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Koh JT, Kim Wei L, Francisco CP, Ravi R, Chan W, Khor C, Asokkumar R. Double balloon enteroscopy versus single balloon enteroscopy: A comparative study. Medicine (Baltimore) 2024; 103:e38119. [PMID: 38758917 PMCID: PMC11098199 DOI: 10.1097/md.0000000000038119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
Device assisted enteroscopy (DAE) like the double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE) are postulated to ease small bowel examination and performance of therapy. However, studies comparing the effectiveness of these 2 modalities have yielded varying results. The aim of this study is to compare the efficacy and safety of SBE and DBE. We retrospectively reviewed records of patients who underwent DBE (n = 82) or SBE (n = 45) for small bowel exam in our unit from January 2014 to January 2022. Our primary outcomes were to compare the technical success and diagnostic success rates between DBE and SBE. Our secondary outcomes were to compare the therapeutic success, and complication rates. The main indications were suspected GI bleeding (DBE 41.5% vs SBE 48.9%), iron deficiency anemia (DBE 9.8% vs SBE 4.4%) and small bowel lesions (DBE 28.0% vs SBE 44.4%) detected either from prior capsule endoscopy or radiological imaging. Majority of the enteroscopy exam was by antegrade approach (DBE 67.1% vs SBE 77.8%). We found no significant difference in the technical success (DBE 95.1% vs SBE 97.8%, P = .46), diagnostic success (DBE 69.5% vs SBE 77.8%, P = .36) and the therapeutic success rate (DBE 63.2% vs SBE 54.3%, P = .09) between the groups. Complications occurred in 1 case from each group (mucosal tear). None of the complications were major. In patients who underwent enteroscopy, the diagnostic and therapeutic performance of SBE is similar to DBE. Both procedures were safe with low complication rates.
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Affiliation(s)
- Jonathan T.E. Koh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Lim Kim Wei
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Carlos Paolo Francisco
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- St. Lukes Medical Centre, Manila, Philippines
| | - Rajesh Ravi
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Graduate Medical School, Singapore, Singapore
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Singh AK, Srivastava S, Sonika U, Sachdeva S, Aneesh P, Kumar A, Sharma BC, Dalal A. Motorized Power Spiral Enteroscopy (MSE): Is Routine Bougienage of the Upper Esophageal Sphincter (UES) Necessary? Cureus 2024; 16:e52342. [PMID: 38361713 PMCID: PMC10867537 DOI: 10.7759/cureus.52342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Wire-guided bougienage of the upper esophageal sphincter (UES) was performed routinely before per-oral motorized power spiral enteroscopy (MSE). In the present study, we aimed to answer the clinical question of whether routine bougienage of UES is required. Methods This was a retrospective study that included 20 patients who underwent antegrade spiral enteroscopy for various indications. The feasibility and safety of anterograde MSE without prior bougie dilatation of the upper esophageal sphincter were assessed. The technical success rate (TSR), diagnostic yield, and adverse events (AEs) were also assessed. Results In 16 out of the 20 patients, a spiral enteroscope was taken directly across UES into the esophagus without a prior bougie dilatation. The spiral enteroscope could not be negotiated across UES only in one patient, and bougie dilatation was done. The technical success rate was 100%. The diagnostic yield was 80%. Four patients reported AEs. Conclusions MSE had a good technical success rate and diagnostic yield. Routine dilatation of the UES before the procedure may be unnecessary.
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Affiliation(s)
- Alok Kumar Singh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | | | - Ujjwal Sonika
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Sanjeev Sachdeva
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Payila Aneesh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ajay Kumar
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Barjesh C Sharma
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ashok Dalal
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
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Rughwani H, Singh AP, Ramchandani M, Jagtap N, Pal P, Inavolu P, Reddy PM, Januszewicz W, Sekaran A, Nabi Z, Patel R, Lakhtakia S, Banerjee R, Memon SF, Balram P, Darishetty S, Rao GV, Reddy DN. A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Motor Trial (NCT 05548140). Am J Gastroenterol 2023; 118:1855-1863. [PMID: 37463435 DOI: 10.14309/ajg.0000000000002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Device-assisted enteroscopy has revolutionized the management of small-bowel disorders (SBD). No study to date has compared both novel motorized spiral enteroscopy (NMSE) and single-balloon enteroscopy (SBE) as a randomized controlled trial. Hence, this study was planned to include patients having SBD with the primary aim to compare the total enteroscopy rate (TER). METHODS This study was conducted at the Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India, from September 20, 2022, to December 15, 2022. All consecutive patients, older than 18 years with suspected SBD, and planned for total enteroscopy were screened for inclusion. The primary outcome was to compare the TER, and secondary outcomes were to compare the technical success, time taken to reach the depth of maximal insertion, withdrawal time, total procedure time, diagnostic yield, therapeutic success, and adverse events (AE). RESULTS Seventy-two patients of the 110 patients screened were randomized in either NMSE (n = 35) or SBE (n = 37) group. The most common indication for the procedures was obscure gastrointestinal bleed (48%), others being unexplained abdominal pain with indeterminate radiologic findings (32%) and chronic diarrhea (20%). In NMSE group, the TER was 71.4%, whereas in the SBE group, it was 10.8% ( P < 0.0001). The total procedure time (minutes) was much lesser with NMSE (58.17 ± 21.5 minutes) vs SBE (114.2 ± 33.5 minutes) ( P < 0.0001). The diagnostic yield of NMSE (80%) was comparatively higher than SBE (62.1%) ( P = 0.096). Minor AE (grade I) were observed in both the groups: NMSE 8.5% (3/35) and SBE 5.4% (2/37). DISCUSSION This randomized controlled trial shows that with NMSE higher TER can be achieved in shorter duration with minimal AE, compared with SBE.
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Affiliation(s)
- Hardik Rughwani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Aniruddha Pratap Singh
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Partha Pal
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Pradev Inavolu
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - P Manohar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Rajendra Patel
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Rupa Banerjee
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Sana Fathima Memon
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Putta Balram
- Department of Anaesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Santosh Darishetty
- Department of Anaesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Guduru Venkat Rao
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
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Nishida M, Hasegawa Y, Hata J. Basic practices for gastrointestinal ultrasound. J Med Ultrason (2001) 2023; 50:285-310. [PMID: 36087155 PMCID: PMC10354189 DOI: 10.1007/s10396-022-01236-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
The standard diagnostic modalities for gastrointestinal (GI) diseases have long been endoscopy and barium enema. Recently, trans-sectional imaging modalities, such as computed tomography and magnetic resonance imaging, have become increasingly utilized in daily practice. In transabdominal ultrasonography (US), the bowel sometimes interferes with the observation of abdominal organs. Additionally, the thin intestinal walls and internal gas can make structures difficult to identify. However, under optimal US equipment settings, with identification of the sonoanatomy and knowledge of the US findings of GI diseases, US can be used effectively to diagnose GI disorders. Thus, the efficacy of GIUS has been gradually recognized, and GIUS guidelines have been published by the World Federation for Ultrasound in Medicine and Biology and the European Federation of Societies for Ultrasound in Medicine and Biology. Following a systematic scanning method according to the sonoanatomy and precisely estimating the layered wall structures by employing color Doppler make diagnosing disease and evaluating the degree of inflammation possible. This review describes current GIUS practices from an equipment perspective, a procedure for systematic scanning, typical findings of the normal GI tract, and 10 diagnostic items in an attempt to help medical practitioners effectively perform GIUS and promote the use of GIUS globally.
