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1.
Medicine (Baltimore) ; 99(7): e18837, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049785

RESUMO

Patients with cirrhosis are known to develop small bowel mucosal lesions. However, the occurrence of mucosal lesions in patients with abnormal liver function test results in the absence of chronic liver disease has not been fully evaluated. This study aims to examine the association between small bowel endoscopic lesions and liver dysfunction in patients without confirmed chronic liver disease.Two hundred ninety six consecutive patients who met the selection criteria underwent capsule endoscopy. The severity of the small intestinal mucosal lesions was evaluated quantitatively using the Lewis scoring system, and hepatic dysfunction was evaluated using an algorithm-based combination scoring system with 8 individual serological markers.Small bowel lesions were observed in 121 patients (40.88%). Hepatic dysfunction was significantly more prevalent in patients with small bowel lesions than in those without lesions (33.1%; 40/121 and 5.7%; 10/175, respectively; P < .001). The mean serum ALT and AST levels were significantly higher in patients with small bowel lesions than in those without lesions (P = .007 and P = .004, respectively). The mean scores for AST to Platelet Ratio Index, Forns Index, S-Index, Fibrosis-4 Index and BARD were significantly higher in patients with small bowel lesions than those without lesions. The Lewis score significantly and positively correlated with the Forns Index (P = .008) and the FIB-4 Index (P = .006).There is a close correlation between small intestinal mucosal lesions and hepatic dysfunction. The severity of hepatic dysfunction is directly proportional to the severity of the small intestinal mucosal lesions in patients without confirmed chronic liver disease.


Assuntos
Mucosa Intestinal/patologia , Intestino Delgado/patologia , Hepatopatias/epidemiologia , Adulto , Idoso , Endoscopia por Cápsula , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Projetos de Pesquisa , Estudos Retrospectivos
3.
Zhonghua Nei Ke Za Zhi ; 59(2): 124-128, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074685

RESUMO

Objective: To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics. Methods: From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People's Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea. Results: The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn's disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05]. Conclusions: Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico , Enteropatias/diagnóstico , Intestino Delgado/patologia , Doença de Crohn/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Enteropatias/epidemiologia , Masculino
4.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586954

RESUMO

Small bowel diaphragm disease (SBDD) is characterised by circumferential lesions of short length (<5 mm), causing intrinsic stenosis of the small bowel lumen. A 63-year-old women with a history of long-term non-steroidal anti-inflammatory use, presented with a 12-month history of intermittent episodes of colicky abdominal pain, nausea and vomiting. Her only past surgery was a laparoscopic hysterectomy. Abdominal CT demonstrated an area of thickening in the mid small bowel, however a diagnostic laparoscopy failed to demonstrate adhesions or any external abnormality. A capsule endoscope did not progress beyond the mid small bowel at the site of a suspected diaphragm. The patient underwent a laparotomy and using the retained capsule as a marker, the area of bowel affected by SBDD was identified. With an ageing population and the widespread use of non-steroidalanti-inflammatory drugs, general surgeons may see an increase in the incidence of SBDD.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Dor Abdominal , Anastomose Cirúrgica , Endoscopia por Cápsula , Diagnóstico Diferencial , Feminino , Humanos , Doenças do Íleo/induzido quimicamente , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/induzido quimicamente , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Laparotomia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 98(43): e17580, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651863

RESUMO

INTRODUCTION: Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication. PATIENT CONCERNS: A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years. DIAGNOSES: The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention. INTERVENTION: Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days. OUTCOMES: At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved. LESSONS: Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.


Assuntos
Cápsulas Endoscópicas/efeitos adversos , Endoscopia por Cápsula/efeitos adversos , Doença de Crohn/diagnóstico por imagem , Corpos Estranhos/fisiopatologia , Obstrução Intestinal/fisiopatologia , Doença de Crohn/patologia , Defecação , Feminino , Corpos Estranhos/etiologia , Humanos , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Adulto Jovem
6.
Cir Cir ; 87(S1): 48-52, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501631

