Wang YP, Lu CL. Development of narrow-band image imaging based on hyperspectral image conversion technology for capsule endoscopy. OPTICS IN HEALTH CARE AND BIOMEDICAL OPTICS XIII 2023:8. [DOI: https:/doi.org/10.1117/12.2688844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
|
|
7
|
Nakamura M, Kawashima H, Ishigami M, Fujishiro M. Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy. Intern Med 2022; 61:5-13. [PMID: 34121000 PMCID: PMC8810252 DOI: 10.2169/internalmedicine.6823-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibit the progress of PC and SBCE, even though they do not have any stenotic symptoms or abnormalities on imaging. In this review, we summarize the indications and limitations of PC prior to SBCE, especially the contraindications, and discuss clinical scenarios in which even PC should be avoided, and therefore such areas of stenosis should be evaluated by alternative modalities. We thus propose this new algorithm to evaluate the patency of the GI tract for patients with suspected and known small bowel stenosis in order that they may undergo SBCE safely.
Collapse
Affiliation(s)
- Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | | | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
|
8
|
Masselli G, Guida M, Laghi F, Polettini E, Gualdi G. Magnetic Resonance of Small Bowel Tumors. Magn Reson Imaging Clin N Am 2019; 28:75-88. [PMID: 31753238 DOI: 10.1016/j.mric.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Magnetic resonance (MR) imaging is rapidly increasing clinical acceptance to evaluate the small bowel and can be the initial imaging method to investigate small bowel diseases. MR examinations may provide the first opportunity to detect and characterize tumors of the small bowel. Intraluminal and extraluminal MR findings, combined with contrast enhancement and functional information, allow accurate diagnoses and consequently characterization of small bowel neoplasms. This article describes the MR findings of primary small bowel neoplasms and the MR findings for the differential diagnosis are discussed.
Collapse
Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy.
| | - Marianna Guida
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesca Laghi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Elisabetta Polettini
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Gianfranco Gualdi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| |
Collapse
|
|
9
|
Min M, Noujaim MG, Green J, Schlieve CR, Vaze A, Cahan MA, Cave DR. Role of Mucosal Protrusion Angle in Discriminating between True and False Masses of the Small Bowel on Video Capsule Endoscopy. J Clin Med 2019; 8:E418. [PMID: 30934710 PMCID: PMC6518286 DOI: 10.3390/jcm8040418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022] Open
Abstract
The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small bowel on video capsule endoscopy. We retrospectively reviewed video capsule endoscopies of 34 patients who had suspected small-bowel lesions between 2002 and 2017. Mucosal protrusion angles were defined as the angle between the small-bowel protruding lesion and surrounding mucosa and were measured using a protractor placed on a computer screen. We found that 25 patients were found to have true submucosal masses based on pathology and 9 patients had innocent bulges due to extrinsic compression. True submucosal masses had an average measured protrusion angle of 45.7 degrees ± 20.8 whereas innocent bulges had an average protrusion angle of 108.6 degrees ± 16.3 (p < 0.0001; unpaired t-test). Acute angle of protrusion accurately discriminated between true submucosal masses and extrinsic compression bulges on Fisher's exact test (p = 0.0001). Our findings suggest that mucosal protrusion angle is a simple and useful tool for differentiating between true masses and innocent bulges of the small bowel.
Collapse
Affiliation(s)
- May Min
- Department of Internal Medicine, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA 01655, USA.
| | - Michael G Noujaim
- Department of Internal Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27705, USA.
| | - Jonathan Green
- Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA 01655, USA.
| | - Christopher R Schlieve
- Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA 01655, USA.
| | - Aditya Vaze
- Division of Cardiology, University of California Irvine, 333 City Blvd W., Suite 400 Orange, CA 92868, USA.
| | - Mitchell A Cahan
- Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA 01655, USA.
| | - David R Cave
- Division of Gastroenterology, University of Massachusetts Medical School, 55 Lake Ave N., Worcester, MA 01655, USA.
| |
Collapse
|
|
10
|
Johnston CA, Yung DE, Joshi A, Plevris JN, Koulaouzidis A. Small bowel malignancy in patients undergoing capsule endoscopy at a tertiary care academic center: Case series and review of the literature. Endosc Int Open 2017; 5:E463-E470. [PMID: 28573179 PMCID: PMC5451279 DOI: 10.1055/s-0043-106186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Small bowel cancer is rare, accounting for < 5 % of all gastrointestinal neoplasms. Capsule endoscopy has become the procedure of choice for non-invasive diagnosis of small bowel diseases. Data on capsule endoscopy diagnosis of small bowel cancer are limited. The objective of the study was to determine the frequency, indications and diagnostic work-up of patients with small bowel malignancy found by capsule endoscopy at a Scottish tertiary center. PATIENTS AND METHODS In this retrospective study, records all patients who underwent small bowel capsule endoscopy at our center over a 10-year period were reviewed for possible malignancy. Further data were gathered on preceding and subsequent investigations, management and outcome of these patients. RESULTS From 1949 studies, small bowel malignancies were diagnosed in only 7 patients (0.36 %; 2F/5M; median age 50, range 34 - 67). The main indication was iron-deficiency anemia (n = 5). Prior to capsule endoscopy, 6 of 7 patients had bidirectional endoscopies and one had gastroscopy. All prior investigations were normal or nondiagnostic. Two of 7 experienced capsule retention. Five of 7 underwent surgery. Four patients died, giving a 5-year survival rate of 42.9 %. CONCLUSION Small bowel malignancies diagnosed by capsule endoscopy are rare, and the median age of 50 indicates they are more common in relatively younger patients. Capsule endoscopy is effective at diagnosing a rare malignancy when other imaging modalities have failed.