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Affiliation(s)
- Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Yuichi Hasegawa
- Department of Clinical Laboratory, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Jiro Hata
- Department of Laboratory Medicine (Endoscopy and Ultrasound), Kawasaki Medical School Hospital, Okayama, Japan
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Carretero C, Bojorquez A, Eliakim R, Lazaridis N. Updates in the diagnosis and management of small-bowel Crohn's disease. Best Pract Res Clin Gastroenterol 2023; 64-65:101855. [PMID: 37652654 DOI: 10.1016/j.bpg.2023.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Cristina Carretero
- Gastroenterology Department, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Clínica Universidad de Navarra. Pio XII 36, 31004, Pamplona, Spain.
| | - Alejandro Bojorquez
- Gastroenterology Department, Clínica Universidad de Navarra, Clínica Universidad de Navarra. Pio XII 36, 31004, Pamplona, Spain.
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tek-Aviv, Israel.
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom; Saint Luke's Hospital, Small Bowel Service, Agias Sofias 18, 54622, Thessaloniki, Greece.
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Chan W, Wei LK, Tan T, Hsiang LG, Kong C, Salazar E, Koay D, Khor C, Asokkumar R. Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study. Gastrointest Endosc 2023; 97:314-324. [PMID: 36228697 DOI: 10.1016/j.gie.2022.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/03/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Motorized spiral enteroscopy (MSE) has been postulated to ease the complexities of the standard-of-care double-balloon enteroscopy (DBE). However, there are no comparative studies between MSE and DBE. This study aimed to compare the therapeutic outcomes and safety between MSE and DBE. METHODS In this case-matched study, patients were matched 1:2 (MSE/DBE) by age, sex, body mass index, and American Society of Anesthesiology scores. Thirty-one patients who underwent MSE were compared with 62 patients who underwent DBE from 2014 to 2022. Our primary outcomes were to compare the technical and diagnostic success rates between DBE and MSE. Our secondary outcomes were to compare the therapeutic success and adverse event rates. RESULTS The main indications for enteroscopy were suspected GI bleeding and positive radiologic findings. Prior abdominal surgery was reported in 35.5% and 22.6% of DBE and MSE patients, respectively. Most were antegrade enteroscopy (71%). We found no significant difference in the technical success (DBE 98.4% vs MSE 96.8%, P = .62), diagnostic success (DBE 66.1% vs MSE 54.8%, P = .25), and therapeutic success rates (DBE 62.8% vs MSE 52.9%, P = .62) between the groups. Adverse events occurred in 1 DBE and 11 MSE patients. Most were minor (n = 10, 25.6%). Two patients (5.1%) in the MSE group sustained deep lacerations in the proximal esophagus requiring hospitalization. One developed ileal perforation after MSE needing surgical repair. CONCLUSIONS In patients requiring enteroscopy, the diagnostic and therapeutic performance of MSE is similar to DBE. An increased frequency of adverse events was observed with MSE. There are some restrictions in the indication because of the design of MSE.
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Affiliation(s)
- Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Lim Kim Wei
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Terence Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Lim Gek Hsiang
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Christopher Kong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Doreen Koay
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
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A Gastroenterologist's Approach to the Diagnosis and Management of Gastrointestinal Stromal Tumors. Gastroenterol Clin North Am 2022; 51:609-624. [PMID: 36153113 DOI: 10.1016/j.gtc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. These tumors have been shown to harbor oncogenic mutations of the c-kit tyrosine kinase receptor or platelet-derived growth factor receptor alpha (PDGFRA). Immunohistochemical analysis of GISTs allows for the differentiation of these tumors from other mesenchymal tumors of the GI tract such as leiomyomas and leiomyosarcomas. All GISTs have the potential to behave in a malignant fashion. Tumor location, size, and mitotic index are factors used to predict the risk of malignant behavior. Endoscopy and endoscopic ultrasound play a critical role in the diagnosis of GISTs and can yield important information to further risk-stratify tumors and determine management. This article provides a gastroenterologist's perspective on the diagnosis and management of GISTs.
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Singh P, Singla V, Bopanna S, Shawl MR, Garg P, Agrawal J, Arya A, Mittal V, Bhargava R, Madan K. Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience. DEN OPEN 2022; 3:e148. [PMID: 35898825 PMCID: PMC9307745 DOI: 10.1002/deo2.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/18/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022]
Abstract
Objective Evaluation and management of small bowel disorders have always been challenging due to the limitations of the existing technology. Motorized power spiral enteroscopy (PSE) is an innovative new technique that offers easier, faster, and more complete small bowel evaluation with the ability to perform therapeutics. We aimed to evaluate the safety and efficacy of PSE in various indications. Methods Retrospective analysis of prospectively collected data of consecutive patients, who underwent PSE at a tertiary care center. Primary outcome measures were technical success rate, pan-enteroscopy rate, diagnostic and therapeutic yield, and the secondary outcomes measures were the depth of maximal insertion, median insertion time, and adverse events. Results Fifty-four patients (mean age of 49.38 ± 16.26 years) underwent PSE for small bowel evaluation. Technical success rate was 95.55% (antegrade route) and 93.10% (retrograde route). Pan-enteroscopy rate is 46.29% and antegrade enteroscopy to the cecum was achieved in eight patients. Overall diagnostic and therapeutic yields were 85.18% and 30.76%, respectively. The most common findings were ulcero-stricturing lesions (51.92%) followed by vascular lesions (9.61%). The most common histopathologic diagnosis was Crohn's disease in 29.62%. Median depth of maximal insertion was 400 cm (range 150-550 cm; antegrade route) and 180 cm (range 50-350 cm; retrograde route). The median insertion time to depth of maximal insertion was 70 min (range 30-110 min; antegrade route) and 45 min (range 20-70 min; retrograde route). PSE-associated major adverse events occurred in one patient and minor adverse events were seen in 48.14%. Conclusion PSE is a safe and effective modality for the evaluation of small bowel disorders with a high diagnostic yield.