RESUMO

Background: The retention of the endoscopic capsule (EC) is a serious complication and exceptionally, acute intestinal obstruction is conditioned. Clinical case: 64 years-old man, previously treated by gastroenterology for Crohn's disease. With good initial response to pharmacological treatment for 6 weeks, subsequently with the onset of pain and symptoms not explained by colonoscopy. EC was performed, presenting at 48 hours bowel obstruction symptoms with data of systemic inflammatory response and peritoneal irritation. Exploratory laparotomy with bowel resection and side-to-side stapled anastomosis was performed, histopathology report confirmed obstruction of the bowel lumen due to impacted EC in ileal stenosis area. In the immediate postoperative period with good evolution. At 8 weeks of the procedure, he went for an enterocutaneous fistula, which had a good response to conservative treatment. Conclusion: The rate of retention of CE in Crohn's disease is 5-6%, prior to its use, it is recommended to perform imaging studies to evaluate the bowel permeability, however negative studies do not exclude the presence of stenosis. In cases where intestinal resection is indicated, it is recommended to be wide with side-to-side stapled anastomosis to reduce the risk of recurrence of the disease.


Assuntos
Endoscopia por Cápsula/efeitos adversos , Doença de Crohn/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Tratamento Conservador , Doença de Crohn/diagnóstico por imagem , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Fístula Intestinal/terapia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia
7.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511264

RESUMO

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest-abdomen-pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.


Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Melanoma/complicações , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Idoso , Anemia/etiologia , Endoscopia por Cápsula , Evolução Fatal , Humanos , Neoplasias do Íleo/secundário , Neoplasias do Jejuno/secundário , Masculino , Melanoma/secundário
9.
10.
World J Gastroenterol ; 25(31): 4534-4554, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496630

RESUMO

BACKGROUND: Crohn's disease (CD) can affect the entire gastrointestinal tract. Proximal small bowel (SB) lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries. The assessment of SB in patients with CD is therefore necessary because it may have a significant impact on prognosis with potential therapeutic implications. Because of the weak correlation that exists between symptoms and endoscopic disease activity, the "treat-to-target" paradigm has been developed, and the associated treatment goal is to achieve and maintain deep remission, encompassing both clinical and endoscopic remission. Small bowel capsule endoscopy (SBCE) allows to visualize the mucosal surface of the entire SB. At that time, there is no recommendation regarding the use of SBCE during follow-up. AIM: To investigate the impact of SBCE in a treat-to-target strategy in patients with CD. METHODS: An electronic literature search was conducted in PubMed and Cochrane library using the following search terms: "capsule endoscopy", in combination with "Crohn's disease" and "treat-to-target" or synonyms. Two authors independently reviewed titles and abstracts identified by the search strategy after duplicates were removed. Following the initial screening of abstracts, all articles containing information about SBCE in the context of treat-to-target strategy in patients with CD were included. Full-text articles were retrieved, reference lists were screened manually to identify additional studies. RESULTS: Forty-seven articles were included in this review. Two indexes are currently used to quantify disease activity using SBCE, and there is good correlation between them. SBCE was shown to be useful for disease reclassification in patients who are suspected of having or who are diagnosed with CD, with a significant incremental diagnostic yield compared to other diagnostic modalities. Nine studies also demonstrated that the mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment in patients with CD. This review also demonstrated that SBCE can detect post-operative recurrence to a similar extent as ileocolonoscopy, and proximal SB lesions that are beyond the reach of the colonoscope in over half of the patients. CONCLUSION: SBCE could be incorporated in the treat-to-target algorithm for patients with CD. Randomized controlled trials are required to confirm its usefulness and reliability in this indication.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/terapia , Íleo/diagnóstico por imagem , Mucosa Intestinal/diagnóstico por imagem , Jejuno/diagnóstico por imagem , Protocolos Clínicos , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/patologia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Humanos , Íleo/patologia , Mucosa Intestinal/patologia , Jejuno/patologia , Prognóstico , Recidiva , Reprodutibilidade dos Testes , Resultado do Tratamento
12.
World J Gastroenterol ; 25(28): 3808-3822, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391775

RESUMO

BACKGROUND: Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn's disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn's disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM: To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS: Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient's demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS: Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r = 0.875, P < 0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI > 10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn's disease, those with a positive PCDAI (> 10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%; P = 0.018). CONCLUSION: We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.