Collapse
Affiliation(s)
- Connor A Johnston
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alka Joshi
- Ninewells Hospital and Medical School, Dundee, UK
| | - John N Plevris
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
|
11
|
Rodrigues JP, Pinho R, Rodrigues A, Silva J, Ponte A, Sousa M, Carvalho J. Validation of SPICE, a method of differentiating small bowel submucosal lesions from innocent bulges on capsule endoscopy. REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2017; 109. [PMID: 28071061 DOI: 10.17235/reed.2017.4629/2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
|
12
|
|
|
13
|
Abstract
BACKGROUND The verbalisation of quality standards and parameters by medical societies are relevant for qualitative improvement but may also be an instrument to demand more resources for health care or be a unique characteristic. Within the health care system 3 different quality levels can be defined: structure, process and result quality. METHODS The current S2k guideline of the German Society for Gastroenterology (quality requirements for gastrointestinal endoscopy) AWMF registry no. 021-022 provides recommendations based on the available evidence for the structure quality (requirements for equipment, human resources) as well as for the process quality (patient preparation, conduct, documentation) and result quality (follow-up of specific endoscopic procedures). RESULTS Based on these recommendations, measurable quality indicators/parameters for the endoscopy have been selected and formulated. General quality parameters for endoscopic examinations are given as well as quality parameters for specific procedures for the preparation, conduct, and follow-up of specific endoscopic interventions. CONCLUSION Only the regular review of processes and courses by means of defined measurement parameters builds up the basis for corrections based on facts. In addition, the implementation of recommended standards may be an instrument in demanding more resources from the health care system and, therefore, should be embedded as routine.
Collapse
Affiliation(s)
- Ulrike W. Denzer
- Clinic for Interdisciplinary Endoscopy, University Clinic Hamburg Eppendorf, Hamburg, Germany
| |
Collapse
|
|
14
|
Detection of small bowel tumor based on multi-scale curvelet analysis and fractal technology in capsule endoscopy. Comput Biol Med 2016; 70:131-138. [PMID: 26829705 DOI: 10.1016/j.compbiomed.2016.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 02/07/2023]
Abstract
Wireless capsule endoscopy (WCE) has been a revolutionary technique to noninvasively inspect gastrointestinal (GI) tract diseases, especially small bowel tumor. However, it is a tedious task for physicians to examine captured images. To develop a computer-aid diagnosis tool for relieving the huge burden of physicians, the intestinal video data from 89 clinical patients with the indications of potential tumors was analyzed. Out of the 89 patients, 15(16.8%) were diagnosed with small bowel tumor. A novel set of textural features that integrate multi-scale curvelet and fractal technology were proposed to distinguish normal images from tumor images. The second order textural descriptors as well as higher order moments between different color channels were computed from images synthesized by the inverse curvelet transform of the selected scales. Then, a classification approach based on support vector machine (SVM) and genetic algorithm (GA) was further employed to select the optimal feature set and classify the real small bowel images. Extensive comparison experiments validate that the proposed automatic diagnosis scheme achieves a promising tumor classification performance of 97.8% sensitivity and 96.7% specificity in the selected images from our clinical data.
Collapse
|
|
15
|
Boal Carvalho P, Cotter J. Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:28-35. [PMID: 28868427 PMCID: PMC5580122 DOI: 10.1016/j.jpge.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Pedro Boal Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
| |
Collapse
|
|
16
|
Masselli G, Di Tola M, Casciani E, Polettini E, Laghi F, Monti R, Bernieri MG, Gualdi G. Diagnosis of Small-Bowel Diseases: Prospective Comparison of Multi-Detector Row CT Enterography with MR Enterography. Radiology 2015; 279:420-31. [PMID: 26599801 DOI: 10.1148/radiol.2015150263] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively compare the accuracies of computed tomographic (CT) enterography and magnetic resonance (MR) enterography for the detection and characterization of small-bowel diseases. MATERIALS AND METHODS The institutional review board approved the study protocol, and informed consent was obtained from all participants. From June 2009 to July 2013, 150 consecutive patients (81 men and 69 women; mean age, 38.8 years; range, 18-74 years), who were suspected of having a small-bowel disease on the basis of clinical findings and whose previous upper and lower gastrointestinal endoscopy findings were normal, underwent CT and MR enterography. Two independent readers reviewed CT and MR enterographic images for the presence of small-bowel diseases, for differentiating between inflammatory and noninflammatory diseases, and for extraenteric complications. The histopathologic findings of surgical (n = 23) and endoscopic (n = 32) biopsy specimens were used as the reference standard; the results of video-capsule endoscopy (n = 36) and clinical follow-up (n = 59) were used only to confirm the absence of small-bowel disease. RESULTS MR and CT enterography were successfully performed in all 150 patients. Overall sensitivity, specificity, and accuracy, respectively, in identifying patients with small-bowel lesions were 75.9% (41 of 54), 94.8% (91 of 96), and 88.0% (132 of 150) for CT enterography and 92.6% (50 of 54), 99.0% (95 of 96), and 96.7% (145 of 150) for MR enterography. The sensitivity of MR enterography was significantly higher than that of CT enterography for the detection of both overall small-bowel diseases (P = .0159) and neoplastic diseases (P = .0412) but not for the detection of inflammatory diseases (P > .99) or noninflammatory and nonneoplastic diseases (P = .6171). CONCLUSION MR enterography is more accurate than CT enterography in the detection of small-bowel diseases; MR enterography was more accurate in detecting neoplastic diseases in particular.