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Affiliation(s)
- Pankaj Singh
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Vikas Singla
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Sawan Bopanna
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Muzaffer Rashid Shawl
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Pallavi Garg
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Jatin Agrawal
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Anupama Arya
- Department of PathologyMax Super Speciality HospitalNew DelhiIndia
| | - Vibhuti Mittal
- Department of PathologyMax Super Speciality HospitalNew DelhiIndia
| | - Richa Bhargava
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
| | - Kaushal Madan
- Centre for Gastroenterology, Hepatology and EndoscopyMax Super Speciality HospitalNew DelhiIndia
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Deliwala SS, Chawla S. Ballooning Your Way in Altered Anatomy ERCP: Ready for Deductive Learning. Dig Dis Sci 2022; 67:2696-2698. [PMID: 35001243 DOI: 10.1007/s10620-021-07348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Smit S Deliwala
- Department of Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | - Saurabh Chawla
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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Hanscom M, Stead C, Feldman H, Marya NB, Cave D. Video Capsule Endoscopy and Device-Assisted Enteroscopy. Dig Dis Sci 2022; 67:1539-1552. [PMID: 34383197 PMCID: PMC8358900 DOI: 10.1007/s10620-021-07085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/09/2022]
Abstract
Mark Hanscom Courtney Stead Harris Feldman Neil B. Marya David Cave.
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Affiliation(s)
- Mark Hanscom
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Courtney Stead
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Harris Feldman
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Neil B. Marya
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - David Cave
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
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Yamanashi K, Katsurada T, Nishida M, Onishi R, Omotehara S, Otagiri S, Sakurai K, Nagashima K, Kinoshita K, Takagi R, Sakamoto N. Crohn's Disease Activity Evaluation by Transabdominal Ultrasonography: Correlation with Double-Balloon Endoscopy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2595-2605. [PMID: 33595133 DOI: 10.1002/jum.15645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Transabdominal ultrasonography (US) has been reported as a useful tool for evaluating Crohn's disease (CD) activity. Endoscopic findings and Crohn's disease activity index (CDAI) are currently considered the gold standard for assessing CD activity. We assessed the correlation between US and double-balloon endoscopy (DBE), and CDAI for evaluating CD activity. METHODS We analyzed patients with CD undergoing US and DBE within 10 days between the procedures. The intestine was divided into four segments and analyzed by the US scoring system (US-CD) and the simple endoscopic score for Crohn's disease (SES-CD). CDAI was compared with US-CD and SES-CD. Spearman's rank correlation coefficient was used for statistical analysis. RESULTS Twenty-five patients with CD (11 women, 14 men; mean age 35.4 ± 14.9 years, range 16-65 years) were enrolled. Twenty-four patients received antitumor necrosis factor inhibitor therapy. CDAI was 128.1 (range 36-227). A significant moderate correlation was found between the US-CD and SES-CD in all segments (ρ = .64, P < .01). The US-CD showed a strong correlation with CDAI (ρ = .78, P < .01), whereas the SES-CD showed a moderate correlation (ρ = .55, P < .05). CONCLUSIONS US-CD and SES-CD showed a moderate correlation for assessing CD activity. US-CD showed a stronger correlation with CDAI than SES-CD, suggesting that US could more accurately evaluate the disease activity.
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Affiliation(s)
- Kana Yamanashi
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takehiko Katsurada
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine/Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Reizo Onishi
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine/Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shinsuke Otagiri
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kensuke Sakurai
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Kenji Kinoshita
- Department of Gastroenterology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Ryo Takagi
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology/Inflammatory Bowel Disease Group, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
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12
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Barlass U, Melson J. Rev up your engines: a new approach to access the deep small bowel by motorized spiral enteroscopy. Gastrointest Endosc 2021; 93:1371-1372. [PMID: 33691976 DOI: 10.1016/j.gie.2020.12.029] [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: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Usman Barlass
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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13
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The utility of faecal and urine biomarkers for small bowel diseases. Curr Opin Gastroenterol 2021; 37:284-294. [PMID: 33769381 DOI: 10.1097/mog.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Small bowel diseases pose a unique diagnostic and management challenge and often requires tertiary specialist referral. The use of biomarkers may provide a cheap, noninvasive tool to assess the small bowel in terms of diagnosis, offering a better way to triage referrals and select patients for early management. This review looks at the most recent evidence behind the use of several faecal and urine biomarkers for small bowel diseases. RECENT FINDINGS Faecal calprotectin shows the most promise, with evidence to support its role in predicting relapse postsurgery and monitoring treatment response in patients with Crohn's disease. A faecal calprotectin less than 50 μg/g may also be used as a cut-off to triage further investigation. Faecal lactoferrin also appears promising as a marker of small bowel inflammation. A positive faecal immunohistochemistry test precapsule may help to prioritize referrals for obscure bleeding. SUMMARY The use of biomarkers in the diagnosis and management of small bowel disease is still controversial and remains unclear. More studies are required to further develop their potential and before societal guidelines can be developed to direct their appropriate use in clinical practice.
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Ramchandani M, Rughwani H, Inavolu P, Singh AP, Tevethia HV, Jagtap N, Sekaran A, Kanakagiri H, Darishetty S, Reddy DN. Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital (with video). Gastrointest Endosc 2021; 93:616-626. [PMID: 32663489 DOI: 10.1016/j.gie.2020.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Novel motorized spiral enteroscopy (NMSE) is a recent advancement in the field of enteroscopy and offers multiple features, including self-propulsion, better irrigation, and shorter enteroscope length with a larger channel. The aim of this study was to evaluate the efficacy in terms of diagnostic yield and therapeutic success of NMSE in patients undergoing enteroscopy by antegrade and/or retrograde approaches for suspected small-bowel disease. METHODS We retrospectively evaluated consecutive patients with symptomatic small-bowel disease who underwent enteroscopy over a 6-month period. Diagnostic yield, therapeutic success, total enteroscopy rate (TER), technical success, total procedural time, depth of maximal insertion, and adverse events related to the NMSE procedure were noted. RESULTS Of 61 patients (mean age, 45.67 ± 15.37 years; 43 men) included for NMSE, 57 patients underwent successful enteroscopy with a technical success of 93.4%. The overall diagnostic yield was 65.5% (95% confidence interval, 52.31-77.27) and 70.1% (95% confidence interval, 56.60-81.57) in patients who underwent successful NMSE; TER was 60.6%: 31.1% by the antegrade approach and 29.5% by a combined antegrade and retrograde approach. Depth of maximal insertion and procedural time was of 465 cm (range, 100-650) and 40 minutes (range, 25-60), respectively, by the antegrade approach and 140 cm (range, 50-200) and 35 minutes (range, 30-60) by the retrograde route. Lesions were classified as inflammatory (n = 25), vascular (n = 10), and mass (n = 4). Biopsy specimens were obtained in 50.8% subjects, and 23% patients underwent therapeutic procedures. No major adverse events were seen. CONCLUSIONS NMSE is a promising technology, showing high efficacy as a diagnostic and therapeutic tool in the management of otherwise difficult-to-treat small-bowel disease.
