Differentiation of benign and malignant bowel lesions by transabdominal ultrasound using grey-scale and Doppler parameters

The Effectiveness of Transabdominal Ultrasonography in Managing Chronic Constipation in the Elderly, with a Focus on the Underlying Pathological Conditions

Chronic constipation is more common in the elderly and associated with numerous diseases. For the diagnosis of chronic constipation in the elderly, it is essential to exclude constipation secondary to colorectal cancer or other causes. Chronic constipation in the elderly also often requires lifestyle modifications, as well as drug treatments because of the involvement of pathologies such as reduced colonic transport capacity and rectal hyposensitivity. Therefore, it is extremely important to evaluate the pathophysiology of both the colon and the rectum. Transabdominal ultrasonography (TUS) is a key technique for providing comprehensive medical care and allows simultaneous functional assessment and exclusion of organic diseases related to constipation such as colorectal cancer. Although several studies have reported the clinical utility of TUS for chronic constipation, which includes its simplicity, noninvasiveness, and low cost, the majority were in children. Thus, there are limited studies in adults. Herein, we review the utility of TUS for indirect assessment of colonic transit time using several TUS parameters that can be applied clinically, as well as treatment options for chronic constipation. The constipation index (i.e., mean transverse diameter of the colon), assessed by TUS, is a useful indirect indicator of colonic transit time. If the constipation index is <21.2, increased fiber or treatment with osmotic agents should be used. If the constipation index is ≥21.2, then the ratio of the left to the right lateral colonic diameters should be evaluated. If this value is ≥0.5, a secretagogue or bile acid transporter inhibitor should be administered. It is noteworthy that nursing care is becoming increasingly important in Japan's super-aging society. A significant proportion of nursing care is provided to patients with chronic constipation, a cohort that is predicted to grow in the future. In these patients, fecal masses often remain in the rectum, which may require an enema or stool extraction. Therefore, it is important to assess both the presence of feces in the rectum and the consistency of the feces. Recently, portable ultrasound (US) devices equipped with artificial intelligence have been developed and used clinically for treatment of patients with chronic constipation in nursing care. Rectal findings using portable US devices can aid in selecting appropriate constipation treatments. Thus, portable US will likely become increasingly important as a next-generation examination device in nursing care. TUS (including portable US) is noninvasive, simple, and repeatable and will become a fundamental modality in the management of chronic constipation.

Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?

PURPOSE OF REVIEW

The incidence of celiac disease (CD) has increased over the last decades in part due to better disease awareness. Small bowel ultrasound (sb US) enables dynamic assessment of the bowel; although this topic has been addressed, the use of sb US in the diagnosis and in the follow-up of CD patients is limited to a few specialized tertiary referral centers. Herein, we aimed at summarizing the available literature on this topic to better define the potential clinical implications of sb US in CD, also through a comparison with other available diagnostic techniques.

RECENT FINDINGS

According to available data, sb US can be of help in confirming or excluding CD in patients with clinical suspicion; specifically, the finding of increased gall bladder volume, free abdominal fluid and enlargement of mesenteric lymph nodes reliably and accurately predicts the diagnosis of CD, whereas the absence of bowel dilatation and increased peristalsis may exclude the diagnosis. However, the place of intestinal US in the diagnostic algorithm of CD is likely to vary depending on the probability of the disease in a given population. There are only a few studies on the role of sb US in complicated CD, even if recent reports suggest a possible clinical role. There is a lack of data on follow-up of CD patients, particularly with the aim of detecting a poor diet adherence. According to current data sb US parameters have been shown to be of value in confirming and excluding the diagnosis of CD. Prospective studies with large sample size are warranted to determine whether to include sb US in the available guidelines for CD diagnosis and monitoring.

Transabdominal ultrasonographic features in the diagnosis of gastrointestinal lymphoma

Background

Gastrointestinal (GI) lymphoma is a challenging disease. We aimed to study and characterize the different endoscopic and transabdominal ultrasonography (TUS) features of gut lymphoma and to assess whether TUS has a complementary role to endoscopy in the diagnosis of GI lymphoma.

Methods

This study was conducted on 21 patients with GI lymphoma, attending the GI endoscopy and liver unit, Endemic Medicine Department and Oncology Department in Kasr El Aini Hospital, Cairo University. Patients were subjected to GI endoscopy (upper endoscopy & colonoscopy) and transabdominal ultrasonography. The diagnosis was finally based on histopathology of core biopsies (obtained either endoscopically or by ultrasonography) and immuno-histochemistry.

Results

In all 21 patients with GI lymphoma included in this study, TUS could accurately determine the site of disease affection compared to endoscopy which is considered the gold standard for site localization. The main TUS pathologic features detected were increased wall thickness of the affected bowel segment with a mean value of (15.6±5.9 mm) and loss of layering pattern in 16 patients (76%). While the most common endoscopic features were ulcers and mass lesions accounting for 38% of the patients for each. Diffuse large B-cell lymphoma was found in 19 patients (90%). Because of endoscopic biopsies were conclusive in 14 patients (67%), TUS guided biopsy was resorted to in 7 patients and was diagnostic in all of them.

Conclusions

Transabdominal ultrasonography is a useful tool in the diagnosis of GI lymphoma that is complementary to conventional diagnostic endoscopic procedures.

The role of intestinal ultrasound in diagnostics of bowel diseases

Intestinal ultrasound is a safe and inexpensive method that allows visualisation of the gastrointestinal tract and detection of abnormalities. This examination involves the use of two different ultrasound transducers: a low-frequency convex probe and high-frequency linear probe. When needed, the performance of these methods can be enhanced by the use of contrast media or Doppler techniques. Intestinal ultrasound is mostly utilised for the diagnosis and follow-up of patients with inflammatory bowel diseases, helping to avoid frequent use of invasive and expensive diagnostic procedures and leading to early implementation of suitable treatment. This technique can also serve to detect other pathologic conditions that are present in the gastrointestinal tract. It is a promising method with high sensitivity and specificity, which has gained popularity in recent years and has the potential to become the method of choice in the diagnostics of many intestinal disorders.

Small Bowel Ultrasound beyond Inflammatory Bowel Disease: An Updated Review of the Recent Literature

The use of bowel ultrasonography (US) for the evaluation of gut diseases has increased in recent years and has been proven to provide a widely available, non-invasive and inexpensive method for the initial work-up and follow-up of different intestinal diseases, limited mostly by technical challenges posed by the patient's anatomy. The present review aims to provide an extensive overview of the main pathologic features at US examination of intestinal diseases other than inflammatory bowel disease, both acute (e.g., acute appendicitis, colonic diverticulitis, infectious diseases and ischemic conditions) and chronic (e.g., celiac disease, cystic fibrosis and other enterocolites). The identification of typical US features may help in the diagnostic process and guide the treatment approach. Therefore, the application of knowledge of the US appearance of gastrointestinal diseases is of relevance in enabling greater diagnostic performance and better patient management.