Collapse
Affiliation(s)
- Gabriele Masselli
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marco Di Tola
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Emanuele Casciani
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Elisabetta Polettini
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca Laghi
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Riccardo Monti
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Giulia Bernieri
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianfranco Gualdi
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
|
17
|
Fujita M, Manabe N, Honda K, Murao T, Osawa M, Kawai R, Akiyama T, Shiotani A, Haruma K, Hata J. Usefulness of Ultrasonography for Diagnosis of Small Bowel Tumors: A Comparison Between Ultrasonography and Endoscopic Modalities. Medicine (Baltimore) 2015; 94:e1464. [PMID: 26448000 PMCID: PMC4616743 DOI: 10.1097/md.0000000000001464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ultrasonography is a standard, noninvasive modality used to evaluate patients with gastrointestinal diseases. This study assessed the usefulness of ultrasonography in the detection of small bowel tumors. This study enrolled 558 consecutive patients (295 males, 263 females; mean age 71.1 years) who underwent ultrasonography before capsule endoscopy and/or balloon-assisted endoscopy. Ultrasonographic detection of small bowel tumors was compared with detection by capsule endoscopy and/or balloon-assisted endoscopy. In addition, factors affecting small bowel tumor detection by ultrasonography and clinical characteristics of patients with small bowel tumors undetected by ultrasonography were evaluated. Ninety-seven tumors (52 benign, 45 malignant) detected by capsule endoscopy and/or balloon-assisted endoscopy were retrospectively analyzed. The sensitivity and specificity of ultrasonography in the detection of small bowel tumors were 50.5% (47/93) and 100% (465/465), respectively. If we restricted patients to those with a tumor >20 mm in size, its detection ratio would become higher (91.7%): the ratio of submucosal tumor >20 mm in size was 85.7% (6/7) and that of partial and circumferential ulcerative tumors >20 mm in size was 96.9% (31/32), respectively. Small bowel tumors detected by ultrasonography (mean 33.2 mm) were significantly larger than those undetected by ultrasonography (mean 8.7 mm). The percentage of small bowel tumors located in the ileum detected by ultrasonography (70.6%) was significantly higher than those undetected by ultrasonography (29.4%). Of the 46 small bowel tumors undetected by ultrasonography, 42 (91.3%) were benign tumors with good clinical prognosis. Ultrasonography is a useful modality for detecting larger small bowel tumors and ulcerative lesions. Ultrasonography should be considered a first-line modality for patients suspected of having small bowel tumors, because most small bowel tumors undetected by ultrasonography were benign tumors with good clinical prognosis.
Collapse
Affiliation(s)
- Minoru Fujita
- From the Division of Gastroenterology, Department of Internal Medicine (MF, TM, MO, AS); Division of Endoscopy and Ultrasound, Department of Clinical Pathology and Laboratory Medicine (NM, RK, JH); Department of General Medicine (KH); Department of Pathology (TA); Department of General Internal Medicine, Kawasaki Medical School, Kurashiki, Japan (KH); and Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan (KH)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
18
|
Bizzotto A, Riccioni ME, Landi R, Marmo C, Barbaro B, Costamagna G. Small-Bowel Tumors, Polyps, and Polyposis Syndromes. ENDOSCOPY IN SMALL BOWEL DISORDERS 2015:175-198. [DOI: 10.1007/978-3-319-14415-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
|
|
19
|
Mao XY, Zhang YF, Mao GP, Ning SB. Diagnostic value of balloon-assisted endoscopy and capsule endoscopy in emergency obscure gastrointestinal bleeding. Shijie Huaren Xiaohua Zazhi 2014; 22:5360-5364. [DOI: 10.11569/wcjd.v22.i34.5360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the diagnostic value of balloon-assisted endoscopy (BAE) and capsule endoscopy (CE) in emergency obscure gastrointestinal bleeding (OGIB).
METHODS: Thirty-four patients with emergency OGIB treated at our hospital from July 2011 to May 2014 were included in this study. Ten cases underwent CE examination before BAE examination, and 34 cases underwent BAE in 72 h after diagnosis.
RESULTS: The detection rate of emergency OGIB by CE was 30% (3/10), among which one case was diagnosed as small intestinal diverticulum, and two cases as stromal tumors. Of the other seven cases which were negative in CE examination, four were small intestinal diverticulum, two were vascular disease and one was small intestine anastomotic ulcer. The detection rate of emergency OGIB by BAE was 88.23% (30/34), among which the numbers of cases of small intestinal diverticulum, stromal tumor, vascular disease, small intestine anastomotic ulcer and intestine ulcer were 16, 4, 4, 4 and 2, respectively. The detection rate of emergency OGIB by BAE was significantly higher than that by CE (88.23% vs 30.00%, P < 0.05).
CONCLUSION: The diagnostic accuracy of BAE for emergency OGIB is higher than that of CE. BAE is safe and effective in the diagnosis of emergency OGIB.