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Affiliation(s)
- Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Hardik Rughwani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Pradev Inavolu
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Aniruddha Pratap Singh
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Harsh Vardhan Tevethia
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Haranath Kanakagiri
- Department of Anesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Santosh Darishetty
- Department of Anesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
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15
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Cortegoso Valdivia P, Skonieczna-Żydecka K, Pennazio M, Rondonotti E, Marlicz W, Toth E, Koulaouzidis A. Capsule endoscopy transit-related indicators in choosing the insertion route for double-balloon enteroscopy: a systematic review. Endosc Int Open 2021; 9:E163-E170. [PMID: 33532554 PMCID: PMC7834922 DOI: 10.1055/a-1319-1452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims When capsule endoscopy (CE) detects a small bowel (SB) target lesion that may be manageable with enteroscopy, the selection of the insertion route is critical. Time- and progression-based CE indices have been proposed for localization of SB lesions. This systematic review analysed the role of CE transit indicators in choosing the insertion route for double-balloon enteroscopy (DBE). Methods A comprehensive literature search identified papers assessing the role of CE on the choice of the route selection for DBE. Data on CE, criteria for route selection, and DBE success parameters were retrieved and analyzed according to the PRISMA statement. Risk of bias was assessed through the STROBE assessment. The primary outcome evaluated was DBE success rate in reaching a SB lesion, measured as the ratio of positive initial DBE to the number of total DBE. Results Seven studies including 262 CEs requiring subsequent DBE were selected. Six studies used time-based indices and one used the PillCam Progress indicator. SB lesions were identified and insertion route was selected according to a specific cut-off, using fixed landmarks for defining SB transit except for one study in which the mouth-cecum transit was considered. DBE success rate was high in all studies, ranging from 78.3 % to 100 %. Six of seven studies were high quality. Conclusions The precise localization of SB lesions remains an open issue, and larger studies are required to determine the most accurate index for selecting the DBE insertion route. In the future, 3 D localization technologies and tracking systems will be essential to accomplish this tricky task.
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Affiliation(s)
- Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | | | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
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16
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Cañadas Garrido R, Rincón Sánchez R, Costa Barney V, Roa Ballestas P, Espinosa Martínez C, Pinzón Arenas D, Ramírez Barranco R. Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Kirakosyan E, Lokhmatov M. High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with Peutz-Jeghers Syndrome. Eur J Pediatr Surg 2020; 30:529-535. [PMID: 31770782 DOI: 10.1055/s-0039-3400286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary hamartomatous polyposis with predominant localization in the jejunum and ileum and high risk of bowel perforation after traditional polypectomy. The modern enteroscopy is the only possible technique for visualizing and performing intraluminal endoscopic microsurgical manipulations in the deep sections of the small intestine. The study aims to develop an optimal method for the diagnosis and treatment of polyps in children with PJS. MATERIALS AND METHODS During 2015 to 2018 we conducted 30 comprehensive examinations of children with PJS in The Department of Endoscopic Research of the National Medical Research Center for Children's Health. We performed esophagogastroduodenoscopy and colonoscopy with removal of polyps more than 7 mm, then video capsule endoscopy and, guided by this, therapeutic single-balloon enteroscopy. Our technique for removal of polyps is general in all parts: (1) creating a "resistant pillow"; (2) electroexcision of polyp; (3) clipping the removal site. RESULTS Successfully performed electroexcision of polyps, which were located in the deep parts of the small intestine at a distance of 30 segments (one segment is 10 cm), reached a diameter of 2.5 cm, had a long pedicle. The postoperative period was uneventful. CONCLUSION We have developed an optimal method of diagnostic and therapeutic measures, the observance of which allows us to avoid delayed perforations of the small intestine in the area of polypectomy in the postoperative period in children with PJS. Thanks to this technique, modern enteroscopy is becoming the only possible alternative to bowel resection in children with PJS.
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Affiliation(s)
- Evgeniya Kirakosyan
- International School "Medicine of the Future", Sechenov University Faculty of Medicine, Moscow, Russia
| | - Maxim Lokhmatov
- Department of Pediatric Surgery and Urology-Andrology, Sechenov University, Moscow, Russia.,Department of Endoscopic Research, Scientific Center of Children's Health, Moscow, Russia
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18
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Jia Y, Michael M, Bashashati M, Elhanafi S, Dodoo C, Dwivedi AK, Carrion AF, Othman MO, Zuckerman MJ. Evaluation of the diagnostic and therapeutic utility of retrograde through-the-scope balloon enteroscopy and single-balloon enteroscopy. World J Gastrointest Endosc 2020; 12:459-468. [PMID: 33269055 PMCID: PMC7677883 DOI: 10.4253/wjge.v12.i11.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retrograde single balloon enteroscopy (SBE) is a minimally invasive procedure which is less frequently performed compared with antegrade SBE. There are few studies on the retrograde through-the-scope enteroscopy (TTSE), a novel technique for evaluation of the small bowel. AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE. METHODS Clinical data and complications of retrograde TTSE (2014-2018) and retrograde SBE (2011-2018) performed in a community hospital were reviewed and presented as mean ± SD or frequency (%) and compared using proper statistical tests. Technical success was defined as insertion of the enteroscope > 20 cm beyond ileocecal valve. RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied. The most common indication for retrograde enteroscopy was iron deficiency anemia (41 patients) followed by gastrointestinal bleeding (37 patients), and chronic diarrhea (7 patients). The duration of retrograde SBE procedure (91.9 ± 34.2 min) was significantly longer compared with retrograde TTSE (70.5 ± 30.7 min) (P = 0.04). Technical success was comparable in TTSE [23/27 (85.2%)] and SBE [41/54 (75.9%) (P = 0.33)]. The mean depth of insertion beyond the ileocecal valve in retrograde SBE (92.5 ± 70.0 cm) tended to be longer compared with retrograde TTSE (64.6 ± 49.0 cm) (P = 0.08). No complication was observed in this study. CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe. Retrograde TTSE takes a shorter time and has a comparable technical success with SBE. TTSE has a lower capacity of small bowel insertion.
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Affiliation(s)
- Yi Jia
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Majd Michael
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Mohammad Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Christopher Dodoo
- Biostatistics and Epidemiology Consulting Lab, Office of Research Resources and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Alok K Dwivedi
- Biostatistics and Epidemiology Consulting Lab, Office of Research Resources and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Andres F Carrion
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Mohamed O Othman
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77082, United States
| | - Marc J Zuckerman
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
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19
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Cañadas Garrido R, Rincón Sánchez RA, Costa Barney VA, Roa Ballestas PA, Espinosa Martínez CA, Pinzón Arenas DF, Ramirez Barranco R. Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 86:51-58. [PMID: 32499179 DOI: 10.1016/j.rgmx.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/01/2020] [Accepted: 03/10/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. AIMS To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. MATERIALS AND METHODS A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. RESULTS Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). CONCLUSIONS The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.
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Affiliation(s)
- R Cañadas Garrido
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - R A Rincón Sánchez
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - V A Costa Barney
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - P A Roa Ballestas
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C A Espinosa Martínez
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - D F Pinzón Arenas
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - R Ramirez Barranco
- Unidad de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Esteban Delgado P, Alberca de Las Parras F, López-Picazo Ferrer JJ, León Molina J. Quality indicators in enteroscopy. Enteroscopy procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:299-308. [PMID: 32193937 DOI: 10.17235/reed.2020.6946/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the project "Quality Indicators in Gastrointestinal Endoscopy," under the leadership of the Sociedad Española de Patología Digestiva (SEPD), our goal is to propose the procedures and the structure, process, and outcome indicators required for the application and assessment of quality in enteroscopy. To this end a search was performed for quality indicators in enteroscopy. Quality of evidence was measured by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, and classified as high, moderate, low, and very low. A total of 10 process indicators (one preprocedure, eight procedure, one postprocedure) were identified for enteroscopy, with appropriate indication and choice of most efficient route being most significant.
