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Dohan A, Boudiaf M, Dray X, Samaha E, Cellier C, Camus M, Eveno C, Dautry R, Soyer P. Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy: A preliminary study. Eur Radiol 2017; 28:206-213. [PMID: 28710577 DOI: 10.1007/s00330-017-4927-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). PATIENTS AND METHODS After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. RESULTS Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. CONCLUSION Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. KEY POINTS • Virtual enteroscopy is feasible and well tolerated. • Virtual enteroscopy appears to be accurate for detection of small-bowel tumours. • Sensitivity and PPV of virtual enteroscopy is 92.0% and 92.0%. • Radiation dose is lower with virtual enteroscopy compared to MDCT-enteroclysis.
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Affiliation(s)
- Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France. .,Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Xavier Dray
- Department of Digestive Diseases, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Elia Samaha
- Gastroenterology and Endoscopy Unit, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Christophe Cellier
- Gastroenterology and Endoscopy Unit, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France.,Université Sorbonne Paris Cité, Paris Descartes, Paris, France
| | - Marine Camus
- Université Sorbonne Paris Cité, Paris Descartes, Paris, France.,Department of Gastroenterology, Hôpital Cochin - Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Clarisse Eveno
- Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.,Department of Surgical Oncologic and Digestive Unit, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75475, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Philippe Soyer
- Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.,Department of Body and Interventional Imaging, Hôpital Cochin - Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Jovanovic I, Vormbrock K, Zimmermann L, Djuranovic S, Ugljesic M, Malfertheiner P, Fry LC, Mönkemüller K. Therapeutic double-balloon enteroscopy: a binational, three-center experience. Dig Dis 2011; 29 Suppl 1:27-31. [PMID: 22104749 DOI: 10.1159/000331125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS There are few reports focusing on therapeutic small bowel endoscopy. The aim of this study was to analyze the results of therapeutic small bowel endoscopy in a large cohort of patients. METHODS A retrospective study of a prospectively collected database comprising all patients undergoing diagnostic and therapeutic small bowel endoscopy in three centers. RESULTS A total of 614 double-balloon enteroscopies were performed in 534 patients. The most common pathological findings were angiodysplasias and vascular lesions (n = 98, 18%), mucosal ulcers and erosions (n = 95, 17.8%), polyps and tumors (including patients with familiar polyposis syndrome such as Peutz-Jeghers syndrome, familiar adenomatous polyps syndrome, neurofibromatosis, adenocarcinoma, neuroendocrine tumors and gastrointestinal stromal tumors) (n = 52, 9.7%), and strictures (Crohn's disease, ischemia, tumors) (n = 12, 2.2%). The mean duration of therapeutic small bowel enteroscopy was 67 min (range 30-115) compared to 50 min (range 25-105) for diagnostic procedures (p < 0.05). A therapeutic small bowel endoscopy was performed in 121 patients (22%). Therapeutic procedures included argon plasma coagulation of vascular lesions (n = 73), polypectomy (n = 49), mucosectomy (n = 5), stricture dilation (n = 7), foreign body extraction (n = 7), injection of fibrin glue (n = 10), and clip placement (n = 5). There were a total of 5 complications (0.9%; paralytic ileus, n = 2, pancreatitis, n = 1, bleeding n = 2). No perforations or deaths occurred. CONCLUSION Endoscopists performing double-balloon enteroscopy should be trained and prepared to provide therapeutic interventions for small bowel disorders including argon plasma coagulation, injection, hemoclipping, polypectomy, mucosectomy and foreign body extraction. Therapeutic small bowel endoscopy, albeit associated with complications in about 1% of cases, can be considered a relatively safe procedure.
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Affiliation(s)
- Ivan Jovanovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
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