Collapse
|
|
20
|
Santhakumar C, Liu K. Evaluation and outcomes of patients with obscure gastrointestinal bleeding. World J Gastrointest Pathophysiol 2014; 5:479-486. [PMID: 25400992 PMCID: PMC4231513 DOI: 10.4291/wjgp.v5.i4.479] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/23/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes.
Collapse
|
|
21
|
Abstract
Objective. Balloon enteroscopy (BE) and capsule enteroscopy (CE) are enteroscopy methods that allow examination and treatment of the small bowel. Before the CE and BE era, the small intestine was difficult to access for investigation. Small intestinal tumours are infrequent conditions, but about half of them are malignant. Materials and Methods. A total of 303 BEs were performed in 179 patients. Oral insertion was performed in 240 and anal in 63 BEs. Indications for the procedure in our patients with small bowel tumours were anaemia and/or bleeding, obstruction, suspicion of carcinoid tumour, or suspicion of Peutz-Jeghers syndrome. Results. In 50 of our 179 patients (28%), we diagnosed some small intestinal tumours: hamartomas in Peutz-Jeghers syndrome in 16 patients, adenocarcinoma in 7, lymphoma in 6, carcinoid tumour in 4, melanoma and stromal tumour in 3, adenoma, lipoma, and inflammatory polyps in 2, and granular cell tumour, cavernous lymphangioma, fibrolipoma, Cronkhite-Canada polyps, and metastatic involvement in individual cases. Conclusion. BE facilitates exploration and treatment of the small intestine. The procedure is generally safe and useful. BE and CE are essential modalities for the management of small intestinal diseases.
Collapse
|
|
22
|
Abstract
OBJECTIVE Recent studies have provided a better understanding of the biologic behavior of gastrointestinal carcinoid tumors. This article focusing on imaging of gastrointestinal carcinoids will emphasize epidemiology, molecular biology, taxonomy, histopathology, and management. CONCLUSION Gastrointestinal carcinoids are a biologically heterogeneous group of tumors, with variable clinical presentation and biologic behavior. Imaging can play an important role in multidisciplinary identification and management of this disease.
Collapse
|
|
23
|
Masselli G, Polettini E, Laghi F, Monti R, Gualdi G. Noninflammatory conditions of the small bowel. Magn Reson Imaging Clin N Am 2013; 22:51-65. [PMID: 24238132 DOI: 10.1016/j.mric.2013.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Magnetic resonance (MR) imaging has been playing an evolving role in evaluating noninflammatory small-bowel conditions, such as tumors and malabsorption syndrome. MR imaging has shown to be superior to other diagnostic methods in identifying tumors of the small bowel. MR enterography and MR enteroclysis are both valid for studying noninflammatory conditions of the small intestine, although MR enteroclysis may be considered the modality of choice because of its accuracy in the diagnosis of small-bowel neoplasms. Intraluminal and extraluminal MR findings, combined with contrast-agent enhancement and functional information, help to make an accurate diagnosis and consequently to characterize small-bowel diseases.
Collapse
Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I hospital, Sapienza University, Via del Policlinico 155, Rome 00161, Italy.
| | | | | | | | | |
Collapse
|
|
24
|
Gurkan OE, Karakan T, Dogan I, Dalgic B, Unal S. Comparison of double balloon enteroscopy in adults and children. World J Gastroenterol 2013; 19:4726-4731. [PMID: 23922469 PMCID: PMC3732844 DOI: 10.3748/wjg.v19.i29.4726] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/14/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients.
METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative enema. The patients were followed up for 2 h after the procedure in terms of possible complications.
RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); Peutz-Jeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation.
CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.
Collapse
|
|
25
|
Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol 2013; 19:3726-46. [PMID: 23840112 PMCID: PMC3699039 DOI: 10.3748/wjg.v19.i24.3726] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 02/06/2023] Open
Abstract
The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.
Collapse
|
|
26
|
Small Bowel Imaging: Clinical Applications of the Different Imaging Modalities—A Comprehensive Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/419542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
Collapse
|
|
27
|
Amzallag-Bellenger E, Soyer P, Barbe C, Diebold MD, Cadiot G, Hoeffel C. Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours. Eur Radiol 2013; 23:1901-10. [PMID: 23479221 DOI: 10.1007/s00330-013-2800-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/25/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection. MATERIAL AND METHODS Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19-85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies. RESULTS Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89-100 %], 96 % [90-100 %], 93 % [83-100 %], 98 % [94-100 %] and 96 % [92-100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56-85 %] and 93 % [83-100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P = 0.008). CONCLUSION MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection. KEY POINTS • MR enterography accurately detects mesenteric small bowel tumours. • MR enterography is a well-tolerated imaging technique. • Intravenous administration of gadolinium chelate improves sensitivity for detecting small-bowel tumours.
Collapse
Affiliation(s)
- Elisa Amzallag-Bellenger
- Department of Radiology, Hôpital Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex, France.
| | | | | | | | | | | |
Collapse
|
|
28
|
Abstract
Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby allowing the diagnosis of early or subtle structural abnormalities and guiding treatment and decisions in patient care.