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Affiliation(s)
| | | | | | - Joaquín León Molina
- Instituto Murciano de Investigación Biosanitaria,, Hospital Clínico Universitario Virgen de la Arrixaca
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21
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Mujtaba S, Chawla S, Massaad JF. Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives. J Clin Med 2020; 9:jcm9020402. [PMID: 32024301 PMCID: PMC7074258 DOI: 10.3390/jcm9020402] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 01/30/2023] Open
Abstract
Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.
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22
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Bansal R, Khan R, Scaffidi MA, Gimpaya N, Genis S, Bukhari A, Dhillon J, Dao K, Bonneau C, Grover SC. Undisclosed payments by pharmaceutical and medical device manufacturers to authors of endoscopy guidelines in the United States. Gastrointest Endosc 2020; 91:266-273. [PMID: 31738925 DOI: 10.1016/j.gie.2019.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Payments from pharmaceutical and medical device manufacturers to authors of clinical practice guidelines (CPGs) may influence practice recommendations. It is therefore important to evaluate the completeness of financial conflict of interest (FCOI) declarations among CPG authors. METHODS We performed a cross-sectional analysis of industry payments to authors of endoscopy guidelines published by 5 GI societies between 2014 and 2017. For each author we identified payments using the disclosure section of CPGs and the Centers for Medicare & Medicaid Services Open Payments (CMS-OP) database. We calculated the prevalence, monetary value, and type of declared and undeclared payments among authors. Payments were assessed for the calendar year of and before publication. RESULTS Thirty-seven CPGs were included in the analysis comprising 569 author entries (91 unique individuals; 66.43% men, 92.6% physicians, 66.4% academically affiliated). Four hundred fifty-one episodes (79%) involved FCOIs, 451 (79%) had undisclosed FCOIs in the CMS-OP, and 445 (77%) had FCOIs relevant to a CPG recommendation. The median undisclosed payment value was $4807.26 (interquartile range, $334.84-$20,579.75). Male authors (odds ratio, 2.23; 95% confidence interval, 1.47-3.39) and academically affiliated authors (odds ratio, 8.87; 95% confidence interval, 5.57-14.13) were significantly more likely to have undeclared payments (P < .001). No CPGs met all National Academy of Medicine criteria. CONCLUSIONS Recognizing concerns about the accuracy of the CMS-OP, there are substantial discrepancies between industry-reported payments and author self-disclosure. Additionally, there is a high prevalence of undisclosed payments by pharmaceutical and medical device manufacturers to these authors. Given the potential impact of these discrepancies and undisclosed payments on CPGs, more accurate reporting and alternative strategies for managing FCOI are needed.
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Affiliation(s)
- Rishi Bansal
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Shai Genis
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Abbas Bukhari
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Jeevan Dhillon
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Dao
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Chris Bonneau
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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23
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Pedro F, Romano J, Rebelo M, Matias R, Carmo E. Catastrophic Gastrointestinal Bleeding: Always Consider Meckel's Diverticulum. Eur J Case Rep Intern Med 2020; 6:001224. [PMID: 31893196 PMCID: PMC6936918 DOI: 10.12890/2019_001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/22/2019] [Indexed: 11/25/2022] Open
Abstract
Meckel’s diverticulum, a congenital malformation of the gastrointestinal tract, is asymptomatic in the majority of patients but can be associated with some complications. Gastrointestinal bleeding is one such complication and is more common in children than in adults. Despite the variety of examinations available, diagnosis can be difficult, especially in older patients, because the sensitivity of examinations decreases with patient age. Here we present the case of a young man with gastrointestinal bleeding in whom a diagnosis of Meckel’s diverticulum was made intra-operatively.
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Affiliation(s)
- Filipa Pedro
- Unidade de Cuidados Intensivos do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.,Serviço de Medicina Interna, Hospital Distrital de Santarém, Portugal
| | - Joana Romano
- Serviço de Cirurgia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Marta Rebelo
- Unidade de Cuidados Intensivos do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Rogério Matias
- Serviço de Cirurgia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Eduarda Carmo
- Unidade de Cuidados Intensivos do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
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Abstract
PURPOSE OF REVIEW Strictures of the small bowel are an underdiagnosed entity with significant morbidity because of obstruction and risk of perforation and penetrating disease. RECENT FINDINGS Recent advances in imaging, enteroscopy, and therapeutic advances particularly in Crohn's disease have enabled gastroenterologists to target and individualize management of small bowel strictures, preventing untimely surgery and complications. SUMMARY All patients with obstructive symptoms, suspected small bowel disease, and negative panendoscopy should be evaluated for small intestinal strictures with cross-sectional imaging and considered for capsule endoscopy. Furthermore, the role of device-assisted enteroscopy, initially employed as a diagnostic tool, has evolved into triaging and delivering further medical and interventional treatments.
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Affiliation(s)
- Deniz Durmush
- Prince of Wales Clinical School, UNSW Medicine, Gastrointestinal and Liver Unit, Prince of Wales Hospital, Randwick
| | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, RPA Medical Centre, Camperdown, Sydney, New South Wales, Australia
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25
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Management of small bowel polyps: from small to big. Curr Opin Gastroenterol 2019; 35:250-256. [PMID: 30844897 DOI: 10.1097/mog.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Benign small bowel polyps or mass are clinically poorly distinguishable from malignant small bowel masses, and the diagnostic conditions are almost the same. The important point for clinicians is first to take advantage of the different available diagnostic tools to optimize the diagnostic algorithm of a small bowel polyp or mass. Next, according to the clinical situation, associated disease or sporadic situation, the difficulty is to adapt the treatment decision to the patient situation. RECENT FINDINGS The last 20 years have been marked by the development of major diagnostic tools for small bowel diseases (capsule endoscopy, cross-sectional imaging with enteroclysis and balloon-assisted enteroscopy) and by the major decrease of intra-operative enteroscopy as a diagnostic mean. SUMMARY On the basis of considerable development of capsule endoscopy and the improvement of cross-sectional small bowel imagining, small bowel polyps represent now a frequent clinical situation for gastroenterologists.