Assuntos
Endoscopia por Cápsula , Duodeno/diagnóstico por imagem , Íleo/diagnóstico por imagem , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Imagem por Ressonância Magnética , Adolescente , Criança , Duodeno/patologia , Feminino , Humanos , Íleo/patologia , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/patologia , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estados Unidos
13.
J Vet Intern Med ; 33(5): 1964-1969, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31381197

RESUMO

BACKGROUND: Video capsule endoscopy (VCE) is a noninvasive imaging modality that can identify mucosal lesions not detected with traditional endoscopy or abdominal sonography. In people, VCE is used in diagnostic and management protocols of various gastrointestinal (GI) disorders, particularly in GI bleeding of obscure origin or unexplained iron deficiency anemia (IDA). OBJECTIVE: To evaluate the utility of VCE in the identification of mucosal lesions in dogs with evidence of GI hemorrhage. ANIMALS: Sixteen client-owned dogs that underwent VCE. METHODS: Retrospective case-control study. Medical records were reviewed to include dogs with microcytosis, low normal mean corpuscular volume, or clinical GI bleeding that received VCE. RESULTS: Median age of dogs was 8.7 years (range, 8 months to 15 years) with a median weight of 21.7 kg (range, 6.9-62.5 kg). Abdominal ultrasound (16), abdominal radiography (4), and abdominal CT (1) did not identify a cause for GI blood loss. Gastric mucosal lesions were identified by VCE in 15 of 16 dogs and small intestinal lesions in 12 of 14 dogs, with 2 capsules remaining in the stomach. Endoscopy was performed in 2 dogs before VCE; 1 dog had additional small intestinal lesions identified through the use of VCE. CONCLUSIONS AND CLINICAL IMPORTANCE: Video capsule endoscopy is a minimally invasive diagnostic tool that can identify GI lesions in dogs presenting with microcytosis with or without GI hemorrhage when ultrasonography is inconclusive; however, the majority of lesions identified would have been apparent with conventional endoscopy.


Assuntos
Endoscopia por Cápsula/veterinária , Doenças do Cão/diagnóstico por imagem , Índices de Eritrócitos/veterinária , Hemorragia Gastrointestinal/veterinária , Anemia Ferropriva/etiologia , Animais , Endoscopia por Cápsula/métodos , Estudos de Casos e Controles , Cães , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Masculino , Estudos Retrospectivos
14.
World J Gastroenterol ; 25(27): 3538-3545, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367155

RESUMO

The advent of video capsule endoscopy into clinical routine more than 15 years ago led to a substantial change in the diagnostic approach to patients with suspected small bowel diseases, often indicating a deep enteroscopy procedure for diagnostical confirmation or endoscopic treatment. Device assisted enteroscopy was developed in 2001 and for the first time established a practicable, safe and effective method for evaluation of the small bowel. Currently with double-balloon enteroscopy, single-balloon enteroscopy and spiral enteroscopy three different platforms are available in clinical routine. Summarizing, double-balloon enteroscopy seems to offer the deepest insertion depth to the small bowel going hand in hand with the disadvantage of a longer procedural duration. Manual spiral enteroscopy seems to be a faster procedure but without reaching the depth of the DBE in currently available data. Finally, single-balloon enteroscopy seems to be the least complicated procedure to perform. Despite substantial improvements in the field of direct enteroscopy, even nowadays deep endoscopic access to the small bowel with all available methods is still a complex procedure, cumbersome and time-consuming and requires high endoscopic skills. This review will give an overview of the currently available techniques and will further discuss the role of the upcoming new technology of the motorized spiral enteroscopy (PowerSpiral).


Assuntos
Enteroscopia de Balão/instrumentação , Endoscopia por Cápsula/instrumentação , Endoscópios Gastrointestinais , Enteropatias/diagnóstico por imagem , Enteroscopia de Balão/efeitos adversos , Enteroscopia de Balão/métodos , Tecnologia Biomédica/tendências , Endoscopia por Cápsula/efeitos adversos , Endoscopia por Cápsula/métodos , Humanos , Enteropatias/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Invenções/tendências
15.
Rom J Morphol Embryol ; 60(1): 159-165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31263840