Collapse
Affiliation(s)
- Gabriele Masselli
- Department of Radiology, Università di Roma Sapienza, Viale del Policlinico, Rome, Italy.
| | | |
Collapse
|
|
29
|
Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position. ACTA ACUST UNITED AC 2012; 37:279-87. [PMID: 21538021 DOI: 10.1007/s00261-011-9739-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Peutz-Jeghers syndrome (PJS) is a familial polyposis syndrome characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. The aim of our study was to retrospectively determine the diagnostic value of MR enterography (MRE), performed in supine and prone position, in the detection of small bowel polyps in PJ patients. MATERIALS AND METHODS We retrospectively reviewed MRE examinations of 8 PJS patients who underwent MRE, pushed-double-ballon enteroscopy, laparoscopic endoscopy or surgery, within 3 months. Polietilenglicole was orally administered before the examination. True FISP and HASTE sequences were acquired in supine and prone position; 3D VIBE Gd-enhanced sequences in prone position only. RESULTS Concordance between MRE and endoscopy was 72.6% for polyps <15 mm, 93% for polyps >15 mm. In supine and prone position concordance with endoscopy for polyps <15 mm was 63% and 66.8%, respectively. In the detection of smaller polyps the difference between supine position only and supine plus prone position was statistically significant (P < 0.027). DISCUSSION MRE performed by combining prone and supine position was accurate in the detection of PJS polyps, with 93% concordance with enteroscopy for larger and more risky polyps. MRE offers a promising and non invasive alternative to capsule endoscopy, suggesting the possibility of an effective yearly surveillance in PJ patients.
Collapse
|
|
30
|
Arber N, Moshkowitz M. Small Intestinal Cancers. HANDBOOK OF GASTROINTESTINAL CANCER 2012:67-85. [DOI: 10.1002/9781118423318.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
|
|
31
|
Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy. Eur Radiol 2012; 22:1167-71. [PMID: 22447355 DOI: 10.1007/s00330-012-2398-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/16/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. KEY POINTS • Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions. • Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation. • A fair and unbiased comparison of the two investigations is still needed.
Collapse
|
|
32
|
The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding. Eur Radiol 2012; 22:1159-66. [PMID: 22270143 DOI: 10.1007/s00330-011-2374-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. METHODS We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. RESULTS Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. CONCLUSIONS Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. KEY POINTS • CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). • Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. • Negative CT enterography does not exclude important causes of small bowel bleeding. • Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy.
Collapse
|
|
33
|
Vere C, Streba C, Rogoveanu I, Georgescu M, Pirvu D, Iordache S, Gheonea D, Saftoiu A, Ciurea T. The contribution of the video capsule endoscopy in establishing the indication of surgical treatment in the tumoral pathology of the small bowel. CURRENT HEALTH SCIENCES JOURNAL 2012; 38:69-73. [PMID: 24778844 PMCID: PMC3994675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/25/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) represents a novel method which allows safe, non-invasive and rapid exploration of the small bowel. Our aim was to determine the feasibility CE has in assessing tumoral pathology of the small bowel and aiding surgical teams in determining appropriate treatment. Material and Method Our study was conducted on 11 patients who presented tumoral pathology of the small bowel, from a total of 50 patients investigated by VCE. Malignancy was determined on the surgical resection piece, by histological exam. Statistic analysis of the data was conducted using Fisher's Exact Test. Results Tumoral pathology was represented by: 3 intestinal polyps, 2 benign stromal tumors, 2 malign stromal tumors, 2 adenocarcinomas, one neuroendocrine malign tumor and one duodenal papilla carcinoma. We followed the presence of malign tumors in regards to age. All malign tumors (n=6) were recorded in patients over 60 years old, while benign tumors were recorded in most cases (80%, n=4) in people under 60 years old. One case of benign tumor (intestinal polyp) was observed above 60 years old. Conclusion Capsule endoscopy represents a real help for the surgeon, as it allows identification of small bowel pathology, giving information regarding the approximate localization of lesions, their size and orienting on their nature. Tumoral pathology is encountered mainly with the old age population and can be presented under a multitude of forms. We believe that an efficient method for incipient detection and a protocol to establish malignity is necessary.
Collapse
Affiliation(s)
- C.C. Vere
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - C.T. Streba
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - I. Rogoveanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - M. Georgescu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - D. Pirvu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - Sevastita Iordache
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - D.I. Gheonea
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - A. Saftoiu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| | - T. Ciurea
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova
| |
Collapse
|
|
34
|
Girelli CM, Porta P, Colombo E, Lesinigo E, Bernasconi G. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74:1067-74; quiz 1115.e1-5. [PMID: 21907982 DOI: 10.1016/j.gie.2011.07.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/01/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Submucosal malignant masses (SMMs) and innocent bulges look similar on small-bowel capsule endoscopy (SBCE). In a previous observational study, 4 criteria associated with innocent bulges were recognized. OBJECTIVE To devise and validate an index based on these criteria (smooth, protruding lesion index on capsule endoscopy [SPICE]) to discriminate SMMs from innocent bulges. DESIGN Single-center, prospective study. SETTING General hospital in Busto Arsizio, Italy. PATIENTS This study involved 25 of 424 consecutive SBCEs performed on as many patients having SBCE findings of smooth, round, protruding lesions. INTERVENTION Patients' evaluation up to the final diagnosis. At study entry, a short video clip of the lesion was obtained and deidentified for blind SPICE calculation. MAIN OUTCOME MEASUREMENTS SPICE accuracy, using the final diagnosis of each patient as the criterion standard. RESULTS Six patients had SMMs (4 GI stromal tumors, 2 neuroendocrine tumors), and 19 had innocent bulges. SPICE scores ranged from 0 to 4; they discriminated SMMs from innocent bulges (P = .002). A SPICE value >2 had 83.3% sensitivity and 89.4% specificity, and the area under the curve was 0.90 (95% confidence interval, 0.72-0.98; P < .001) for the detection of SMMs. LIMITATIONS Single-center study; small sample size; no invasive ascertainment in 36% of patients. CONCLUSION SPICE is easy to calculate and useful for distinguishing SMMs from innocent bulges. An index >2 is predictive of SMM.