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Yane K, Hayashi T, Katanuma A. Successful emergency endoscopic drainage for afferent limb syndrome-induced severe acute cholangitis in a patient with altered Roux-en Y anatomy. Dig Endosc 2018; 30:802-803. [PMID: 30039511 DOI: 10.1111/den.13241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Kei Yane
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
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A Deeper Look at the Small Bowel: Training Pathways in Video Capsule Endoscopy and Device-Assisted Enteroscopy. Dig Dis Sci 2018; 63:2210-2219. [PMID: 29869767 DOI: 10.1007/s10620-018-5133-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although there are guidelines for video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), little is known about fellowship training in these technologies. AIMS The aims were to better characterize current small bowel endoscopy training in 3-year GI fellowship programs and 4th-year advanced endoscopy programs in the U.S. METHODS We developed an online multiple-choice survey to assess current GI fellowship program training in small bowel endoscopy. The survey was distributed via email to GI fellowship program directors in the U.S. RESULTS Of the 168 program directors contacted, 59 responded (response rate = 35.1%). There was no statistically significant difference in the availability of VCE or DAE between respondents and non-respondents. VCE training was universally available in 3-year training programs, with 84.8% (50/59) requiring it for fellows. The majority of 3-year GI fellows graduated with independence in VCE: 83.1% (49/59) of programs reported "most" or "all" graduates were able to read independently. DAE techniques were available in 86.4% of training programs (51/59). Training in DAE was more limited and shared between 3-year and 4th-year programs: 12.1% (7/58) of 3-year programs required training in DAE and 22.9% (8/35) of 4th-year programs required training in DAE . CONCLUSIONS Training in VCE is widely available in U.S. GI fellowship programs, although programs have different ways of incorporating this training into the curriculum and of measuring competency. While DAE technology was available in the majority of programs, training was less frequently available, and training is shared between 3-year fellowship programs and 4th-year advanced endoscopy programs .
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D'Incao RB, Appel-da-Silva MC, Marcon PDS, Correa EM, Manenti E, Corso CO. Unusual Cause of Gastrointestinal Bleeding in a Patient with Turner Syndrome. Case Rep Gastroenterol 2018; 12:292-296. [PMID: 30022918 PMCID: PMC6047543 DOI: 10.1159/000489300] [Citation(s) in RCA: 1] [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] [Received: 03/07/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022] Open
Abstract
Turner syndrome is an exclusively female genetic disease caused by complete or partial absence of the second X chromosome. It is classically characterized by congenital lymphedema, short stature, and gonadal dysgenesis. In addition, the syndrome is associated with several other abnormalities. One of them is gastrointestinal bleeding, which is frequently associated with inflammatory bowel disease, but it can also be caused by vascular lesions such as hemangioma, vascular ectasia, and telangiectasia. We report the case of a patient with Turner syndrome with an episode of gastrointestinal bleeding, outlining our pathway for the investigation and treatment of this condition.
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Affiliation(s)
| | | | | | - Eduardo Marques Correa
- Department of Gastroenterology and Endoscopy, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Euler Manenti
- Department of Cardiology, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Carlos Otávio Corso
- Department of Surgery, Universidade Federal do Rio Grande do Sul and Hospital Mãe de Deus, Porto Alegre, Brazil
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Blanco-Velasco G, Hernández-Mondragón O, Blancas-Valencia J, Paz-Flores V, Fuentes-Hernández D, Rodríguez-González P, González-Ortíz B. Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Al-Bawardy B, Piovezani Ramos G, Lennon RJ, Gorospe E, Wong Kee Song LM, Bruining DH, Alexander JA, Coelho-Prabhu N, Fidler JL, Rajan E. Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding. Endosc Int Open 2018; 6:E694-E699. [PMID: 29868634 PMCID: PMC5979197 DOI: 10.1055/a-0599-6085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS The rate of recurrent small-bowel bleeding (SBB) remains high despite the advent of balloon assisted enteroscopy (BAE). The study aims were to determine: (1) the diagnostic and therapeutic yields, and adverse event rate of repeat BAE in SBB, and (2) the predictors of a positive repeat BAE. METHODS A retrospective review of a BAE database was conducted. Patients who had > 1 BAE for SBB were included. Primary outcomes were diagnostic yield, therapeutic yield, and adverse events of repeat BAE. Secondary outcomes were predictors of a positive repeat BAE. RESULTS A total of 175 patients (55 % men; mean age 64.1 ± 16.3 years) were included. The diagnostic and therapeutic yields of repeat BAE were 55 % and 42 %, respectively. Repeat BAE adverse events occurred in 5 % with self-limited abdominal pain being most common. Patients with a positive repeat BAE were significantly older than the negative group (68.6 ± 13.9 vs. 60.9 ± 17.1; P = 0.001) and were more likely to have cardiac comorbidities (OR 2.4, 95 %CI: 1.3 - 4.6; P = 0.01), chronic kidney disease (OR 2.3, 95 %CI: 1.1 - 4.9; P = 0.04), chronic obstructive pulmonary disease (OR 3.3, 95 %CI: 1.3 - 8.1; P = 0.01), positive initial BAE (OR 3.6, 95 %CI: 1.9 - 6.8; P < 0.001), and antegrade procedure (OR 3.3, 95 %CI: 1.7 - 6.1; P < 0.001). On multivariate analysis, a positive initial BAE and antegrade route were the only significant predictive factors. CONCLUSIONS Performing a repeat BAE for SBB appears safe and provided modest yields. A positive initial BAE and antegrade route were predictive of a positive repeat BAE.
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Affiliation(s)
- Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Emmanuel Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - David H. Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jeff L. Fidler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,Corresponding author Elizabeth Rajan, MD Division of Gastroenterology & HepatologyMayo Clinic200 First Street, S.W.RochesterMN 55905USA+1-507-284-0538
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Zhu CN, Friedland J, Yan B, Wilson A, Gregor J, Jairath V, Sey M. Presence of Melena in Obscure Gastrointestinal Bleeding Predicts Bleeding in the Proximal Small Intestine. Dig Dis Sci 2018. [PMID: 29516329 DOI: 10.1007/s10620-018-5003-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. METHODS A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine. Multi-variable regression was performed to control for confounders. RESULTS During the study, 288 patients met the eligibility criteria. Subjects with melena accounted for 37.1% of the cohort and were more likely to be older (mean age 66.9 vs. 63.9, p = 0.0457), take warfarin (15.1 vs. 9.4%, p = 0.0122), and have a lower 12-month hemoglobin nadir (7.3 vs. 8.3 g/dL, p = 0.0002). On crude analysis, 56.1% of patients with melena had a bleeding source within the proximal small intestine compared to 34.8% for those without (RR 1.61, 95% CI 1.24-2.09, p = 0.0004). On multi-variable analysis, the presence of melena doubled the odds of finding a bleeding site within the proximal small intestine (OR 1.97, 95% CI 1.17-3.33, p = 0.010). CONCLUSIONS The presence of melena doubles the odds of finding a bleeding site within the proximal small intestine among patients with OGIB, and deep enteroscopy, if performed before a capsule study, should begin with an antegrade approach in these patients.
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Affiliation(s)
- Cindy Ningfu Zhu
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Joshua Friedland
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Brian Yan
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Aze Wilson
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jamie Gregor
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Robarts Clinical Trials, London, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.
- London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd. E., London, ON, N6A 5W9, Canada.