RESUMO

INTRODUCTION: Small bowel tumors (SBTs) are rare. The advent of small bowel capsule endoscopy (SBCE) revolutionized the diagnosis of small bowel pathology, the SBCE major breakthrough consequently doubled the diagnostic rate of SBTs. Being a visual technique, without ability to take biopsies, SBCE has limitations in the diagnostic work-up of SBTs. AIM: To assess if structured visual description of SBTs detected by SBCE correlates with the histological type. PATIENTS, MATERIALS AND METHODS: We included patients with SBTs, evaluated by SBCE and furthermore explored, for which a final histopathological diagnosis was made, either on biopsy tissue samples, or on surgical specimens, using routine techniques and immunohistochemistry. The SBCE findings and reports were reviewed in order to assess the main macroscopic features of the SBTs, which were further correlated with the histological type. RESULTS: SBTs frequency at SBCE was 5.2%. All SBTs presented as protruding lesions. Features as size, color, type, shape, discoloration, presence of mucosa ulceration, bleeding stigmata or potential, contributed outlining a prototype. SBCE was accurate in terms of localization and suspected diagnosis. CONCLUSIONS: Even if SBCE is a purely visual technique, thorough examination and rigorous analysis of macroscopic features, as well as adoption of a structured terminology, may successfully predict the final diagnosis, empowering SBCE not only as a trust comrade in the diagnostic pathways of SBTs, but also as a valuable standalone technique mandating the final therapeutic decision.


Assuntos
Endoscopia por Cápsula/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Zhonghua Nei Ke Za Zhi ; 58(7): 485-495, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269564

RESUMO

Since the original version of "Chinese guideline regarding bowel preparation for gastrointestinal endoscopy" was published in 2013, bowel preparation has been widely investigated around the world. In order to improve the quality of bowel preparation, this guideline is an official statement issued by Digestive Endoscopy Special Committee of Endoscopic Physicians Branch of Chinese Medical Association and Cancer Endoscopy Committee of China Anti-Cancer Association. Domestic special experts were invited to search and grade the relevant literature published. An expert seminar was held, in which experts discussed and identified the recommendations, assessed the power of recommendations and the quality of evidence using the "grading of recommendations assessment, development and evaluation (GRADE)" system. The guideline offers practical recommendations for endoscopists regarding the whole procedure of bowel preparation including aims and requirements, preoperative education, diet restriction, the options of intestinal cleansing agents, antifoaming agents, contraindications, preparation for specific patients, and bowel preparation for enteroscopy and capsule endoscopy.


Assuntos
Endoscopia por Cápsula , Colonoscopia/métodos , Guias de Prática Clínica como Assunto , China , Humanos
17.
Intern Med ; 58(22): 3235-3238, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31327823

RESUMO

Blind pouch syndrome-associated anastomotic ulcer is rare, and its endoscopic features remain poorly described. A 79-year-old man was referred to our hospital for melena. Capsule endoscopy revealed multiple ulcers in the small intestine. Double-balloon endoscopy (DBE) and a gastrografin examination through DBE revealed a potential anastomotic ulcer, a blind pouch, and a side-to-side anastomosis in the middle of the small intestine. Laparoscopic partial resection of the small intestine with anastomosis was performed on the suspected blind pouch syndrome-associated anastomotic ulcer. To our knowledge, this is the first report describing the endoscopic features of a blind pouch syndrome-associated anastomotic ulcer.


Assuntos
Síndrome da Alça Cega/complicações , Endoscopia por Cápsula/métodos , Enteroscopia de Duplo Balão/métodos , Intestino Delgado/patologia , Úlcera/complicações , Idoso , Síndrome da Alça Cega/diagnóstico por imagem , Síndrome da Alça Cega/cirurgia , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparoscopia , Masculino , Úlcera/diagnóstico por imagem , Úlcera/cirurgia
18.
Pediatr Surg Int ; 35(11): 1197-1210, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31300851

RESUMO

PURPOSE: This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed. METHODS: Patients aged ≤ 18 years treated surgically for NVGIB were analysed. RESULTS: Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed. CONCLUSIONS: The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Adolescente , Algoritmos , Falso Aneurisma/complicações , Endoscopia por Cápsula , Criança , Pré-Escolar , Coristoma/complicações , Doença de Crohn/complicações , Úlcera Duodenal/complicações , Feminino , Mucosa Gástrica , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Gastrointestinais/complicações , Artéria Hepática , Humanos , Lactente , Masculino , Divertículo Ileal/complicações , Compostos Radiofarmacêuticos , Pertecnetato Tc 99m de Sódio , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações
19.
Curr Gastroenterol Rep ; 21(9): 42, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31346777