Collapse
Affiliation(s)
- Carlo M Girelli
- First Division of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Busto Arsizio (VA), Italy.
| | | | | | | | | |
Collapse
|
|
35
|
Wei XM, Gu GL, Xu LM, Mao GP, Wang SL. Advances in the prevention, diagnosis and treatment of Peutz-Jeghers syndrome. Shijie Huaren Xiaohua Zazhi 2011; 19:3111-3116. [DOI: 10.11569/wcjd.v19.i30.3111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disease caused by inactivating germline mutations of the LKB1/STK11 gene and characterized by mucocutaneous pigmentation, multiple gastrointestinal hamartomatous polyps and family history. Life-threatening complications include intestinal obstruction and an increased risk for developing gastrointestinal malignancies and extraintestinal cancers. Surgery and endoscopic therapy are still main ways to manage gastrointestinal polyposis in PJS patients, and double-balloon enteroscopy has important clinical significance in the diagnosis and treatment of this disease. With the development of translational medicine, molecular targeted therapy (e.g., selective COX-2 inhibitors) brings a new approach to preventive treatment of gastrointestinal polyposis in PJS patients. Traditional Chinese medicine provides an alternative choice. In this paper, we review the recent advances in the prevention, diagnosis and treatment of PJS.
Collapse
|
|
36
|
Issa H, Poovathumkadavil AM, Almousa F, Al-Salem AH. Metastatic Malignant Melanoma of the Small Intestines Diagnosed by Capsule Endoscopy. Gastroenterology Res 2011; 4:236-239. [PMID: 27957022 PMCID: PMC5139850 DOI: 10.4021/gr342w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2011] [Indexed: 11/21/2022] Open
Abstract
Malignant melanoma is a fairly common tumor that shows an unusual predilection to metastasize to the small intestines. The time interval between the diagnosis of metastasizing melanoma and the initial diagnosis is variable. This as well as the non specific symptoms and the fact that the small bowel is inaccessible both radiologically and endoscopically lead to delay in diagnosis. We present a case of metastatic malignant melanoma to the small intestines diagnosed several years post excision by capsule endoscopy. Metastatic melanoma in the small bowel should be suspected in any patient with a previous history of malignant melanoma who develops non specific gastrointestinal symptoms. Capsule endoscopy which is non invasive, convenient to the patient and devoid of radiation should form part of their diagnostic investigation.
Collapse
Affiliation(s)
- Hussain Issa
- Department of internal medicine, Division of gastroentrology, Dammam, Saudi Arabia
| | | | - Fadel Almousa
- Department of internal medicine, Division of gastroentrology, Dammam, Saudi Arabia
| | - Ahmed H Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
| |
Collapse
|
|
37
|
Hakim FA, Alexander JA, Huprich JE, Grover M, Enders FT. CT-enterography may identify small bowel tumors not detected by capsule endoscopy: eight years experience at Mayo Clinic Rochester. Dig Dis Sci 2011; 56:2914-9. [PMID: 21735085 DOI: 10.1007/s10620-011-1773-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/28/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is widely accepted as the preferred diagnostic test in the evaluation of small bowel diseases. However, small bowel tumors (SBT) are sometimes missed by CE. Preliminary studies suggest that CT-enterography (CTE) may play a role in detecting SBT. AIMS The purpose of this study was to compare the performance of CE and CTE in detecting SBT METHODS: This was a single center, retrospective study. Patients treated at the Mayo Clinic Rochester between January 2000 and December 2008 with a discharge diagnosis of SBT and negative initial esophagogastroduodenoscopy (EGD) and colonoscopy were identified through a search of the electronic medical records. Among 103 identified patients, 41 had undergone CE, CTE or both, and comprised our study group. The exact binomial sensitivity of CE and CTE in detecting SBT was calculated. Demographic characteristics, clinical presentation, results of diagnostic tests, and tumor characteristics were recorded for each patient. RESULTS CTE and CE detected 38/41 (sensitivity 92.7%; 95% CI 80.1-98.5) and 8/27 (sensitivity 29.6%; 95% CI 13.8-50.2) of the SBT identified at Mayo Clinic Rochester, respectively. Seventeen patients had both CTE and CE. In this subgroup of patients, CTE detected SBT in 16/17 (sensitivity 94.1; 95% CI 72.7-99.9) and CE in 6/17 (sensitivity 35.3%; 95% CI 13.3-59). The matched paired difference in the sensitivity of two techniques in detecting SBT was statistically significant (P = 0.004). CONCLUSION CTE may identify SBT not diagnosed by CE.