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Mans L, Arvanitakis M, Neuhaus H, Devière J. Motorized Spiral Enteroscopy for Occult Bleeding. Dig Dis 2018; 36:325-327. [PMID: 29698967 DOI: 10.1159/000488479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/13/2018] [Indexed: 02/02/2023]
Abstract
Small-bowel disorders remain a diagnostic and therapeutic challenge due to intestinal length. Their management was revolutionized by the emergence of deep enteroscopy. In comparison with video capsule endoscopy, deep enteroscopy allows diagnostic and therapeutic interventions. Spiral enteroscopy (Spirus Medical Endo-Ease Overtube) achieves progression by gentle push and manual clockwise rotation inducing pleating of the small bowel on the endoscope. It has the advantage of shorter examination time and more stability during withdrawal but requires two operators. The Novel Motorized Spiral Enteroscope (Olympus Corp.) incorporates a user-controlled motor contained in the handle of the endoscope. This would offer the possibility to accelerate the procedure, facilitate insertion, and simplify the technique with a single operator.
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Affiliation(s)
- Laura Mans
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Benmassaoud A, Sasson MS, Pamphile JC, Martel M, Lakatos PL, Barkun AN, Soulellis C, Bessissow T. The Use of Balloon-assisted Enteroscopy at a Large Volume Centre: A Retrospective Analysis. J Can Assoc Gastroenterol 2018; 1:33-39. [PMID: 31294394 PMCID: PMC6488007 DOI: 10.1093/jcag/gwy007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives Balloon-assisted enteroscopy (BAE) is increasingly used for the evaluation of small bowel disorders. We quantified local diagnostic and therapeutic yields of BAE in patients with suspected small bowel diseases. Methods Adult patients undergoing BAE between January 2010 and July 2015 at McGill University Health Centre were included. Procedures were identified using a prospectively maintained database. Patients were excluded if procedure report was unavailable. Electronic medical records were reviewed. Analyses were restricted to patients who did not have a previous BAE. Results BAE was performed in 453 patients, including 421 anterograde cases. Patients had a mean age of 61.0 ± 17.5 years. Most common indications for referral were obscure gastrointestinal bleeding (OGIB) (n=207, 45.7%), abnormal imaging (n=88, 19.4%), suspected small bowel neoplasia (SBN) (n=39, 8.6%) and Crohn’s disease (CD) (n=31, 6.8%). A diagnosis was established in 216 procedures (47.7%). A pre-endoscopic indication of CD (odds ratio [OR]: 3.78; 95% Confidence Interval [CI], 1.60–8.90), OGIB (OR: 3.69, 95% CI, 2.03–6.71), suspected SBN (OR: 2.45; 95% CI, 1.06–5.65) and previous VCE (OR: 9.33; 95% CI, 3.24–26.90) were associated with abnormal findings. A therapeutic procedure was performed in 126 cases (28.3%). OGIB (OR: 7.00; 95% CI, 3.83–12.81), previous video capsule endoscopy (VCE) (OR: 7.86; 95% CI, 2.93–21.04) and suspected SBN (OR: 6.30; 95% CI, 2.58–21.04) were associated with performance of a therapeutic intervention. Complication rate was 1.6%, with bleeding in seven cases and one perforation. Conclusions In carefully selected patients, such as those with OGIB, Crohn’s disease and previous VCE, BAE was a safe procedure that led to the identification of abnormal findings and therapeutic interventions.
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Affiliation(s)
- Amine Benmassaoud
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Mark Solomon Sasson
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | | | - Myriam Martel
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada.,First Department of Medicine, Semmelweis University, Korányi S., Budapest, Hungary
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | | | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
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Blanco-Velasco G, Hernández-Mondragón OV, Blancas-Valencia JM, Paz-Flores V, Fuentes-Hernández D, Rodríguez-González P, González-Ortíz B. Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:234-237. [PMID: 29449094 DOI: 10.1016/j.rgmx.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND AIMS Peutz-Jeghers syndrome is an autosomal dominant inherited pathology characterized by gastrointestinal hamartomatous polyps, predominantly in the small bowel, and pigmented mucocutaneous lesions. Guidelines suggest polypectomy with a balloon-assisted enteroscope when polyps are larger than 10mm. Complications in adults can be as high as 6.8%, but there is little information on pediatric populations. Our aim was to describe the safety and efficacy of polypectomy in a group of pediatric patients with Peutz-Jeghers syndrome using balloon-assisted enteroscopy. MATERIALS AND METHODS A retrospective study was conducted at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI on pediatric patients with Peutz-Jeghers syndrome that required balloon-assisted enteroscopy and polypectomy within the time frame of January 2010 and December 2015. Patients that underwent polypectomy with a push enteroscope were excluded from the study. RESULTS A total of 35 polypectomies were performed on 4 patients (female/male: 3/1). The mean age of the patients was 13.7 years (range:11-16). Twelve enteroscopies were carried out, 8 of which were anterograde. A single-balloon enteroscope was used in 7 procedures and a double-balloon enteroscope in 5. The mean size of the polyps was 1.6cm (range: 1-4cm). A major complication (acute pancreatitis) presented in only one case (8.3%). No other major complications associated with the procedures were observed. CONCLUSION Balloon-assisted enteroscopy with polypectomy in children is a safe and effective procedure, with complications similar to those reported in adults.
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Affiliation(s)
- G Blanco-Velasco
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - O V Hernández-Mondragón
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - J M Blancas-Valencia
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - V Paz-Flores
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - D Fuentes-Hernández
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - P Rodríguez-González
- Servicio de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - B González-Ortíz
- Servicio de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Rahmi G, Vinet MA, Perrod G, Saurin JC, Samaha E, Ponchon T, Canard JM, Edery J, Maoulida H, Chatellier G, Durand-Zaleski I, Cellier C. Efficacy of double-balloon enteroscopy for small-bowel polypectomy: clinical and economic evaluation. Therap Adv Gastroenterol 2017; 10:465-472. [PMID: 28567116 PMCID: PMC5424870 DOI: 10.1177/1756283x17696232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/23/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We evaluated first the feasibility of endoscopic small-bowel polypectomy and second, the economic aspects, by comparing the cost of endoscopic and surgical polyp resection. METHODS A prospective, observational, multicenter study included 494 patients with positive capsule endoscopy (CE) before double-balloon enteroscopy (DBE). We selected only CE with at least one polyp. The retrospective economic evaluation compared patients treated by DBE or surgery for small-bowel polypectomy. Hospital readmission because of repeat polyp resection or complication-related interventions was noted. The 1-year cost was estimated from the viewpoint of the healthcare system and included procedures, hospital admissions and follow up. RESULTS CE indicated one or more polyps in 62 (12.5%) patients (32 males, 49 ± 5 years), all of whom underwent a successful DBE exploration. The DBE polyp diagnostic yield was 58%. There were no major complications. A total of 26 (42%) patients in the DBE group and 19 (39%) in the control group required hospital readmission. All readmissions in the DBE group were for repeat procedures to remove all polyps, and in the control group, for surgical complications. The total cost of the initial hospitalization (€4014 ± 2239 DBE versus €11,620 ± 7183 surgery, p < 0.0001) and the 1-year total cost (€8438 ± 9227 DBE versus €13,402 ± 7919 surgery, p < 0.0001) were lower in the DBE group. CONCLUSIONS Endoscopic polypectomy was efficient and safe. The total cost at 1 year was less for endoscopy than surgery. DBE should be proposed as the first-line treatment for small-bowel polyp resection.