RESUMO

PURPOSE OF REVIEW: There has been an exponential increase in the incidence of esophageal adenocarcinoma (EAC) over the last half century. Barrett's esophagus (BE) is the only known precursor lesion of EAC. Screening for BE in high-risk populations has been advocated with the aim of identifying BE, followed by endoscopic surveillance to detect dysplasia and early stage cancer, with the intent that treatment can improve outcomes. We aimed to review BE screening methodologies currently recommended and in development. RECENT FINDINGS: Unsedated transnasal endoscopy allows for visualization of the distal esophagus, with potential for biopsy acquisition, and can be done in the office setting. Non-endoscopic screening methods being developed couple the use of swallowable esophageal cell sampling devices with BE specific biomarkers, as well as trefoil factor 3, methylated DNA markers, and microRNAs. This approach has promising accuracy. Circulating and exhaled volatile organic compounds and the foregut microbiome are also being explored as means of detecting EAC and BE in a non-invasive manner. Non-invasive diagnostic techniques have shown promise in the detection of BE and may be effective methods of screening high-risk patients.


Assuntos
Adenocarcinoma/diagnóstico , Esôfago de Barrett/diagnóstico , Detecção Precoce de Câncer/métodos , Neoplasias Esofágicas/diagnóstico , Esôfago/patologia , Lesões Pré-Cancerosas/diagnóstico , Adenocarcinoma/química , Adenocarcinoma/etiologia , Adenocarcinoma/microbiologia , Esôfago de Barrett/complicações , Esôfago de Barrett/genética , Esôfago de Barrett/microbiologia , Biomarcadores Tumorais/análise , Endoscopia por Cápsula , Neoplasias Esofágicas/química , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/microbiologia , Esofagoscopia , Esôfago/química , Esôfago/microbiologia , Humanos , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/genética , Lesões Pré-Cancerosas/microbiologia
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 662-667, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302965

RESUMO

Objective: To clarify the feasibility and safety of magnetically guided capsule endoscopy (MGCE) in minors. Methods: A descriptive cohort study was carried out to retrospectively collect the data of minors (<18 years) who underwent MGCE in Ruijin Hospital from April 2015 to October 2018. Exclusion criteria: patients with dysphagia, obvious gastrointestinal bleeding, diagnosed or suspected gastrointestinal obstruction, or congenital gastrointestinal malformations or intestinal fistula; patients with previous bowel surgery, or in poor general condition; patients with implants; pregnant patients; patients with incomplete data or without data. A total of 218 patients, including 122 males and 96 females, with mean age of (12.0±3.1) (5-17) years and 236 times of examination were included. The capsule size of the Ankon MGCE system was 11.8 mm×27 mm, taking two pictures per second, with a viewing angle of 140 degrees. Data of gastric visualization (0% to 100%), gastric cleanliness (satisfactory cleanliness was defined as a clear display of the gastric mucosa; the effect of bubbles or mucus on the visual field was negligible, or the gastric mucosa was slightly blurred; a small amount of air bubbles or mucus affected slightly the field of view), gastric or small bowel examination time, lesion detection rate, etc. were recorded. All the patients were followed up for 2 weeks to confirm capsule excretion and to record adverse events. Results: A total of 202 patients (217 times) completed gastric examination and 112 patients (125 times) completed small bowel examination. The median gastric visualization of cardia, fundus, body, angulus, antrum and pylorus was 100%, 90% (75%,100%), 100% (80%,100%), 100%, 100%, and 100%, respectively. The cleanliness of the gastric cardia, fundus, body, angle, antrum, and pylorus was assessed to be satisfactory in 100.0%, 76.5% (153/200), 92.5% (185/200), 97.5% (195/200), 99.5% (199/200), and 100.0% of patients, respectively. In 202 patients undergoing gastric examination, the median gastric exanimation time was 10.5 (7.3, 13.9) minutes. In 112 patients undergoing small bowel examination, the median gastric transit time was 51.5 (20.6, 112.0) minutes and the median small bowel transit time was 232.4 (181.8, 321.6) minutes. The small bowel transit rate was 91.1% (102/112). The lesion detection rates of stomach, duodenum and jejunoileum were 18.8% (38/202), 8.1% (10/124) and 26.8% (30/112) respectively. No complications or adverse events occurred. Conclusion: MGCE is feasible and safe to detect both gastric cavity and small bowel in minors.


Assuntos
Endoscopia por Cápsula/métodos , Enteropatias/diagnóstico , Gastropatias/diagnóstico , Adolescente , Endoscopia por Cápsula/instrumentação , Criança , Pré-Escolar , Duodenopatias/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Jejuno/diagnóstico , Imãs , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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