Collapse
Affiliation(s)
- Fayaz A Hakim
- General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | |
Collapse
|
|
38
|
Soyer P, Boudiaf M, Fishman EK, Hoeffel C, Dray X, Manfredi R, Marteau P. Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 2010; 80:10-30. [PMID: 21035353 DOI: 10.1016/j.critrevonc.2010.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022] Open
Abstract
This article describes the recent advances in radiological imaging of malignant neoplasms of the mesenteric small bowel and provides an outline of new trends and perspectives that can be anticipated. The introduction of multidetector row technology, which allows the acquisition of submillimeter and isotropic voxels, has dramatically improved the capabilities of computed tomography in the investigation of the mesenteric small bowel. This technology combined with optimal filling of small bowel loops through the use of appropriate enteral contrast agents has markedly changed small bowel imaging. Computed tomography-enteroclysis, which is based on direct infusion of enteral contrast agent into the mesenteric small bowel through a naso-jejunal tube, provides optimal luminal distension. By contrast, computed tomography-enterography is based on oral administration of enteral contrast agent. These two techniques are now well-established ones for the detection and the characterization of small bowel neoplasms. During the same time, combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging has gained wide acceptance for the evaluation of patients with suspected small bowel neoplasms. Rapid magnetic resonance imaging sequences used in combination with specific enteral contrast agents generate superb images of the mesenteric small bowel so that magnetic resonance-enteroclysis and magnetic resonance-enterography are now considered as effective diagnostic tools for both the detection and the characterization of neoplasms of the mesenteric small bowel. Recent improvements in image post-processing capabilities help obtain realistic three-dimensional representations of tumors and virtual enteroscopic views of the small bowel that are useful for the surgeon and the gastroenteroenteologist to plan surgical or endoscopic interventions. Along with a better knowledge of the potential and limitations of wireless capsule endoscopy and new endoscopic techniques, these recent developments in radiological imaging reasonably suggest that substantial changes in the investigation of small bowel tumors may be anticipated in a near future, thus potentially create a new paradigm shift after standard small bowel follow-through study has been universally abandoned.
Collapse
Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP and Université Diderot-Paris, France.
| | | | | | | | | | | | | |
Collapse
|
|
39
|
Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy. Eur Radiol 2010; 21:79-86. [PMID: 20652705 DOI: 10.1007/s00330-010-1896-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 05/31/2010] [Accepted: 06/14/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To retrospectively compare the diagnostic capabilities of 64-section CT enteroclysis with those of video capsule endoscopy (VCE) to elucidate the cause of obscure gastrointestinal bleeding. METHODS Thirty-two patients who had 64-section CT enteroclysis and VCE because of obscure gastrointestinal bleeding were included. Imaging findings were compared with those obtained at double balloon endoscopy, surgery and histopathological analysis, which were used as a standard of reference. RESULTS Concordant findings were found in 22 patients (22/32; 69%), including normal findings (n=13), tumours (n=7), lymphangiectasia (n=1) and inflammation (n=1), and discrepancies in 10 patients (10/32; 31%), including ulcers (n=3), angioectasias (n=2), tumours (n=2) and normal findings (n=3). No statistical difference in the proportions of abnormal findings between 64-section CT enteroclysis (11/32; 34%) and VCE (17/32, 53%) (P=0.207) was found. However, 64-section CT enteroclysis helped identify tumours not detected at VCE (n=2) and definitely excluded suspected tumours (n=3) because of bulges at VCE. Conversely, VCE showed ulcers (n=3) and angioectasias (n=2) which were not visible at 64-section CT enteroclysis. CONCLUSION Our results suggest that 64-section CT enteroclysis and VCE have similar overall diagnostic yields in patients with obscure gastrointestinal bleeding. However, the two techniques are complementary in this specific population.
Collapse
|
|
40
|
Chang HK, Yu E, Kim J, Bae YK, Jang KT, Jung ES, Yoon GS, Kim JM, Oh YH, Bae HI, Kim GI, Jung SJ, Gu MJ, Kim JY, Jang KY, Jun SY, Eom DW, Kwon KW, Kang GH, Park JB, Hong S, Lee JS, Park JY, Hong SM. Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases. Hum Pathol 2010; 41:1087-96. [PMID: 20334897 DOI: 10.1016/j.humpath.2010.01.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/12/2010] [Accepted: 01/13/2010] [Indexed: 12/27/2022]
Abstract
Small intestinal adenocarcinoma is a rare malignant neoplasm, and its clinicopathologic characteristics have not been well elucidated. A total of 197 small intestinal adenocarcinoma cases were collected from 22 institutions in South Korea and were evaluated for clinicopathologic factors that affect the prognosis of small intestinal adenocarcinoma patients using univariate and multivariate analyses. The mean patient age was 59 years, and the male-to-female ratio was 1.7:1. Tumors were located in the duodenum of 108 cases (55%), the jejunum in 59 (30%), and the ileum in 30 (15%). Predisposing conditions were observed in 23 cases (12%), including 17 cases with sporadic adenomas, 3 with Peutz-Jeghers syndrome, 2 with Meckel diverticulum, and 1 with Crohn disease. Synchronous or metachronous malignant tumors were identified in 31 cases (16%), including 13 colorectal and 10 stomach cancers. About 90% of tumors were classified as either pT3 (63 cases) or pT4 (112 cases). The median survival time for all small intestinal adenocarcinoma patients was 39.7 months. Compared with small intestinal adenocarcinomas without accompanying sporadic adenomas, small intestinal adenocarcinomas with accompanying adenomas were more well differentiated (P < .0001), with a more polypoid growth pattern (P < .0001), a lower pT classification (P < .0001), less perineural invasion (P = .01), and less lymphatic invasion (P = .03). Small intestinal adenocarcinoma patients with associated sporadic adenomas (77%) had a significantly better 5-year survival rate than those without sporadic adenomas (38%, P = .02). By univariate analysis, small intestinal adenocarcinoma patients had significantly different survival based on pT classification (P = .003), lymph node metastasis (P < .0001), distal location (jejunal and ileal carcinomas) (P = .003), retroperitoneal tumor seeding (P < .0001), vascular invasion (P = .007), lymphatic invasion (P = .001), peritumoral dysplasia (P = .004), and radiation therapy (P = .006). By multivariate analysis, lymph node metastasis (P = .01) and distal location (P = .003) were independent predictors of a worse prognosis. In conclusion, (1) small intestinal adenocarcinomas are diagnosed at an advanced disease stage; therefore, the development of strategies for detection at an earlier stage is needed. (2) Small intestinal adenocarcinoma patients with an adenomatous component had a better survival than those without an adenomatous component. (3) Lymph node metastasis and distal location (jejunum and ileum) of tumor are the most important independent prognostic factors.