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Affiliation(s)
| | | | - Guillaume Perrod
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris cité, Paris, France
| | - Jean-Christophe Saurin
- Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Elia Samaha
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris cité, Paris, France
| | - Thierry Ponchon
- Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Jean-Marc Canard
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris cité, Paris, France Clinique du Trocadéro, Paris, France
| | - Joël Edery
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris cité, Paris, France
| | - Hassani Maoulida
- AP-HP URC-Eco Ile-de-France, Inserm U1123, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gilles Chatellier
- Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital, INSERM, Unité d’Épidémiologie et de Recherche Clinique, Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP URC-Eco Ile-de-France, Inserm U1123, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Christophe Cellier
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris cité, Paris, France
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Abstract
PURPOSE OF REVIEW The breakthrough success of capsule endoscopy and device-assisted enteroscopy has inspired researchers to test and push the boundary of these technologies. The authors herein summarize the latest and most significant studies with clinical impact. RECENT FINDINGS Competing capsule endoscopy models have enriched the platform of this wireless device. The role of capsule endoscopy in Crohn's disease is expanding as we learn more of the significance of disease distribution and response to treatment. The benefit of capsule endoscopy in abdominal pain has previously been sceptical, but may have a role. Device-assisted enteroscopy demonstrates significant benefit in the management of patients with Crohn's disease and Peutz-Jeghers syndrome. On the contrary, long-term data suggest that endotherapy to small bowel angioectasia may not be as beneficial to patients as we once thought. The role of device-assisted enteroscopy in novel territory, including coeliac disease and endoscopic retrograde cholangiopancreatography, continues to be tested. SUMMARY The limit of capsule endoscopy and enteroscopy is yet to be reached. Accumulating long-term data alludes to the benefits of our current practice while spawning novel indications for small bowel endoscopy.
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Faulx AL, Lightdale JR, Acosta RD, Agrawal D, Bruining DH, Chandrasekhara V, Eloubeidi MA, Gurudu SR, Kelsey L, Khashab MA, Kothari S, Muthusamy VR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 2017; 85:273-281. [PMID: 28089029 DOI: 10.1016/j.gie.2016.10.036] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 02/08/2023]
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Abstract
Deep enteroscopy allows for the diagnosis and treatment of small bowel disorders that historically required operative intervention. There are a variety of endoscopic platforms using balloons and rotational overtubes to facilitate small bowel intubation and even allow for total enteroscopy. Obscure gastrointestinal bleeding is the most common indication for deep enteroscopy. By visualizing segments of the small bowel not possible through standard EGD or push enteroscopy, deep enteroscopy has an established high rate of identification and treatment of bleeding sources. In addition to obscure bleeding, other common indications include diagnosis and staging of Crohn's disease, evaluation of findings on capsule endoscopy and investigation of possible small bowel tumors. Large endoscopy databases have shown deep enteroscopy to be not only effective but safe. Recent research has focused on comparing the diagnostic rates, efficacy, and total enteroscopy rates of the different endoscopic platforms.
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Affiliation(s)
- Brian P Riff
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA
| | - Christopher J DiMaio
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA.
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Gurudu SR, Bruining DH, Acosta RD, Eloubeidi MA, Faulx AL, Khashab MA, Kothari S, Lightdale JR, Muthusamy VR, Yang J, DeWitt JM. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc 2017; 85:22-31. [PMID: 27374798 DOI: 10.1016/j.gie.2016.06.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 02/06/2023]
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Pasha SF, Leighton JA. Detection of suspected small bowel bleeding: challenges and controversies. Expert Rev Gastroenterol Hepatol 2016; 10:1235-1244. [PMID: 27366927 DOI: 10.1080/17474124.2016.1207525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Detection of small bowel (SB) bleeding remains a challenge to gastroenterologists, with a dearth of standardized recommendations regarding evaluation and management. Areas covered: A recursive literature search was performed using PubMed, Cochrane and Medline databases for original and review articles on SB and obscure gastrointestinal bleeding (OGIB). Based upon the available literature, this review outlines the main challenges and controversies, and provides a practical and cost-effective approach towards SB bleeding. Expert commentary: SB bleeding is suspected in patients with persistent or recurrent bleeding after negative bidirectional endoscopy, and unexplained iron deficiency anemia. Selection of test(s) should be individualized based upon patient presentation and suspicion for type of underlying lesion. Endoscopic or radiologic evaluation and treatment is the mainstay in the majority of patients, while pharmacologic agents may have a role in patients with refractory bleeding, and those unable to undergo evaluation.
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Affiliation(s)
- Shabana F Pasha
- a Division of Gastroenterology and Hepatology , Mayo Clinic Arizona , Scottsdale , AZ , USA
| | - Jonathan A Leighton
- a Division of Gastroenterology and Hepatology , Mayo Clinic Arizona , Scottsdale , AZ , USA
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Soto JA. Commentary to "ACG clinical guideline: diagnosis and management of small bowel bleeding". Abdom Radiol (NY) 2016; 41:1217-8. [PMID: 27108125 DOI: 10.1007/s00261-016-0739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jorge A Soto
- Department of Radiology, Boston Medical Center, Boston University School of Medicinte, 820 Harrison Av., 3rd Floor, Boston, MA, 02118, USA.
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Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom. Dig Dis Sci 2016; 61:1440-7. [PMID: 27017225 PMCID: PMC4875872 DOI: 10.1007/s10620-016-4123-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/06/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are an increasingly prevalent form of mechanical support for patients with end-stage heart failure. These devices can be implanted both as a bridge to transplant and as definitive/destination therapy. Gastrointestinal (GI) bleeding is one of the most common and recalcitrant long-term complications following LVAD implantation, with an incidence approaching 30 %. AIMS This review will discuss what is known about the pathophysiology of GI bleeding in LVADs and the currently available options for medical and/or endoscopic management. RESULTS The pathophysiology of bleeding is multifactorial, with hemodynamic alterations, acquired von Willebrand factor deficiency, and coagulopathy being most often implicated. The majority of bleeding events in this population result from angioectasias and gastroduodenal erosive disease. While these bleeding events are significant and often require transfusion therapy, they are rarely life threatening. Endoscopy remains the standard of care with upper endoscopy offering the highest diagnostic yield in these patients. However, the effectiveness of endoscopic hemostasis in this population is not well established. A small number of studies have evaluated medical therapy and alterations in LVAD settings as a means of preventing or treating bleeding with variable results. CONCLUSIONS In summary, GI bleeding with LVADs is a common occurrence and will continue to be as more LVADs are being performed for destination therapy.
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