Collapse
Affiliation(s)
- Hee-Kyung Chang
- Department of Pathology, Kosin University College of Medicine, Pusan, 602-702 South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Pilpilidis I, Fasoulas K, Paroutoglou G. Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis. World J Gastroenterol 2009; 15:6075-9. [PMID: 20027680 PMCID: PMC2797664 DOI: 10.3748/wjg.15.6075] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the prevalence of small bowel polyps by wireless capsule endoscopy (WCE) in patients with familial adenomatous polyposis (FAP).
METHODS: We examined prospectively 14 patients with FAP to assess the location, size and number of small-intestinal polyps. Patients’ age, sex, years of observation after surgery, type of surgery, duodenal polyps and colorectal cancer at surgery were analyzed.
RESULTS: During WCE, polyps were detected in 9/14 (64.3%) patients. Duodenal adenomatous polyps were found in nine (64.3%) patients, and jejunal and ileal polyps in seven (50%) and eight (57.1%), respectively. The Spigelman stage of duodenal polyposis was associated with the presence of jejunal and ileal polyps. Identification of the ampulla of Vater was not achieved with WCE. Importantly, the findings of WCE had no immediate impact on the further clinical management of FAP patients. No procedure-related complications were observed in the patients.
CONCLUSION: WCE is a promising noninvasive new method for the detection of small-intestinal polyps. Further investigation is required to determine which phenotype of FAP is needed for surveillance with WCE.
Collapse
|
|
42
|
Adenocarcinoma of Meckel’s diverticulum diagnosed by capsule endoscopy and single-balloon enteroscopy. Clin J Gastroenterol 2009; 2:388-393. [DOI: 10.1007/s12328-009-0111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
|
|
43
|
Kopacova M, Tacheci I, Rejchrt S, Bures J. Peutz-Jeghers syndrome: Diagnostic and therapeutic approach. World J Gastroenterol 2009; 15:5397-408. [PMID: 19916169 PMCID: PMC2778095 DOI: 10.3748/wjg.15.5397] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals. PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors). Bleeding, obstruction and intussusception are common complications in patients with PJS. Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men). Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.
Collapse
|
|
44
|
Bresci G. Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009. World J Gastrointest Endosc 2009; 1:3-6. [PMID: 21160643 PMCID: PMC2999069 DOI: 10.4253/wjge.v1.i1.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/10/2009] [Accepted: 02/17/2009] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal bleeding can be obscure or occult (OGIB), the causes and diagnostic approach will be discussed in this editorial. The evaluation of OGIB consists on a judicious search of the cause of bleeding, which should be guided by the clinical history and physical findings. The standard approach to patients with OGIB is to directly evaluate the gastrointestinal tract by endoscopy, abdominal computed tomography, angiography, radionuclide scanning, capsule endoscopy. The source of OGIB can be identified in 85%-90%, no bleeding sites will be found in about 5%-10% of cases. Even if the bleedings originating from the small bowel are not frequent in clinical practice (7.6% of all digestive haemorrhages, in our casuistry), they are notoriously difficult to diagnose. In spite of progress, however, a number of OGIB still remain problematic to deal with at present in the clinical context due to both the difficulty in exactly identifying the site and nature of the underlying source and the difficulty in applying affective and durable diagnostic approaches so no single technique has emerged as the most efficient way to evaluate OGIB.
Collapse
Affiliation(s)
- Giampaolo Bresci
- Giampaolo Bresci, UO Gastroenterrologia, AOUPisana, Pisa 56125, Italy
| |
Collapse
|
|
45
|
Kav T, Bayraktar Y. Five years' experience with capsule endoscopy in a single center. World J Gastroenterol 2009; 15:1934-42. [PMID: 19399924 PMCID: PMC2675082 DOI: 10.3748/wjg.15.1934] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/19/2009] [Accepted: 03/26/2009] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.
Collapse
|
|
46
|
Abstract
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.
Collapse
|
|
47
|
Masselli G, Gualdi G. Evaluation of small bowel tumors: MR enteroclysis. ACTA ACUST UNITED AC 2008; 35:23-30. [PMID: 19096749 DOI: 10.1007/s00261-008-9490-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 11/13/2008] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method's diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.
Collapse
Affiliation(s)
- Gabriele Masselli
- Radiology Dea Department, Umberto I Hospital, University La Sapienza, Viale del Policlinico, Rome, 155-00161, Italy.
| | | |
Collapse
|